Went in Search of a Stone But Found a Diamond: Case Report on Giant Submandibular Salivary Gland Sialolith with Acute on Chronic Sialadenitis

Giant sialoliths are uncommon and can lead to significant morbidity if not promptly treated. While smaller stones can be managed conservatively or with minimally invasive techniques, larger stones often necessitate surgical intervention. A patient presented with swelling on the left side of the neck for 2 years, accompanied by intermittent pain for 2 months, exacerbated after meals. A tender, firm swelling measuring 5 × 5 cm was observed in the left submandibular region. There was no erythema or lymphadenopathy. The opening of the salivary gland duct was normal. The swelling was palpable bimanually. An enlarged left submandibular gland with a heterogeneous echo pattern, multiple dilated ducts, and increased vascularity. Intraparenchymal hyperechoic foci with posterior acoustic shadowing suggested a sialolith measuring approximately 1.5 cm. Acute on chronic sialadenitis. A diagnosis of acute-on-chronic sialadenitis with a large sialolith was established. The patient was initiated on antibiotics and subsequently underwent submandibular salivary gland excision under general anaesthesia. A thickened fibrous capsule was noted over the submandibular salivary gland. The gland was excised after retracting the mylohyoid muscle. The submandibular ganglion and hypoglossal nerve were identified and preserved. A dilated Wharton’s duct was noted with large calculi within it and partly intraglandular. Calculi were extracted and the duct was doubly ligated and cut. A drain was placed in the submandibular region. The postoperative period was uneventful. This case highlights the effective surgical management of a giant sialolith. Early diagnosis and appropriate intervention are crucial in preventing complications and ensuring favourable patient outcomes.