Difficulties in Diagnosis of Sialolithiasis: A Case Series

Sialolithiasis is one of the most common and extensively obstructive disorders of the major salivary glands. Here, we report 3 cases of sialolithiasis in the submandibular salivary gland showing symptomatic similarities to other dental and non-dental disorders of the maxillofacial area. How the various clinical features of this condition and findings on 3D-CT may lead to a misdiagnosis are also discussed. In the first case, that of a 45-year-old woman, a final diagnosis of a non-radiopaque submandibular sialolith allowed the initially indicated surgical extraction of a malerupted and semi-impacted right mandibular 3rd molar to be abandoned. In the second case, that of a 57-year-old woman, radiographic findings had previously led to a diagnosis of ameloblastoma, which had masked the presence of sialolithiasis for at least 9 years, despite the radiopacity of the sialolith. Meanwhile, exacerbation of sialolithiasis was mistaken for lymphadenitis. In the third case, that of a 40-year-old woman, sialolithiasis was diagnosed in a timely manner, despite the fact that the dentists' attention had initially been focused on odontopathological symptoms. One feature of the present report is the concurrence of dental and non-dental pathologies affecting the same sextant as the sialolithiasis. Despite recent advances in imaging technology and diagnostics, cases of sialolithiasis being misdiagnosed continue to occur in clinical practice.