Submandibular sialolithiasis in a child

Abstract

A 14-year-old boy presented with a 6-year history of intermittent right submandibular swelling. It arose with no specific trigger but was associated with pain on swallowing. It usually lasted several hours before spontaneously subsiding. There was no pyrexia, sore throat, tuberculosis contact or foreign travel.On examination the lump measured 3×3 cm, was non-tender, firm, mobile, non-fluctuant, with normal overlying skin. The patient thrived along the 25th and 50th centiles for height and weight respectively. No lymphadenopathy, pallor or petechiae was noted. All systemic examinations were normal.Laboratory findings, chest x-ray and neck ultrasound scan were normal. A presumed diagnosis of reactive submandibular lymphadenitis was made but the swelling was resistant to antibiotics. Subsequent bimanual palpation revealed a stone in the right submandibular gland. This was confirmed on neck x-ray (figure 1) and was removed surgically.Sialolithiasis in children comprises only 3% of all cases. 1 The youngest documented age in case reports is 2 years. 2 The majority occur within the submandibular gland as in our case or in the proximal Wharton's duct but they can arise anywhere along the duct or in other salivary glands. 2 Calculi account for half of major salivary gland diseases with prevalence of 0.45%. 3 Typical presentation is intermittent swelling and pain particularly on mastication because of increased salivary flow. Due to the anatomical position, submandibular swellings are often mistaken for cervical lymphadenopathy. 3 Bimanual/intraoral examination is most helpful. 4 X-ray, sialography, ultrasound, CT are useful in stone evaluation. 5 Treatment options include conservative care, lithotripsy, intervention radiology and sialoadenectomy. 1 REFERENCES 1 Kim JP, Park JJ, Son HY, et al. An unusual case of bilateral submandibular sialolithiasis. J Med cases 2012;3:106-9. 2 Ellies M, Laskawi R. Diseases of the salivary glands in infants and adolescents. Head Face Med 2010;6:1. 3 Mehana H, McQueen A, Robinson M, et al. Salivary gland swellings. BMJ 2012;345:36-41. 4 Chung MK, Jeong HS, Ko MH, et al. Pediatric sialolithiasis: what is different from adult sialolithiasis? Int J Pediatr Otorhinolaryngol 2007;71:787-91. 5 Hébert G, Ouimet-Oliva D, Nicolet V, et al. Imaging of the salivary glands. Can Assoc Radiol J 1993;44:342-9.Figure 1 X-ray showing calculus in right submandibular salivary duct. Whyte LA, et al. Arch Dis Child 2013;98:405-407.

Considerations of Multi-Imaging Modalities for Diagnosing of Sialolithiasis in the Submandibular Gland: A Case Report

“…Symptomatic sialoliths need to be treated surgically by transoral sialolithotomy (for ductal sialoliths), interventional sialoliths with or without lithotripsy, or excision of the affected salivary glands (for intraglandular sialoliths). [11][12][13][14][15][16] In this case, various modalities were used to establish the final diagnosis of the patient. Some tests aren't really necessary, such as a cervical radiograph.…”

Baş Boyun Bölgesi̇ndeki̇ Yumuşak Doku Kalsi̇fi̇kasyon Ve Ossi̇fi̇kasyonlari

“…Tükürük akışı stimüle edildiğinde bu şika-yetler artacaktır. Submandibular siyalolitler lenfadenopatiyle karışabilir, bimanuel palpasyon ayırıcı tanıda yardımcı olur 3,26 . Radyografta genellikle silindirik radyoopasiteler şeklindedir, submandibular bezdeki taşlar genellikle daha uzun ve düzensiz şekillidirler (Şekil 4).…”

“…KIBT'nin diş hekimliğinde yaygın kullanılmaya başlan-ması siyalografi uygulamalarının üç boyutlu olarak da gerçekleştirilmesine olanak sağlamıştır. Ayrıca günü-müzde siyaloendoskopi ile de bezin lümeni ve tıkan-manın sebebi incelenebilmektedir [25][26][27][28] . Küçük taşlar bimanuel palpasyonla çıkarılabilir, eğer taşlar daha büyük ve derin yerleşimli ise ve semptomatik hale gelirse ESWL (piezoelektrik ekstrakorporeal shock wave lithotripsy) ile kırılabilir ya da cerrahi olarak taş ve bezin çıkartılması gerekebilir 3 .…”