Presentation
Pain worsening at mealtimes. Swelling under left jaw.
Patient Data
The left submandibular gland demonstrates several calculi: upper region calculi protruding out from the gland, mid-region calculi protruding out on the lateral aspect of the gland and the lower region calculi all within the gland. Intra-glandular ductal radicles are not dilated. The left submandibular gland is diffusely enlarged compared to the right. The parenchyma appears to have areas of atrophy. A few small cervical nodes adjacent to the left submandibular gland, likely reactive.
Case Discussion
Submandibular sialolithiasis is a common cause of salivary gland obstruction, often presenting with pain and swelling exacerbated by meals due to increased saliva flow. The submandibular gland is particularly prone to calculi formation due to the higher concentration of calcium and mucus in its secretions and the upward course of Wharton's duct 1. The actual aetiology of sialolithiasis is unknown.
Early diagnosis and treatment are essential to prevent complications such as infections or chronic gland dysfunction. Imaging modalities like ultrasound, CT and MR-sialography are crucial for identifying the presence and location of calculi. Conservative management is often first-line, but intervention procedures may be required for persistent cases 2.
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