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The diagnostic challenge of sialolithiasis

 Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Sahar M.N. Bukhary,
Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmau.jmau_92_22

The major salivary glands (parotid, submandibular, and sublingual) are most frequently obstructed by calculi within the salivary gland, or more uncommonly, by ranulas. Despite the well-defined clinical and radiographic diagnostic features, sialolithiasis may sometimes be confused with sialadenitis and ranulas, especially when encountered in general dental practice. We, therefore, present a case that illustrates this diagnostic dilemma to highlight the salient features of all three conditions. A 28-year-old female presented with a history of a submandibular swelling for 8 months. On intraoral examination, a bluish sublingual swelling was identified at the left side of the lingual frenum, causing a slight elevation of the tongue. The preliminary diagnosis was of a ranula; however, the clinical history suggested sialolithiasis. A hard structure was palpated in the submandibular gland, and a mandibular occlusal film revealed a large ductal sialolith. Sialolithotomy was performed under local anesthesia, and a single 7.2 mm stone was retrieved. The postoperative follow-up period was uneventful, with good healing and restored normal salivary flow. Despite the fairly clear clinical and radiographic diagnostic criteria suggestive of sialolithiasis, the bluish-tinged swelling of the floor of the mouth prompted the examining dentist to provisionally diagnose a ranula. Sialolithiasis is a common obstructive condition of the salivary gland encountered in the dental setting. Despite the clinical and radiographic features usually guiding the correct diagnosis, it can be a challenging diagnosis for less experienced dentists, who must always carefully consider the history, clinical, and radiographic findings.

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