Senior Lecturer, Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
Sialolithiasis is considered as one of the most frequently encountered diseases of the salivary glands. The most susceptible site is the submandibular gland and its duct. However, megaliths have been sparsely reported in the literature. This article portrays management of a sialolith and a megalith in a 26-year-old and a 59-year-old male patient, respectively. The sialolith in the first case case was 4 mm long, whereas the second case demonstrated a megalith measuring 46 mm at its greatest size. Follow-up revealed normal functioning and a painless gland in the first case, while the second case showed no eventful complications. It is interesting to know that both patients remained relatively pain-free, despite having such longstanding sialolith/megaliths. After removal of the small sialolith, the gland regained its normal functioning swiftly, whereas in the case of the megalith, the gland removal was mandatory because such a longstanding megalith led to irreversible functional injury to the gland.
CPD/Clinical Relevance: A giant sialolith can be easily misdiagnosed as a submandibular infection or neoplasm, especially when the patient presents with a longstanding pain-free swelling. Hence, early and appropriate referral and investigation is necessary for early diagnosis and treatment.
Article
Sialolithiasis refers to a pathological condition that arises due to partial or complete obstruction of the salivary gland or its associated duct by a calculus or a stone.1 These calculi or stones organize and mineralize around a nucleus of debris consisting of bacterial colonies, mucus plugs, shed ductal epithelial cells and foreign bodies.2 After mumps, it is the most frequently encountered disease of the major salivary glands.3 The typical presentation of sialolithiasis is painful swelling of the involved salivary gland, which is intensified during mealtimes. Although salivary flow is constant, it increases 10-fold during meals. This sudden increase in saliva production and flow causes severe pain, even in a partially obstructed salivary gland and/or duct. However, most salivary calculi/stones are painless.1 The most usual site of their occurrence is Wharton's duct or a submandibular duct due to alkalinity and viscosity of saliva, higher quantity of mineral salts, such as calcium, and a tortuous ductal course. Wharton's duct exhibits the highest incidence of sialolithiasis, followed by Stensen's duct, and the least incidence is seen in Bartholin's duct.4 Although sialoliths can be found in any age, the peak incidence is in the 4th to 6th decade of life. Males have a slightly higher predilection than females, with a ratio of 5.5:4.5.1 Sialoliths measuring 5–10 mm in size are considered normal, whereas sialoliths larger than 10 mm are designated as unusually sized sialoliths. Giant sialoliths or megaliths detected in the Wharton's duct measuring ≥3.5 cm have been categorized as a rare presentation. According to the literature, only 29 such cases have been reported over the past 22 years.1, 4 The aim of this paper is to report clinical and radiographic presentation of two contrasting cases of sialolithiasis.
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