SOMETHING HARD

UNDER THE
TONGUE
TUTORIAL 6
BLOK IV.2
 GROUP MEMBERS :
FARHAN WIRANDA (1910070110006)
LAILA SYAFIRA (1910070110008)
SRI DEWI SAFITRI (1910070110015)
LINDA PUSPITASARI (1910070110019)
DZAKY ZAHRAN MUSTI (1910070110024)
BAGAS PRAMUDYA P (1910070110026)
CITRA NANDYA KIRANA (1910070110027)
NABILA SUPRIADI (1910070110028)
AMIA PRATAMA (1910070110038)
SITI FATIMAH (1910070110076)
RULLY CAHYO SERCIO (1910070110091)
 “SOMETHING HARD UNDER THE TONGUE”

A 40-year-old man came to the General Hospital with complaints of swelling

and pain at the bottom of the tongue. From the anamnesis the pain increases
when eating spicy food. Complaints have been going on since 1 week ago and
have never been treated. Extra-oral examination revealed swelling in the right
submandibular lymph node. Intra-oral examination of the floor of the mouth in
the lingual frenulum region showed calculi surrounded by an erythematous
area. The olusal photo shows a radiopaque appearance in the region. The
patient asked the dentist to provide treatment for his illness.
 Clarification of Terms

Erythema Calculus
Learning Objectives
Students are able to Students are able to
understand and explain Students are able to
understand and
appropriate diagnoses understand and
explain the
and differential explain appropriate
appropriate
diagnoses in case verses and hadiths
pathophysiology in
scenarios in case scenarios
case scenarios

01 02 03 04 05 06

Students are able to Students are able to Students are able to

understand and understand and understand and
explain the explain the explain the
appropriate appropriate etiology appropriate
examination in case in case scenarios treatment plan in
scenarios case scenarios
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01
Students are able to understand
and explain the appropriate
examination in case scenarios
Physical examination that can be done by bimanual palpation of the floor of the mouth from the posterior
to the anterior direction is often found stones in the ducts, can also feel the enlargement of the ducts and
glands in evaluating the function of the salivary glands in addition to supporting examinations that can be
done, namely through radiological methods to diagnose sialolithiasis

• CT Scan: This method is most often used. CT scan is an adequate examination to diagnose
sialolithiasis if the size of the stone is large or CT scan images per millimeter are performed

• Endoscopy
Endoscopy, also known as sialoendoscopy, is a noninvasive procedure that can completely
explore the ductal system, including the secondary and tertiary branches of the ducts.

• Ultrasonography (USG)
Ultrasound has limitations for detecting sialolithiasis. To clarify the results can use a high
resolution (7-12 MHz) with linear transducers and small surface contact
 02
Students are able to understand and
explain appropriate diagnoses and
differential diagnoses in case scenarios
 Diagnosis and Differential Diagnosis
Diagnosis
Sialolithiasis is a disease found in the salivary glands
which is characterized by a blockage of saliva
secretion by a salivary gland stone (calculus). Salivary
gland calculus is formed due to deposits of tribasic
calcium phosphate salts (Ca3(PO4)2) together with
organic matter consisting of desquamation of epithelial
cells, bacteria, foreign bodies or decomposition of
bacterial production.
Differential diagnosis
There are several diseases that need to be
distinguished from sialolithiasis, acute infections of
the salivary glands are often caused by viral
infections, especially the mumps virus. Inflammation
of the parotid gland such as acute bacterial
sialadenitis caused by Staphylococcus aureus or
pyogens, Streptococcus viri and/or pneumoniae or
Hemophilus influenzae.
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03
Students are able to understand
and explain the appropriate
etiology in case scenarios
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ETIOLOGY

The etiology of sialolith formation is not precisely

known. Several hypotheses have been proposed to
explain the etiology of this stone formation:
mechanical, inflammatory, chemical, neurogenic,
infectious, etc. However, it is thought that alkaline,
viscous, mucus-rich saliva contains a higher percentage
of calcium phosphate as in the submandibular salivary
glands which favors sialolith formation. In addition,
Wharton's long and tortuous position also affects the
submandibular salivary glands more susceptible to
sialolith formation than the parotid glands.
 04
Students are able to understand and
explain the appropriate
pathophysiology in case scenarios
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PATHOPHYSIOLOGY

The exact pathophysiology of sialolithiasis is still

unknown, and various hypotheses have been
proposed. The first is based on the presence of
intracellular microcalculi which, when excreted
in the canal, can become a nidus for further
calcification. The oral cavity may migrate to the
salivary tract and become a nidus for further
calcification. Both hypotheses presuppose the
existence of a guarded organic nidus that
progressively grows with deposition of layers of
inorganic and organic matter.
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05
Students are able to understand
and explain the appropriate
treatment plan in case scenarios

Treatment
Non surgery
In cases with small stones, the recommended
management is nonsurgical medication. These
include oral analgesics, adequate hydration,
local hot compresses, massage to remove
stones, and use of a sialogo to increase salivary
secretion in the ducts. Using antibiotics and
anti-inflammatory in the hope that the stone
will pass through the duct spontaneously.
Home
Surgery
Surgery is often performed especially in cases
with large diameter stones (largest size up to 10
mm), or difficult locations. Sometimes followed
by resection of the salivary glands.
Sialithectomy with an intraoral approach
followed by resection of the salivary glands
with surgical techniques, then the mouth opener
was installed and the tongue was removed.
After being palpated on the floor of the oral
cavity to determine the location of the calculus.
 06
Students are able to understand and
explain appropriate verses and hadiths
in case scenarios
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And your Lord revealed to the bees, "Make nests in the hills, in the trees, and in places made by
humans," then eat of every (kind of) fruit and follow the path of your Lord which has been given to
you. made easy (for you). From the belly of the bee comes a drink (honey) of various colors, in which
there is healing medicine for humans. Verily in that there is a sign (of God's greatness) for those who
think.
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THANK
YOU