Recurrent Sialadenitis with Sialolithiasis of Submandibular Gland: A Case Report

Case Presentation

J Dent App. 2016; 3(4): 358-360.

Recurrent Sialadenitis with Sialolithiasis of Submandibular Gland: A Case Report

Tulasi Lakshmi D¹, Firoz Babu P², Negi LS¹ and Nayyar AS¹*

¹Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post- Graduate Research Institute, Parbhani, Maharashtra, India

²Department of Orthodontics and Dentofacial Orthopedics, Rama Dental College and Hospital, Kanpur, Uttar Pradesh, India

*Corresponding author: Abhishek Singh Nayyar, 44, Behind Singla Nursing Home, New Friends’ Colony, Model Town, Panipat-132 103, Haryana, India

Received: December 02, 2016; Accepted: December 28, 2016; Published: December 30, 2016


Sialoliths are calcareous concretions that may be found in the ducts of the major or, minor salivary glands or, within the glands themselves. The condition is found more commonly in middle-aged adults. The salivary gland most commonly affected is the submandibular gland. Clinically, it presents like an acute, painful, and intermittent swelling of the gland, especially during a meal, when the saliva flow is increased. In this report, we have reported a case of 21 year old male patient with sialolithiasis of the left submandibular duct. The treatment consisted of the use of lemon and orange drop candies, which stimulated the salivary flow and in turn, resulted in the expulsion of stone.

Keywords: Sialolith; Sialadenitis; Salivary Gland


Sialolithiasis is the most common cause of salivary gland obstruction, and is found in approximately 65% of the patients with chronic sialadenitis. Sialoliths are calcified structures that develop within the salivary ductal system. These are usually hard formations and may be round or, oval in shape and may have a variety of sizes. 80- 90% of the salivary gland duct calculi are found in the submandibular gland, 5-10% in the parotid gland and approximately 0-5% in the sublingual and other minor salivary glands. The obstruction can be complete or, partial, and may exhibit recurrence once removed. The incidence of sialolithiasis is shown to peak in the third to sixth decade of life. Submandibular gland sialolithiasis is more common because of the anatomical factors associated with formation of sialoliths in this gland. The Wharton’s duct of the submandibular gland is the longest duct amongst all salivary gland ducts with the path of the duct going in an upward direction (anti-gravity flow). Also, the main portion of the duct is wider than its orifice. Along with these anatomical factors, the submandibular gland saliva is alkaline in nature and rich in mucin, which can promote the formation of a sialolith [1-3]. The aim of this case report is to present a case of sialolithiasis of the submandibular gland in a 21 year old male patient.

Case Presentation

A 21 year old male patient reported to the Department of Oral Medicine and Radiology with a chief complaint of swelling and pain in the region below the tongue on left side since 3 days. Intensity of pain and size of the swelling increased during meals and decreased gradually on its own after an hour. The swelling was, also, associated with pus discharge. He, also, complained of dryness of mouth on left side. There was a history of recurrence of the swelling and occasional pus discharge over the past 6 months for which he used to take medication and the pain and swelling used to get relieved. Patient had difficulty while eating and speaking. He, also, had a history of pan chewing since 3 years. On general examination, patient was conscious and cooperative. Vital signs were within normal limits with the exception of a temperature of 38.9°C (102°F). Submental and submandibular lymph nodes were palpable on left side. Intraorally, there was a solitary, diffuse swelling in the floor of the mouth on left side. It measured 0.6×1.8 cm in dimensions and extended from the lingual frenum to the second premolar region along the course of the Wharton’s duct on left side. The mucosa was red and erythematous with pus discharge from the duct orifice. Wharton’s duct orifice was inflamed and there was an ulcer noted over the swelling anteriorly above the duct orifice (Figure 1). On palpation, the swelling was tender with local rise in temperature. It was firm in consistency with a hard area appreciated along the course of the Wharton’s duct anteriorly close to the duct orifice. On milking, there was pus discharge through the duct orifice. On the basis of history and clinical findings, a provisional diagnosis of recurrent sialadenitis was arrived-at. A true mandibular occlusal radiograph was advised which revealed a solitary homogenous cigar shaped radiopacity measuring approximately 0.4×1.2 cm in dimensions with distinct borders seen mesial to the body of the mandible at premolar region on left side (Figure 2). Based on the above mentioned clinical and radiographic findings, a final diagnosis of recurrent sialadenitis with sialolithiasis of the submandibular gland was given. Patient was put on Tab Amoxycillin-Clavulinic acid 375mg tds, Tab Metrogyl 200mg tds, Tab Paracetamol 200mg tds and chlorhexidine mouthwash for 5 days. A non-surgical management by giving hydration, simultaneous milking of the gland from posterior to anterior direction pushing the calculi towards the orifice, using lemon or, orange drop candy and application of moist heat to the left submandibular region was planned. After 5 days, the patient came with the sialolith expulsed out of the Wharton’s duct orifice with regressed swelling (Figure 3). Clinically, the swelling resolved with no pain. Intra-oral examination demonstrated non-edematous, patent left Wharton’s duct with free flowing saliva. The patient was advised to follow the above mentioned home care instructions for another week. On follow-up examination 1 year later, the patient remained asymptomatic without recurrence of the sialolith.