SURGICAL TREATMENT OF RARE SUBMANDIBULAR SIALOLITH OF EXUBERANT DIMENSIONS

Sialolithiasis is characterized by the formation of stones that obstruct the salivary ducts, leading to inflammation, infection, and reduced salivary flow. Etiopathogenesis is currently unknown, but evidence suggests an interaction with the chemical composition of saliva, specifically due to the combination of various electrolytes such as sodium, potassium, calcium, and phosphates. The stones are generally unilateral, with a higher prevalence in the submandibular gland. Clinical and radiographic exams are essential for diagnosis, with CT and MRI serving as auxiliary methods in cases where stones are not visible in conventional X-rays. Treatment varies depending on the size and location of the stone, ranging from conservative measures like salivary stimulation and compresses to surgical interventions. The aim of this study was to report a rare case of an extensive sialolith with a minimally invasive approach. A female patient sought the maxillofacial surgery service reporting swelling in the floor of the mouth region and difficulty chewing. During the physical examination, hardening of anatomical structures on the right side was identified. Complementary exams, such as occlusal radiography, revealed a symmetric radiopaque area of 35.8 mm, confirming the presence of a remarkably large salivary stone in the duct of the submandibular gland. The treatment of choice was the excision of the sialolith, where tissue synthesis was performed by anatomical planes. In the postoperative period, complete restoration of salivary function and relief of initial symptoms were observed. Therefore, large stones significantly affect salivary flow and gland function, justifying surgical removal as the most appropriate treatment. The surgical technique used in this case, besides being minimally invasive, proved effective in removing the sialolith and preserving the glands structures, resulting in satisfactory recovery and the complete restoration of the patients salivary function.