Int. J. Oral Maxillofac. Surg.

2002; 31: 562–563

doi:10.1054/ijom.2002.0253, available online at http://www.idealibrary.com on

Case Report
Oral Pathology

Multiple sialoliths in sublingual J. Choi, I.-K. Kim, N.-S. Oh

Department of Dentistry, College of Medicine,
Inha University, Incheon, South Korea

gland: Report of a case

J. Choi, I.-K. Kim, N.-S. Oh: Multiple sialoliths in sublingual gland: Report of a
case. Int. J. Oral Maxillofac. Surg. 2002; 31: 562–563.  2002 International
Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd.
All rights reserved.
Key words: sialolithiasis; sublingual gland;
Abstract. We describe a 28-year-old woman with multiple sialoliths in the left multiple sialoliths.
sublingual gland. The sialoliths were removed by transoral sublingual
sialadenectomy. A total of 22 calculi were found. Accepted for publication 25 January 2002

Introduction
Sialolithiasis is a common disease of the
salivary glands. Symptoms include swell-
ing of the involved gland, especially dur-
ing meals, and tenderness, which may
subside but recur later3. Sialolithiasis
occurs mainly in the submandibular
gland (80–90%) and to a lesser extent in
the parotid gland (5–20%). The sublin-
gual gland and the minor salivary glands
are rarely affected5. In most cases
(70–80%), one sialolith is found. Two
sialoliths occur in about 20% of patients
and three or more in about 5%6. We
describe a patient with multiple sialoliths
in the sublingual gland, which usually
has a very low incidence of sialolithiasis.
Case report
A 28-year-old woman was referred
because of diffuse swelling of the left
sublingual region, accompanied by diffi-
culty in swallowing. The patient’s past
medical history was unremarkable. On
physical examination, body temperature,
pulse rate, and blood pressure were
within normal ranges.
Clinical examination showed a fluctu-
ant swelling associated with tenderness
in the left sublingual region. Both
Wharton’s ducts were patent, with clear
salivary flow demonstrated on gentle
manipulation of the submandibular
glands. The tongue was elevated. The
left submandibular and cervical nodes
were not palpable. Radiographic exami-
nation revealed multiple radiopaque
masses in the left sublingual region
(Fig. 2). The clinical diagnosis was mul-
tiple sialoliths in the left sublingual
gland.
With the patient under general
anaesthesia, a large number of calculi
and the left sublingual gland were
removed by an intraoral approach.
About 22 sialoliths were removed from
within and around the sublingual gland.
A small polyethylene tube was inserted
into Wharton’s duct and retained for
3 days to preserve patency. The histo-
pathological diagnosis of the removed
specimen was chronic sialadenitis caused
by sialolithiasis. During 3 years’ follow-
up, there has been no sign or symptom
of recurrence.

Discussion
Sialoliths may be single or multiple.
L et al.5 reported that one
sialolith was present in 75.3% of cases,
two in 15.6%, three in 2.9%, and four to
Fig. 1. Floor of the mouth showing edema. eight in 6.2%. A et al.1
0901-5027/02/050562+02 $35.00/0  2002 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved.

Fig. 2. (A) Occlusal view showing the sialoliths. (B) Computerized
tomogram (coronal view).
reported one case of two sialoliths
among three cases of minor salivary
gland sialolithiasis. In 1972, H &
K2 reported a case of multiple
sialolithiasis of the minor salivary gland
in which three sialoliths were removed.
P et al.6 in 1992 described two rare
cases of multiple sialolithiasis, one
involving four sialoliths within Whar-
ton’s duct, and the other 16 sialoliths in
the orifice of Stensen’s duct. Similar to
the patients described by P, our case
was very rare owing to the presence of
more than 22 sialoliths within and
around the sublingual gland, which usu-
ally has a very low frequency of sialo-
lithiasis, especially that involving
multiple sialoliths.
Sialoliths range in diameter from a
few millimetres to 2 cm or more4. The
sialoliths in our case measured between
less than 1 mm to 5 mm in diameter. We
confirmed up to 22 sialoliths. However,
many microcalculi found in the sub-
lingual gland were too small to measure.
Multiple sialoliths in sublingual gland 563
Fig. 3. (A) Gross specimen of the left sublingual gland and the
sialoliths. (B) Internal view of removed sublingual gland.
associated with eating. JAMA 1962: 181:
We are therefore certain that more than
1115–1119.
22 sialoliths were present.
5. L J, R E, M Y. Sialo-
Solitary sialoliths usually do not lithiasis. A survey on 245 patients and a
recur, although chronic multiple recur- review of the literature. Int J Oral Maxil-
rence has been reported. L lofac Surg 1990: 19: 135–138.
et al.5 estimated that the recurrence 6. P HS, Y HJ, C WH. Multiple
rate of sialolithiasis is 8.9%. Since mul- sialolithiasis; report of two cases. Korean J
tiple sialolithiasis with microcalculi, Maxillofac Plastic Reconst Surg 1992: 14:
present in our patient, may have a high 169–173.
risk of recurrence close follow-up is
required.
Address:
Dr Jinho Choi
Department of Dentistry
References
College of Medicine
1. A D, M L, Inha University
P P, et al. Clinical study of 7-206 3rd St Shinheung-Dong
sialolithiasis. Findings from 100 cases. Hell Choong-gu
Stomatol Chron 1989: 33: 245–251. Incheon
2. H B, K HS. Multiple sialo- Korea
lithiasis of minor salivary glands: report of Tel: 82-32-890-2470,1
a case. Br J Oral Surg 1972: 10: 193–198. Fax: 82-32-890-2475
3. K GO. Textbook of oral & maxillo- E-mail: jinochoi98@yahoo.com
facial surgery, 6th edition. Philadelphia:
CV Mosby company 1984: 638–639.
4. L DM, RM WH, D KD.
Salivary gland calculi-pain, swelling