GROUP 3

SCENARIO 3
MEMBERS
1. PUTRI AZURA JUMER (1710070110001)
2. MUHAMMAD RIFKI (1710070110011)
3. LIA MARIANA LUBIS (1710070110015)
4. RESMA SRI JUNIARTI (1710070110018)
5. AHMAD MUKHLAS ABROR (1710070110026)
6. MUHAMMAD JUMHARI (1710070110044)
7. QURRATA AKYUNI YUSENA (1710070110056)
8. NALFIA LIRA PUTRI (1710070110064)
9. WALHADIYATI MALIK (1710070110065)
10. KARTIKA ANGELINE A F (1710070110066)
11. MUHAMMAD SALMAN RAFI (1710070110067)
12. MEILANI RIZKY NOVIA (1710070110069)
SCENARIO 3
A 33-year-old woman came to the RSGM with
complaints of swelling and pain in the lower part of the
tongue. Complaints have been going on since 1 week
ago and have never been treated. Extra oral examination
is swelling in the right submandibular lymph node. Intra-
oral examination of the floor of the mouth in the frenulum
region appears to be surrounded by erythema. The
panoramic x-ray is found in the region of the radiopaque.
LEARNING OBJECTIVE

1. Students can understand and explain the examination in the case

2. Students can understand and explain the diagnosis in cases
3. Students can understand and explain the etiology in the case
4. Students can understand and explain the clinical picture in the case
5. Students can understand and explain pathogenesis in cases
6. Students can understand and explain management in cases
7. Students can understand and explain complications in cases
1. Examination in the case
1. Physical examination
Physical examination that can be done by bimanual palpation
from posterior to anterior often is obtained by stones in the
duct, also can feel enlarged ducts and glands in evaluating
the function of salivary glands.

2. Supportive checking
Occlusal and panoramic radiological examinations, sialography, ultrason
ography, xeroradiography, computer scintigraphy and tomography which
can indirectly provide information about the existence of sialoliths and s
alivary glands.
2. Diagnosis “Sialolithiasis”

Sialolithiasis is a condition
characterized by blockage of
the salivary glands or excret
ory ducts due to concrete
formation or calcareous sial
oliths.
3. Etiology in the case
The etiology of sialolithiasis is not known with certainty.
The developing theory links the etiology of sialolithiasis
with chronic sialodentitis and partial obstruction of the
salivary gland structure. Another theory states that
sialolithiasis is a manifestation of systemic disease.
Examples of systemic diseases are gout or arthritis,
where stones are formed containing uric acid.
4. Clinical picture in the case
In partial obstruction the symptoms are usually asympt
omatic. Sometimes intermittent gland pain and swelling
are the most common complaints and these symptoms
appear to be related to mealtime syndrome. When exce
ssive appetite arises, salivary gland secretions also incre
ase while drainage through the ducts becomes obstruct
ed resulting in stagnation which causes pain and swolle
n glands. If the stone is located in the main duct near t
he oral cavity, there is swelling and pain on the stone it
self
5. Pathogenesis in cases

The process of forming sialolite consists of 2 phases, namely the pha

se of the formation of the nucleus and the phase of formation of th
e outer layer. In the initial phase the nucleus is formed by salt depos
its related to organic substances which will then coat in the next pha
se by organic and inorganic materials such as bacterial components,
desquamation of epithelial cells, electrolyte changes and decreased
glycoprotein synthesis, this occurs due to decay of cell membranes
due to aging .
6. Management in cases
1. Without surgery
The treatment of salivary gland sialolithiasis with a conservative approach. Treat
ment with antibiotics and anti-inflammatory drugs in the hope that the stones
can pass through the carunkula spontaneously.

2. Surgery
Surgery with an intraoral approach (sialithectomy) especially in cases with large
stone diameters or difficult locations.

3. Minimal invasive
Extracorporeal Shock Wave Lithotrpsy (ESWL) and Interventional sialoendoscopy
7. Complications in cases
Complications caused by sialolithiasis are caused by the pres
ence of stones in the canal which will cause salivary retention
until infection occurs in the parenchymal tissue of the salivar
y glands, causing sialoadenitis. In addition, ductal lumen and
stricture can also occur.