The Diagnostic Challenge of Sialolithiasis

The major salivary glands (parotid, submandibular, and sublingual) are most frequently obstructed by calculi within the salivary gland, or more uncommonly, by ranulas. Despite the well-defined clinical and radiographic diagnostic features, sialolithiasis may sometimes be confused with sialadenitis and ranulas, especially when encountered in general dental practice. We, therefore, present a case that illustrates this diagnostic dilemma to highlight the salient features of all three conditions. A 28-year-old female presented with a history of a submandibular swelling for 8 months. On intraoral examination, a bluish sublingual swelling was identified at the left side of the lingual frenum, causing a slight elevation of the tongue. The preliminary diagnosis was of a ranula; however, the clinical history suggested sialolithiasis. A hard structure was palpated in the submandibular gland, and a mandibular occlusal film revealed a large ductal sialolith. Sialolithotomy was performed under local anesthesia, and a single 7.2 mm stone was retrieved. The postoperative follow-up period was uneventful, with good healing and restored normal salivary flow. Despite the fairly clear clinical and radiographic diagnostic criteria suggestive of sialolithiasis, the bluish-tinged swelling of the floor of the mouth prompted the examining dentist to provisionally diagnose a ranula. Sialolithiasis is a common obstructive condition of the salivary gland encountered in the dental setting. Despite the clinical and radiographic features usually guiding the correct diagnosis, it can be a challenging diagnosis for less experienced dentists, who must always carefully consider the history, clinical, and radiographic findings.