Management of Giant Intraglandular Submandibular Sialolith With Neck Fistula

Abstract

Salivary gland sialolith account for the most common disease of the salivary glands. However, large calculi are considered rare. It was reported that incidence of intraglandular sialolith is rare compared to intraductal ones and may go undetected for years. In literature, few cases of submandibular giant sialolithiasis have been reported. Most of them were intraductal stones got enlarged and presented intraorally. Their management was sialolithectomy via transoral approach. However, fewer cases of large intraglandular sialolith were reported as well. Most of them led to fibrosis and erosion extended to floor of the mouth. Their management was complete surgical excision of gland and stone via extraoral extirpation approach. The present case report describes a 70 years old Saudi male patient presented with an unusual giant intraglandular submandibular sialolith with neck fistula. Orthopantomography and CT scan views were used for diagnosis. Accordingly, management was done via an extraoral incision to completely excise the gland and stone and to explorate the degree of damage and destruction at glandular and paraglandular tissues.