The patient was diagnosed with sialadenitis secondary to sialolithiasis. He underwent sialolithectomy and sub-mandibular gland excision by ENT with no complications and minimal blood loss. The surgeon noted at least three separate stones measuring in total about 15 x 35 mm. The most distal stone was the largest and most solid. After removal of this first stone, the rest of the sialoliths were friable (almost chalky) and followed by purulent drainage.

Almost certainly the formation of this stone was a chronic process exacerbated by bacterial infection incited by the patient "breaking his tooth."