Abstract
Background: Sialolithiasis is the most common salivary gland disorder characterized by calculi formation within the gland and/or its duct. The submandibular gland is most frequently affected due to the peculiar anatomy of the duct and the nature of its secretion. Varying sizes have been described for salivary calculi and unusually large sialoliths measuring above 3.5cm have been reported. Similarly, a few giant sialoliths have been reported in Africans. We therefore report the case of a large sialolith in the Wharton’s duct of a Nigerian male.
Case presentation and management: A 54 year old Nigerian man presented with a hard, painless, left floor of mouth swelling of one year duration. There were recurrent episodes of moderate pain at meal times. Intraoral examination revealed a hard, mobile, non tender, creamy mass on the left side of the floor of the mouth protruding out of the Wharton’s duct orifice. A lower occlusal radiograph revealed a large radio-opacity in the floor of the mouth and a diagnosis of left submandibular sialolithiasis was made. The sialolith was removed non-surgically and measured 4.4cm by 1.8cm. The patient was discharged and follow up period was uneventful.
Conclusion: Large sialoliths are rarely reported in Africans, non-surgical extraction can be attempted for accessible and mobile sialoliths after full evaluation. Complex cases should be referred to the oral and maxillofacial surgeon.
Keywords: Submandibular duct; sialolith; massive; non-surgical; Nigerian
Résumé
Contexte: Le sialolithiase est le trouble des glandes salivaires le plus courant caractérisé par la formation de calculs à l’intérieur de la glande et / ou sa conduite. La glande sous-maxillaire est le plus souvent affectée en raison de l’anatomie particulière de la conduite et de la nature de sa sécrétion. Différentes tailles ont été décrites pour des calculs salivaires et sialoliths inhabituellement grandes mesurant au delà de 3.5cm ont été rapportés. De même, quelques sialoliths géants ont été signalées chez les Africains. Nous rapportons donc le cas d’un grand sialoliths dans le conduit de
Wharton d’un homme nigérian. Présentation de cas et gestion: Un homme nigérian âgé de 54 ans présenté avec un disque indolore, palier gauche de la bouche enflure d’une durée d’un an. Il y avait des épisodes récurrents de douleur modérée au moment de repas. L’examen intra buccal a révélé un disque, mobile, non tendre, de masse crémeuse sur le côté gauche du palier de la bouche saillissant hors de l’orifice du conduit de Wharton. Une radiographie occlusale inférieure a révélé une grande radio opacité dans le palier de la bouche et un diagnostic de sialolithiase sous-maxillaire gauche a été fait. Le sialoliths a été retiré non-chirurgicalement et mesurait 4,4cm par 1,8cm. Le patient a été libéré et la période de suivi était sans incidents.
Conclusion: Les grands sialoliths sont rarement signalés chez les Africains, l’extraction non-chirurgicale peut être tentée pour sialoliths accessibles et mobiles après une évaluation complète. Les cas complexes doivent être renvoyés à la chirurgie buccale et maxillofaciale.
Mots-clés: Conduit sous-mandibulaire; sialoliths; massif; non-chirurgicale; Nigériane
Correspondence: Dr. A.O. Akinyamoju, Department of Oral Pathology, Faculty of Dentistry, College of Medicine, University of Ibadan, Nigeria. E-mail: akindayo2002@yahoo.com
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