Submandibular duct sialoliths of unusual sizes- two case reports

Sialoliths are formed by deposition of calcium salts around the central nidus which may consist of altered salivary mucins, desquamated epithelial cells, bacteria and foreign bodies.1 They may occur at any age, and account for more than 50% of the salivary gland diseases. Approximately 80-90% of these occur in submandibular gland or its duct, 5-10% in parotid gland and remaining in sublingual gland and other minor salivary glands.2‒4 The common involvement of submandibular gland and duct is due to the tenacity of submandibular saliva, which because of its high mucin content adheres to any foreign particle.1 The main etiological factors for stone formation are related to saliva retention and saliva composition: among patients with sialolithiasis, the salivary calcium concentration is higher compared to healthy individuals. Other risk factors include increased saliva viscosity, which may result from chronic dehydration typically seen in elderly persons or to secretory inactivity. Commonly, sialoliths measure 5-10mm in size, stones over 10mm can be reported to be sialoliths of unusual size.3 Giant sialoliths are rare and 95% of them have been reported in submandibular glands, all of them occurring in male patients.5