Submandibular calculi and sialadenitis

Case contributed by Nikos Barmpagiannis

Presentation

Palpable painfull mass in submandibular area for about a month.

Patient Data

Age: 50 years
Gender: Male
ultrasound

Neck ultrasound reveals multiple shadow-casting calculi in the submandibular main duct with concurrent proximal dilatation, as well as increased blood flow due to inflammation. The loss of the gland's normal echo-texture is evident when compared to the contralateral. The more distal stone is impacted near the floor of the mouth.

Case Discussion

Salivary glands calculi (sialolithiasis) is more common in the submandibular (80%) than the parotid (20%) glands, because of the higher mucus concentration. In terms of anatomy, it is notable that the submandibular glands drape around the posterior ends of the mylohyoid muscle (the thin muscle in the submental triangle) and that the retromandibular vein is the anatomical landmark that helps seperate submandibular gland lesions from parotid deep-lobe lesions. Also, if there is dilatation of the submandibular ducts but no calculi is visible, then a possible malignant process of the mouth floor should be very carefully excluded.

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