Giant sialolithiasis involving submandibular gland mimicking osteoma of the mandible - A rare clinicopathological case report and a review of literature.

Abstract

The sialolith is a calcified mass resulting from the crystallization of salivary solute made up of calcium phosphates such as hydroxyapatite and octacalcium phosphate with yellowish discoloration and different shapes and sizes in the range of 1-2 cm normally, while occurrence of large sialolithiasis is rare, with literature showing sizes from 3.5 cm to 7 cm noted till date. About 80% of sialolithiasis occurs in submandibular glands and 20% in parotid gland and <1% is seen with sublingual gland. For small sialolithiasis and for superficially located sialolithiasis at ductal regions, conservative management is performed. However, for larger sialolithiasis, surgical management is mandatory which includes various methods such as transoral sialolithotomy, laser techniques, and sialendoscopy-assisted techniques. Complete excision of salivary gland is recommended for large, multiple, and recurrent cases of sialolith. In the present study, we have presented the unusual-sized rare case of salivary gland stone found in submandibular salivary gland and not in ductal region which was mimicking an osteoma on OPG and discuss the review of literature. This giant sialolith was managed with extraoral submandibular approach followed by TOTO removal of the sialolith which measured about 38 g in weight and 28 mm in size. Present sialolith was the rarest till date with heavyweight of about 38 g and 28 mm in size. Even the conventional method is sufficient to excise the sialolith when other modalities are not available. Chronic sialolith is common in old male patients and shows positive correlation with chronic smoking.