Miscellaneous Sialolithiasis

The incidence of sialolithiasis of the sublingual gland and the minor salivary glands is very rare. In McGurk, Escudier, and Brown's (2004) study of 455 cases of salivary calculi, no cases were present in the sublingual gland or minor salivary glands. As such, swellings of these glands are most likely to engender a clinical diagnosis of neoplastic disease, with the diagnosis of sialolithiasis made only after final histopathologic analysis of the gland occurs (Figure 5.18). One report examining sialolithiasis of the minor salivary glands found that only 20% of cases were correctly clinically diagnosed as sialolithiasis (Anneroth and Hansen 1983). The paucity of accurate diagnosis may also stem from the frequent spontaneous resolution of the problem due to ejection of the calculus (Lagha, Alantar, and Samson et al. 2005). Two stages of minor salivary gland sialolithiasis have been described, including an acute stage characterized by inflamed overlying soft tissue whereby the most common clinical diagnosis is cellulitis of the soft tissue. The chronic stage follows and calls to mind a differential diagnosis of neoplasm, irritation fibroma, or foreign body. An anatomic distribution of 126 cases of sialolithiasis of the minor salivary glands identified a significant majority occurring in either the upper lip or the buccal mucosa. As such, sialolithiasis should be included on the differential diagnosis of an indurated submucosal nodule of the upper lip or buccal mucosa, and surgical excision should be performed.

Figure 5.18a. Floor of the mouth swelling present in a 55-year-old woman. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

Figure 5.18a. Floor of the mouth swelling present in a 55-year-old woman. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

Figure 5.18b. A diffuse mass is noted beneath the surface mucosa that is smooth and of normal color. A presumptive diagnosis of ranula vs. neoplasm was established. A left sublingual gland excision was performed in the standard fashion. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

Figure 5.lSc. The specimen exhibited mild induration without signs of ranula, such that a neoplastic process was favored while the possibility of a mucous escape reaction was discarded. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

Figure 5.lSc. The specimen exhibited mild induration without signs of ranula, such that a neoplastic process was favored while the possibility of a mucous escape reaction was discarded. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

Oral Maxillofacial Specimens

Figures 5.18d and 5.18e. Final histopathology showed a sialolith (d) in the background of sialadenitis (e). Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

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Figure 5.18f. The tissue bed is noted, particularly the lingual nerve (retracted with the vessel loop) and Wharton's duct. Reprinted from: Berry BL. Sialadenitis and sialolithiasis. Diagnosis and management. In: The Comprehensive Management of Salivary Gland Pathology, Carlson ER (ed), Oral and Maxillofacial Surgery Clinics of North America, WB Saunders, Philadelphia, 479-503.

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