A Large Sialolith Perforating the Wharton’s Duct: Review of Literature and a Case Report

Abstract

Sialolithiasis accounts for the most common cause of diseases of salivary glands. The majority of sialoliths occur in the submandibular gland or the Wharton's duct. This article discusses review of literature, predisposing factors, signs and symptoms, diagnostic methods and various modalities available for the management of sialolithiasis. This case report presents a case of sialolith of a large size in the left Wharton's duct, which was explored and removed via an intra-oral approach.Keywords Sialolithiasis Á Wharton's duct Á Transoral sialolithotomy Sialolithiasis, also called salivary calculi or stones, is the occurrence of calcareous concretions in the salivary ducts or glands [1]. Sialolithiasis accounts for more than 50% of the diseases of major salivary glands, and is the most common cause of acute and chronic infections of the salivary glands [2]. Review of LiteratureSialolithiasis usually occurs from the third to fifth decade of life, and slightly more often in males (4:3) [3-5], and is rare in children [4, 5]. The reported incidence of sialolithiasis is 80-94% in submandibular duct or gland, 5-18% in parotid gland, and 2% or less in sublingual gland [4].The most common site is submandibular gland and Wharton's duct, probably, as a consequence of mucinous saliva, a tortuous duct, gravity, and the small orifice of the duct [6]. Simultaneous sialolithiasis in more than one salivary gland is rare [2]. Sialolithiasis occurs in the sublingual and minor salivary glands and ducts in the decreasing order of frequency [1]. The right and left glands and ducts are equally affected [3,4], although bilateral occurrence is rare [4]. However, multiple sialoliths in the same duct or gland are common [4]. Submandibular gland sialoliths have been reported to be radiopaque in 80-94.7% of cases [4,7,8].Although the exact cause of sialolithiasis remains unclear, some sialoliths may be related to dehydration, which increases the viscosity of the saliva; reduced food intake, which decreases the demand for saliva [9]; or certain medications that lower the production of saliva, such as anti-histaminics, anti-hypertensives and anti-psychotics, and antidepressants [9,10]. The lack of saliva can also be caused by several circumstances, including aging, Sjogren's syndrome, and radiotherapy of the head and neck region [10].The predisposing factors are: alkaline pH of saliva, increased calcium concentration in the saliva of submandibular gland, and the tortuous course of the duct [4]. Some other factors inherent to the submandibular gland are: longer and larger caliber of the duct, flow against gravity, slower flow rates and higher mucin content of the saliva [11]. The formation of sialolith is not related to any systemic derangement in calcium or phosphate metabolism [12].A study conducted by Sheman and McGurk [13] indicated no link between water hardness and sialolithiasis or sialadenitis, suggesting that high calcium intake might not lead to sialolithiasis. Patients with gout and patients on diuretic therapy may be predi...

Unusually large sialolith of submandibular gland

“…Sialolithiasis accounts for the most common cause of diseases of salivary glands [1][2][3][4][5][6][7]. Pathologically, sialolithiasis is a disease results in the obstruction of a salivary gland by a sialolith [8,9].…”

Gland excision in submandibular sialolithiasis: A case report.

“…Many do not show signs and predictable symptoms. CT is currently the preferred diagnostic method because it has demonstrated superior accuracy to detect small stones, in comparison to ultrasound, X-rays 12 and magnetic resonance 13,14 .…”

Submandibular Tükürük Bezinde Dev Sialolit: Olgu Sunumu ve Literatür Derlemesi

“…Sialografide kontrast maddeler genellikle sialolitin etrafında akar, küçük, asemptomatik taşlar takip edilebilir (47). Ciddi büyüklükte veya intraparankimal sialolitler cerrahi olarak taşın veya tamamen bezin çıkarılmasıyla tedavi edilebilir (48)(49)(50)(51). Bunun yanında literatürde minimal invaziv bir yöntem olan piezoelektrik cerrahi ile parçalanarak çıkarılan sialolitler de rapor edilmiştir (52).…”