Unusually Large Sialolith of Wharton’s Duct: A Case Report with Review of Literature
DOI:
https://doi.org/10.12970/2308-7978.2017.05.02Keywords:
Wharton’s duct, giant sialolith, transoral.Abstract
Sialolithiasis is a common disease of the salivary glands and a major cause of salivary gland dysfunction. The dominance of submandibular sialoliths is widely investigated. Giant stones (>15 mm) are rare, approximately every tenth or twelfth of the stones belong to this category. Large sialoliths have been reported in the body of salivary glands; however, they have rarely been described in the salivary ducts. We report a case of a 23 year old female with a giant sialolith occurring solely in the submandibular duct, which was removed via a transoral approach under local anesthesia. On gross examination, the sialolith measured 25 mm. The patient’s gland was managed conservatively with sialagogues and analgesics. The gland recovered normal function quickly, and follow-up showed an asymptomatic and normally functioning gland. Thus, a conservative approach to the gland will spare the patient the morbidity associated with gland removal.References
[1] Seifert G. Diseases of Salivary Glands. Berlin, Germany: Springer 2000.
[2] Iro H, Zenk J, Escudier MP, et al. Outcome of minimally invasive management of salivary calculi in 4,691 patients. Laryngoscope 2009; 119: 263-68. https://doi.org/10.1002/lary.20008
[3] McGurk M, Escudier MP, Brown JE. Modern management of salivary calculi. Br J Surg 2005; 92: 107-12. https://doi.org/10.1002/bjs.4789
[4] Escudier MP, Brown JE, Drage NA, McGurk M. Extracorporeal shockwave lithotripsy in the management of salivary calculi. Br J Surg 2003; 90: 482-85. https://doi.org/10.1002/bjs.4067
[5] Yu C, Yang C, Zheng L. Sialendoscopic findings in patients with obstructive sialadenitis: long-term experience. Br J Oral Maxillofac Surg 2013; 51: 337-41. https://doi.org/10.1016/j.bjoms.2012.07.013
[6] Capaccio P, Bottero A, Pompilio M, Ottaviani F. Conservative transoral removal of hilar submandibular salivary calculi. Laryngoscope 2005; 90: 482-85. https://doi.org/10.1097/01.mlg.0000161348.15505.11
[7] Ledesma-Montes C, Garc´es-Ort´ız M, Salcido-Garc´ıa JF, Hern´andez-Flores F, Hern´andez-Guerrero JC. Giant sialolith: case report and review of the literature. J Oral Maxillofac Surg 2007; 65: 128-30. https://doi.org/10.1016/j.joms.2005.10.053
[8] Harrison JD, Epivatianos A, Bhatia SN. Role of microliths in the aetiology of chronic submandibular sialadenitis: A clinicopathological investigation of 154 cases. Histopathol 1997; 31: 237-51. https://doi.org/10.1046/j.1365-2559.1997.2530856.x
[9] Huang TC, Dalton JB, Monsour FN, Savage NW. Multiple, large sialoliths of the submandibular gland duct: a case report. Aust Dent J 2009; 54: 61-65. https://doi.org/10.1111/j.1834-7819.2008.01091.x
[10] Katz P. Endoscopy of the salivary glands. Ann Radiol (Paris) 1991; 34: 110-13.
[11] Manson DK, Chisholm DM. Salivary Glands in Health and Diseases. London, UK: Saunders 1975.
[12] Marchal F, Becker M, Dulguerov P, Lehmann W. Interventional sialendoscopy. Laryngoscope 2000; 110: 318- 20. https://doi.org/10.1097/00005537-200002010-00026
[13] Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg 2001; 127: 66-68. https://doi.org/10.1001/archotol.127.1.66
[14] Baurmash H, Mandel L. Surgical excision of miniature sialoliths in Wharton’s duct. Oral Surg Oral Med Oral Pathol 1959; 12: 165-72. https://doi.org/10.1016/0030-4220(59)90138-0
[15] Baurmash HD. Submandibular salivary stones: current management modalities. J Oral Maxillofac Surg 2004; 62: 369-78. https://doi.org/10.1016/j.joms.2003.05.011
[16] Yu C, Yang C, Zheng L, Wu DM, Zhang J, Yun B. Selective management of obstructive submandibular sialadenitis. B J Oral Maxillofac Surg 2008; 46: 46-49. https://doi.org/10.1016/j.bjoms.2007.06.008
[17] Park JS, Sohn JH, Kim JK. Factors influencing intraoral removal of submandibular calculi. Otolaryngol Head Neck Surg 2006; 135: 704-9. https://doi.org/10.1016/j.otohns.2006.07.013
[18] Junqueira LCU, Rabinovitch M. Reversibility of phenomena induced by excretory duct ligation in rat submaxillary gland. Tex Rep Biol Med 1954; 12: 94-7.
[19] Isacsson G, Ahlner B, Lundquist PG. Chronic sialadenitis of the submandibular gland. Arch Otorhinolaryngol 1981; 232: 91-100. https://doi.org/10.1007/BF00661007
[20] Makdissi J, Escudier MP, Brown JE, Osailan S, Drage N, McGurk M. Glandular function after intraoral removal of salivary gland calculi from the hilum of submandibular gland. Br J Oral Maxillofac Surg 2004; 42: 538-41. https://doi.org/10.1016/S0266-4356(04)00158-5
[21] Van den Akker HP, Busemann-Sokole E. Submandibular gland function following transoral sialolithectomy. Oral Surg 1983; 56: 351-56. https://doi.org/10.1016/0030-4220(83)90341-9
[22] Yoshimura Y, Morshita T, Sugihara T. Salivary gland function after sialolithiasis: scintigraphic examination of submandibular glands with 99m Tc-pertechnetate. J Oral Maxillofac Surg 1989; 47: 704-10. https://doi.org/10.1016/S0278-2391(89)80009-6
[23] Nishi M, Mimura T, Marutani K, Noikura T. Evaluation of submandibular gland function by sialo-scintigraphy following sialolithectomy. J Oral Maxillofac Surg 1987; 45: 567-71. https://doi.org/10.1016/0278-2391(87)90265-5
[24] Marmary Y. A novel and non-invasive method for the removal of salivary gland stones. Int J Oral Maxillofac Surg 1986; 15: 585-7. https://doi.org/10.1016/S0300-9785(86)80063-1
[25] Iro H, Nitsche N, Meier J, Wirtz PM, Ell C. Piezoelectric shock wave lithotripsy of salivary gland stones: an in vitro feasibility study. J Lithotr Stone Dis 1991; 3: 211-6.
[26] Yoshizaki T, Furukawa M. Extracorporeal shock wave lithotripsy for Sialolithiasis. Nihon Jibiinkoka Gakkai Kaiho 1994; 97: 1041-6. https://doi.org/10.3950/jibiinkoka.97.1041
[27] Azaz B, Regev E, Casap N, Chicin R. Sialolithectomy done with a CO2 laser: clinical and scintigraphic results. Oral Maxillofac Surg 1996; 54: 685-8. https://doi.org/10.1016/S0278-2391(96)90681-3
[28] Meyers H. Large calculus in sub maxillary gland. Dental Digest 1942; 48: 420.
[29] Mustard TA. Calculus of unusual size in Wharton’s duct. Br Dent J 1945; 79: 129.
[30] Allen NE. A sialolith within the submaxillary duct and gland: report of a case. J Oral Maxillofac Surg 1956; 14: 65-67.
[31] Cavina C, Santoli A. Su alcuni casi di calcolosi salivare di particulare interese. Minerva Stomatol 1965; 14: 90.
[32] Hoggins GS. Large calcified mass in the submaxillary gland. Oral Surg Oral Med Oral Pathol 1968; 25: 679-81. https://doi.org/10.1016/0030-4220(68)90033-9
[33] Rust TA, Messerly CD. Oddities of salivary calculi. Oral Surg Oral Med Oral Pathol 1969; 28: 862-65. https://doi.org/10.1016/0030-4220(69)90340-5
[34] Raksin SZ, Gould SM, Williams AC. Submandibular duct sialolith of unusual size and shape. J Oral Surg 1975; 33: 142-45.
[35] Isacsson G, Persson NE. The gigantiform salivary calculus. Int J Oral Surg 1982; 11: 135-39. https://doi.org/10.1016/S0300-9785(82)80024-0
[36] Tinsley G. An extraordinarily large asymptomatic submandibular salivary calculus. Br Dent J 1989; 166: 199. https://doi.org/10.1038/sj.bdj.4806773
[37] Hubar JS, Guggenheimer J, Evan M. Megalith. Oral Surg Oral Med Oral Pathol 1990; 70: 245. https://doi.org/10.1016/0030-4220(90)90133-D
[38] Akin I, Esmer N. A submandibular sialolith of unusual size: a case report. J Otolaryngol 1991; 20: 123-25.
[39] Paul D, Chauhan SR. Salivary megalith with a sialocutaneous and a sialo-oral fistula: a case report. J Laryngol Otol 1995; 109: 767-69. https://doi.org/10.1017/S0022215100131263
[40] Bodner L. Giant salivary gland calculi: diagnostic imaging and surgical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 320-23. https://doi.org/10.1067/moe.2002.123863
[41] Gonc¸alves M, Hochuli-Vieira E, Lug˜ao C, Monnazzi MS, Gonc¸alves A. Sialolith of unusual size and shape. Dentomaxillofac Radiol 2002; 31: 209-10. https://doi.org/10.1038/sj.dmfr.4600693
[42] Rai M, Burman R. Giant submandibular sialolith of remarkable size in the coma area of Whartons duct: a case report. J Oral Maxillofac Surg 2009; 67: 1329-32. https://doi.org/10.1016/j.joms.2008.11.014
[43] Miyashita M, Taguchi A, Ochiai T, Kawahara I, Hasegawa H, Kagami H. An aberrant parotid gland duct with a cutaneous orifice, accompanied by sialolithiasis. J Oral Maxillofac Surg 2013; 71: 77-82. https://doi.org/10.1016/j.joms.2012.04.007
[44] Cherian NM, Vichattu SV, Thomas N, Varghese A. Wharton’s duct sialolith of unusual size: a case report with a review of literature. Case Rep Dent 2014. https://doi.org/10.1155/2014/373245
