Intraoral removal of a giant submandibular sialolith obstructing Wharton's duct: a case report

Sialolithiasis is one of the most common pathologies of the submandibular gland; sialoliths account for about 80 percent of all salivary duct calculi. This report presents the unusual case of a large asymptomatic sialolith of the submandibular duct, initially diagnosed as a possible tumor. The giant sialolith was removed via an intraoral approach under local anesthesia. The etiology, pathogenesis, and management of such giant sialoliths are discussed.     

Large sialolith in the submandibular gland of a child

Sialolithiasis is a disorder encountered by oral surgeons that is rarely seen in children, although it is rather common in adults. Most sialolith found in children are smaller than 5 mm in diameter, and the majority of reported cases have been treated by surgically. We report a 9-year-old boy with a sialolith that measured 12 × 3.5 × 3 mm, which had developed in Wharton's duct and was then spontaneously passed.     

A giant submandibular sialolith: management and complications

A case of a 55-year-old man with an unusually large asymptomatic stone (3.5 x 2.0 x 2.0 cm) lying in the Wharton's duct is presented.     

Dislodgement of a submandibular gland sialolith during nasal intubation. A case report

A case of dislodgement of a submandibular sialolith into the oropharynx during nasal intubation is presented. The deleterious effect of the patient aspirating the stone into the lungs was averted by the taking of a lateral skull radiograph and localization and removal of the sialolith.     

A case report of coexistence of a sialolith and an adenoid cystic carcinoma in the submandibular gland

The occurrence of sialoliths in the submandibular gland is 80% due to the specific anatomy of both the gland and its duct. The diagnosis is rather easy because of the obvious clinical signs of the entity. Imaging studies are always necessary in order to treat the patient as effectively as possible. The stones do not tend to occur within the gland as frequently as in the respective duct. The coexistence of sialoliths and malignant tumors is extremely rare. A 70-year-old woman with intraparenchymal stone was operated in our ENT department. In addition to the sialolith the pathological examination revealed the existence of an adenoid cystic carcinoma (ACC), that extended to the neighboring skeletal muscle. This is the reason why we believe it would be useful to report this case of a large stone (14 mm in diameter) located in the submandibular gland coexisting with ACC. This case report is a very good example illustrating that all available means should be used prior to reaching a conclusion and making a health professional decision.     

Submandibular gland sialolith in a renal transplant recipient: a case report

Salivary dysfunction may be due to systemic diseases and medications. The development of sialoliths is a multifactorial event in which disturbances in secretion, microliths, and bacteria may play a major role. A case of sialolith in the submandibular gland of a 58-year old woman, with a medical history of renal failure end kidney transplant, is reported.     

Multiple sialoliths and a sialolith of unusual size in the submandibular duct: a case report

A 49-year-old man with multiple sialoliths in the submandibular duct is described. One of the sialoliths was of remarkable size. This report is of interest because of the unusual size and weight of this sialolith and because of the patient's symptoms, which were relatively mild and of short duration.     

A retrospective case series illustrating a possible association between a widened hilum and sialolith formation in the submandibular gland

ObjectiveThe purpose of this study was to explore any association between anatomical variances in the ductal system and sialolith formation using sialoendoscopy and acrylic resin replication of the ductal system.MethodsA retrospective study of 372 submandibular gland sialoendoscopies was performed to review the findings of the submandibular gland duct anatomy. Using sialoendoscopy and replicated casts, a high rate of hilar widening was noted in patients with submandibular sialolithiasis.ResultsSialolithiasis was detected in 326 of the patients who presented with obstructive symptoms. Around 67% (285/426) of the stones were located in the distal third of the ducts or at the hilum of the submandibular gland. During the sialoendoscopic procedure, the anatomy of the ductal system was examined and 285/326 (87.4%) of the hilums were noted to be widened like a basin. The anatomy of the duct from the replicated casts demonstrated a treelike structure and the basin-like widening of the hilum was found in all the excised submandibular glands.ConclusionUsing sialoendoscopy, a high number of patients presenting with sialolithiasis in the submandibular gland seem to have an anatomical variance in the hilar region. The reproduced ductal system from excised glands also demonstrated this abnormal widening of the hilum. Although further studies need to be performed, we try and explain why there is such a high prevalence of hilar widening in patients with submandibular sialolithiasis.     

Hamartomatous sialolipoma of the submandibular gland: case report

Sialolipoma is a rare tumour of the salivary gland that is composed of mature adipocytes and normal salivary gland tissue. We report an unusual case of a sialolipoma of the submandibular gland in a 77-year-old woman. The location of this tumour has not to our knowledge been previously described. The tumour was excised and has not recurred during 22 months postoperatively.     

Vascular clinical anatomy of the submandibular gland

ObjectiveThe aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap.Material and methodsNeck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle.Results33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV).ConclusionThe CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.     

Plunging ranula as a complication of intraoral removal of a submandibular sialolith

Mucous cysts in the submandibular region--so-called 'plunging' ranula--are relatively uncommon. We report a case of a plunging ranula that complicated excision of an intraductal sialolith of the submandibular gland.     

Sublingual ranula: report of a submandibular clinical case

Ranula is a raised mucocele on the oral floor. When the mucocele extends and passes the sublingual space and invades the submandibular space it may be called 'plunging ranula'. Its etiology is not completely known. Our clinical case is a clear example: a 10-year old formation, not painful, developed during several years and originally of small dimension located in the sublingual region. The purpose of this study is to underline that the surgical treatment of choice, in these clinical situations, is the drainage of the cavity and marsupialization rather than a radical removal.     

Multiple, large sialoliths of the submandibular gland duct: a case report

This paper reviews the major clinical and radiographic features of sialoliths and illustrates these with an unusual case of multiple sialoliths within the submandibular gland duct. The differential diagnosis of other calcific structures both within and outside the salivary gland that may mimic a sialolith is also presented.     

Oncocytic carcinoma of the submandibular gland: a case report and literature review

Oncocytes are characterized by a remarkable number of mitochondria as demonstrated by electron microscopy. Oncocytomas are very rare tumors that are usually benign and typically occur in the parotid gland. Oncocytic carcinomas are exceedingly rare in the salivary glands. We describe a 69-year-old Japanese man with an oncocytic carcinoma of the submandibular gland. We reviewed 38 articles describing oncocytic carcinoma of the head and neck that included clinicopathologic features. Oncocytic carcinomas appear to arise from benign oncocytomas, or may also arise de novo . In oncocytic carcinoma of the head and neck, the presence of distant, rather than local lymph node, metastasis is the most important prognostic indicator.     

Metastasis of submandibular gland carcinoma to the toe bone: a case report

Adenoid cystic carcinoma (ACC) is rare. One of its characteristics is a high rate of distant metastasis, and the most common site is the lungs, followed by the brain and liver. Bony metastases account for up to 1.96% of cases only, however, and metastasis from the blood to the bones of distal limbs is rare. We report a 62-year-old woman who presented with pain caused by bony metastases as the first symptom eight years after being diagnosed with submandibular ACC. Although such cases are rare, they indicate that when patients who have had cancer visit the hospital with other symptoms, clinicians should make sure to rule out metastasis.