Difficulties in Diagnosis of Sialolithiasis: A Case Series

Abstract

Sialolithiasis is one of the most common and extensively obstructive disorders of the major salivary glands. Here, we report 3 cases of sialolithiasis in the submandibular salivary gland showing symptomatic similarities to other dental and non-dental disorders of the maxillofacial area. How the various clinical features of this condition and findings on 3D-CT may lead to a misdiagnosis are also discussed. In the first case, that of a 45-year-old woman, a final diagnosis of a non-radiopaque submandibular sialolith allowed the initially indicated surgical extraction of a malerupted and semi-impacted right mandibular 3rd molar to be abandoned. In the second case, that of a 57-year-old woman, radiographic findings had previously led to a diagnosis of ameloblastoma, which had masked the presence of sialolithiasis for at least 9 years, despite the radiopacity of the sialolith. Meanwhile, exacerbation of sialolithiasis was mistaken for lymphadenitis. In the third case, that of a 40-year-old woman, sialolithiasis was diagnosed in a timely manner, despite the fact that the dentists' attention had initially been focused on odontopathological symptoms. One feature of the present report is the concurrence of dental and non-dental pathologies affecting the same sextant as the sialolithiasis. Despite recent advances in imaging technology and diagnostics, cases of sialolithiasis being misdiagnosed continue to occur in clinical practice.

Multiple sialolithiasis in submandibular gland duct: a rare case report

“…The submandibular gland is the most susceptible to the development of calculi (80-95%), and its duct is the most affected site. This susceptibility is due to the anatomical characteristics of the duct of the submandibular gland and the composition of its salivary secretion [2,4,9]. This case report corroborates these findings.…”

“…Salivary calculi vary widely in size and can be as small as 1 mm or may reach 10 mm (88% of cases), as in the present case [3,4,6]. The mineral findings may be spindle-shaped, cylindrical, or spherical, and are yellowish-brown in color.…”

“…The literature describes a higher frequency of sialoliths in males and in individuals from 30-40 years of age, although they may also affect the young, the elderly, and in rare cases, children [2,4,9,10]. In this clinical case, the patient is female and was 39 years old.…”

“…A sialolith develops from a nucleus of mineralization around bacterial niches, debris, cell remnants, or foreign bodies [4,5]. Its etiology may be related to morpho-anatomical factors, salivary composition or its stasis.…”

“…In 80% of cases, the disease presents as isolated calculi, and only 5% of patients have three or more sialoliths [2,9]. Submandibular sialoliths located in the buccal floor can be detected by palpation [2,4]. Pain and edema at mealtimes or in response to other salivation stimuli are typical signs of calculus in the submandibular gland [2,3,8,9,11].…”