Rare Case of Giant Salivary Stone Puzzled Experts

Salivary stones are hardened mineral sediments that develop in the salivary glands. People aged 30 to 60 are more prone to develop this condition, but men are more likely to get it than women. Just recently, a big salivary stone was recently detected growing in the lower jaw of a patient. The 37-year-old male patient complained of acute pain, but experts did not find anything unusual at first.

The condition is not something dentists get to see every day. Initially, the acute pain and swelling were misdiagnosed as an impacted tooth​, which indicates ‘hidden’ teeth that have not erupted from the gums.

However, when an ultrasound was suggested, the practitioner found a shadow of two centimeters long, in the lower right salivary gland, which was definitely not a tooth. In surgery, a giant sialolith, calcified salivary gland,​ was taken out from the patient’s jaw. Soon enough, the pain and swelling have disappeared.

The Cause is Still Unknown

Such calcified stones are one of the most usual issues linked to salivary glands as it affects 12 out of 1,000 adults every year. Still, such stones bigger than 1.5 centimeters are uncommon. 

Most of the time, salivary stones are smaller than a centimeter, but a few prior reports ​have detailed finding stones of 3.5 centimeters long. These giant obstructions normally appear in the submandibular gland, just like the image used in the article shows.

These stones are usually made of calcium phosphate or calcium carbonate,​ mixed with some salts and protein, magnesium, potassium, and ammonia.​ The exact way they develop is not clear, though. One suggestion is that the consistency of saliva changes for some cause, and becomes similar to a gel, developing a calcified mass. 

For example, there’s a hypothesis that this happens​ when the body starts to generate more saliva bicarbonate, leading the calcium phosphate into a build-up. Other experts believe that has more to do with microbes or epithelial cells getting trapped in the salivary region.

None of these concepts are exclusive of each other, and although the causes are unknown, surgery is the main method of treatment, and it is normally efficient.

The paper detailing the case was published in BMJ Case Reports.

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