Sialodenectomy in Giant Sialolith at

Submandibular Gland
Case Report
Sialodenektomi Pada Giant Sialolith
Kelenjar Submandibula (Laporan Kasus)
drg. Agung Tri Prakoso *
drg. Herman Hambali Sp.BM **
dr. Teguh Marfen D, SpB. SpBTKV ***
 INTRODUCTION
Sialolithiasis is a common disease of salivary
glands characterized by the obstruction of the
salivary secretion by presence stone or a
calculi that called sialolith. 1
Sialoltihiasis 30 % salivary gland Patology

1. Grasesa F, Santiagob C, Simoneta BM, Costa-Bauza A. Sialolithiasis: Mechanism of Calculi

Formation and Etiologic Factors. Clinica Chimica Acta, 2003: 334;p131-36
 CASE REPORT
Male 49 y.o came Oral & Maxillofacial
Departement of Hasan Sadikin Hospital
complaints swelling and intermittent
pain in the lower jaw to the left for 6
month.
Pain complaints arise, especially when
going to eat and lose its charge.
Complaints arise persisted 1 last week.
The patient did not complain of pain in
the teeth and no history of previous
dental pain.
Physical examination:
Awareness Compos mentis
Vital signs within normal limits.
No sign of Sepsis
Extra Oral :
Extra-oral examination seem mild
inflammation in the left
submandibular region.
Extra Oral paplpation :
Hard mass , mobile, size 2-3 cm, define
border and Pain a/r left
submandible
Neck Examination : no lymph node
enlargement.
Intra Oral:
No source of infection in the teeth.
The mass was not palpable intraorally
Palpation on left submandibular gland
no Salivary flow & no purulent
material.
ADDITIONAL EXAMINATION

A panoramic x-ray results

round radiopaque lesion in the left
mandible suspected solid mass
size of 15 mm.

CBCT examination showed a

picture Solid mass on left
submandibular gland size
15,6x11,8 mm
 DIAGNOSE
SIALOLITH in LEFT SUBMANDIBLE GLAND
TREATMENT : SIALODENECTOMY
WITH EXTRAORAL APPROACH IN
GENERAL ANESTHESIA.

Line incision is placed 1-2cm from the

left margin of the mandible.
The incision is done layer by layer, and
then by identify the facial nerve
and artery and Mass identification.
Tha mass (sialolith) was obtain with
submandibular gland and perform
excision
Durante Operation finding:
Submandibular gland with giant
sialolith size 35mm x 21mm.
 FOLLOW UP POST OP
Symmetrical face and no deformity.
No surgical site infection,
No xerostomia,
No injury to the facial nerve, lingual and
hipoglosus.
Pain when eating and recurrent swelling also
not found anymore.
 DEFINITION
Sialolithiasis is a common disease of salivary
glands characterized by the obstruction of the
salivary secretion by presence stone or a
calculi that called sialolith. 1

1. Grasesa F, Santiagob C, Simoneta BM, Costa-Bauza A. Sialolithiasis: Mechanism of Calculi

Formation and Etiologic Factors. Clinica Chimica Acta, 2003: 334;p131-36
 Epidemiology (5)

SIALOLTIHIASIS 30 % salivary gland Patology

ADULT >> CHILD 30-60 years old

MALE >> FEMALE

85 % SUBMANDIBULAR

10 % PAROTIS

5% SUB LINGUAL DAN MINOR

5. James R. Hupp, dkk., Contemporary Oral And Maxillofacial Surgery 6 ed., Mosby, Inc, 2013;
p.406
 CLASSIFICATION
LOCATION
Parotis Gland And Duct
Submandibular gland And Duct
Sublingual gland And Duct
Minor Gland

SIZE
SMALL : < 10mm
LARGE : 10-35 mm
GIANT : < 35 mm

3. Panat SR, Aggarwal A., Upadhyay N., Kishore M., Alok A., Sialolithiasis: A Case Series, Journal
of Dental Sciences & Oral Rehabilitation, July-September, 2013
 Pathophysiology
The etiology and pathogenesis of sialolith formation
is still unknown.

Sialolith formed as a result of deposition of calcium

salts of organic nidus around which contain a
mixture of salivary mucin, bacteria and epithelial
cell desquamation.

Inbalance metabolic increase saliva bikarbonat

level change on calsium solubility
deposition of calcium and phosphate ions
6. Mouli C., Kumar SM, Kailasam S., Shanmugam S., Satish S., Sialolith: A Case Report With
Review Of Literature, Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November
2011 to January 2012.
 CLINICAL FEATURES
Symptomatic and asymptomatic
Typical Symptoms: Strong pain in the salivary glands
when eating
Swelling
Decreased salivary flow, sometimes purulent
cervical lymphadenopathy
palpable hard as a rock at the base of the mouth,
cheek or under the border of the mandible
Sialolith will cause static saliva, which causes the
accumulation of bacteria in the salivary gland
parenchyma and cause sialadenitis. 5
5. James R. Hupp, dkk., Contemporary Oral And Maxillofacial Surgery 6 ed., Mosby, Inc, 2013;
p.406
 CLINICAL EXAMINATION
INSPECTION

PALPATION
In the submandibular sialolith intraoral and extraoral
bimanual examination is usually palpable hard mass,
mobile, with distinct borders.

Examination of sialolith the parotid gland is usually

palpable around Stenson's duct.

Sialolith with a deeper location can not be felt clearly by

palpation 7
7. Mehmet Dalkiz, Sialolithiasis (Salivary Stone), Turk. J. Med. Sci. vol.31, 2001; h.177-79.
 ADDITIONAL EXAMINATION :
X-RAY
Panoramix x -ray
Oclusal x -ray

6. Mouli C., Kumar SM, Kailasam S., Shanmugam S., Satish S., Sialolith: A Case Report With
Review Of Literature, Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November
2011 to January 2012.
 ADDITIONAL EXAMINATION :
SIALOGRAPHY

6. Mouli C., Kumar SM, Kailasam S., Shanmugam S., Satish S., Sialolith: A Case Report With
Review Of Literature, Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November
2011 to January 2012.
 ADDITIONAL EXAMINATION :
ULTRASOUND

6. Mouli C., Kumar SM, Kailasam S., Shanmugam S., Satish S., Sialolith: A Case Report With
Review Of Literature, Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November
2011 to January 2012.
 ADDITIONAL EXAMINATION :
COMPUTED TOMOGRAPHY
Plain CT Scan
Cone Beam Computed
Tomography
Scanning (CBCT-Scan)
 Theraphy: Conservative
Small Sialolith near the mouth of
the duct :
Message + Sialogogues 4

Sialogogues :
Sour lemon drops
Parasympathomimetic drugs
pilocarpin 10 mg
Chewing gum
4. Bagheri S.C, Chris Jo, Clinical Review Of Oral And Maxillofacial Surgery, Mosby, Inc.,
2008;p.123-27
 Theraphy: Transductal Surgical

2. Treister SN, Bruch JM, Clinical Oral Medicine And Pathology, Humana Press, 2010; p.106
 Theraphy: Duct Dilatation

4. Bagheri S.C, Chris Jo, Clinical Review Of Oral And Maxillofacial Surgery, Mosby, Inc.,
2008;p.123-27
 Theraphy: Lithotripsy
Extracorporeal Shock
Wave Lithotripsy
(ESWL)
Endoscopic
Intracorporeal Shock
Wave Lithotripsy
(EISWL)

6.Mouli C., Kumar SM, Kailasam S., Shanmugam S., Satish S., Sialolith: A Case Report With
Review Of Literature, Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November
2011 to January 2012..
 Theraphy:
Endoscopic Retrieval

4. Bagheri S.C, Chris Jo, Clinical Review Of Oral And Maxillofacial Surgery, Mosby, Inc.,
2008;p.123-27
 Theraphy: Sialodenectomy
Sialodenektomi is taking
intact all salivary
glands.
Indication :
Giant and large sialolith
located in the deep and
posterior third or in the
salivary glands
progressive obstruction of
salivary duct

9. McCullom III C, Lee CYS, Blaustein D, Sialolithiasis In An 8-Year-Old Child: Case Report, Pediatr.
Den. Vol. 13, 1991; p.231-33
 Theraphy: Sialodenectomy
Complication :
Nerve Injury :
lingual nerve
hypoglossal
marginal mandibular
branch of the facial nerve.
Xerostomia

Risk :
Bleeding
Swelling
pain
Surgical Site Infections
4.Bagheri S.C, Chris Jo, Clinical Review Of Oral And Maxillofacial Surgery, Mosby, Inc., 2008;p.123-27
 FOLLOW UP & PROGNOSA
Immediate Follow up :
Chief Complain : pain (+/-), swelling (+/-)
Nerve injury
Wound Healing Infection (+/-)

Long Term Follow up

Recurence
Stricture decrease saliva flow, intermitten pain
Saliva Flow xerostomia (+/-)

Prognosa
Ad functionam ad bonam
Ad Vitam ad bonam

4.Bagheri S.C, Chris Jo, Clinical Review Of Oral And Maxillofacial Surgery, Mosby, Inc., 2008;p.123-27
HATUR NUHUN.....