Swelling of the Sublingual Carbuncle Area Caused By a Sialolith in the Salivary Gland Duct-A Case Report

Mohan kumar J^* and Rajasekar MK

^*Correspondence: Mohan kumar J, Department of ENT, Sree Balaji Medical College and Hospital, Chrompet, Chennai, India, Email:

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Introduction

Sialolithiasis is a widespread disorder that affects about 12 out of every 1000 people per year, accounting for more than half of all salivary gland diseases [1]. It may affect children, but adults in their third to sixth decades are more likely to be affected [2]. Males are more likely to produce sialoliths, with some writers suggesting that the submandibular gland forms over 80% of salivary calculi and the parotid gland just 20% [3]. Occasionally, the minor salivary glands and sublingual glands are affected. The Wharton's duct of the submandibular gland is where the majority of salivary calculi (80%) are located. The gland's most distinguishing feature is that the saliva it secretes flows against gravity; it also contains a lot of mucin, calcium, and phosphate. The accessory salivary duct of the submandibular gland is a rare phenomenon. It's a copy of the original Wharton's duct that runs parallel to it [4].

Case Presentation

A 20 years old male patient reported to our department with a chief complaint of decrease of saliva secretion, pain and dysphagia for 3 months. During massage of the gland, decreased salivary flow or purulent exudate may be observed. He had taken conservative analgesia and antibiotic treatment for the same before. On detailed history he presented swelling appears just be for his meals times, which reduced gradually over 2-3 hrs. Pain and tenderness during that time was severe.

On examination no evident dental focus of infection was located. Bimanual palpation of gland showed mild enlargement and tenderness. Findings on blood and serum biochemistry were with in normal limits after preliminary investigations patient was operated for intraoral sialolithotomy for removal of duct stone under local anaesthesia and the specimen stored in diluted formalin and sent histopathology examination, (Figures 1-5).

Figure 1:Pre op view.

Figure 2:Intra Op view.

Figure 3:Post Op view.

Figure 4:Salivary gland calculi.

Figure 5:Histopath report.

Results and Discussion

While salivary gland stones are common in the general population, the cause of sialolith formation is unknown. The sialolith nuclei are often made up of inorganic materials including calcium phosphate and calcium carbonate, although there is evidence that the nidus can also contain bacterial matter [5]. Investigated the mineral composition of sialoliths in different parts of the ductal system and discovered that stones in Wharton's duct contained more whitlockite crystals than those in intra glandular ducts. This may be due to the higher calcium and phosphate content of Wharton's duct saliva [6].

Conclusion

With the newer treatment options of endoscope i.e. salivary Culculi lithotripsy the surgical removal may become minimally invasive but still today the long tested methods of Tran’s oral evacuation of stone especially in distal part of duct are successful with minimum hazards.

References

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