Giant Sialolith with 20 Years of Evolution in the Submandibular Duct

Abstract

Sialolithiasis is a common disease that affects the major salivary glands, which is characterized by obstruction of the gland itself or its excretory duct due to the formation of a sialolith, resulting in decreased salivary flow. It mainly affects the submandibular glands (80%-90%), probably because it has a long duct that surrounds the mylohyoid muscle and emerges against gravity through the Wharton's duct. The size of the salivary calculus can vary from below 1 millimeter (mm) to a few centimeters in diameter, where most stay below 10 mm. Only 7% are greater than 15 mm and these are classified as giant calculi. This report presents a case of asymptomatic giant sialolith (approximately 60 mm in diameter) located in the duct of the right submandibular gland, with 20 years of evolution. The treatment of choice was the surgical removal of the sialolith (calculus) through the salivary duct with maintenance of the gland. Although the individual did not present complaints related to the presence of the giant calculi, its removal had a great impact on their quality of life, since a significant respiratory improvement was reported by the individual. The major difference reported was better sleep quality.

Transoral Approach Used to Remove a Giant Sialolith

“…The size of the calculi vary to those that are <1 milimeter (mm) and 7% that are >15 mm are classified as giant sialoliths. 3 Sialoliths either cause mechanical obstruction of the gland or the excretory portion of the duct by mineral deposition decreasing the flow of saliva.…”