CASE REPORTS J Oral Maxillofac Surg 65:128-130, 2007 Giant Sialolith: Case Report and Review of the Literature Constantino Ledesma-Montes, DDS, MSc, PhD,* Maricela Garcés-Ortíz, DDS, MSc, PhD,† Juan Francisco Salcido-García, DDS, MSc,‡ Florentino Hernández-Flores, DDS, MSc,§ and Juan Carlos Hernández-Guerrero, DDS, MSc, PhD Sialolithiasis is the most common disease of the sali- vary glands. Its estimated frequency is 1.2% in the adult population, with a slight male predominance. 1 More than 80% of the salivary gland calculi appear in the submandibular gland, but they can also be located in the glandular parenchyma and more frequently in the excretory duct. Commonly, sialoliths measure from 1 mm to less than 1 cm. They rarely measure more than 1.5 cm. Giant sialoliths are rare; a search of the literature found that 16 cases measuring 3.5 cm or more, in- cluding the case reported herein, have been pub- lished (Table 1). 2-16 The aim of this article is to present a case of a giant sialolith and to communicate the results of a search of the literature on giant sialoliths (3.5 cm or larger). Report of a Case A 34-year-old Mexican mestizo man was seen in the Out- patient Clinic of the División de Estudios de Posgrado e Investigación (Facultad de Odontología, Universidad Nacio- nal Autónoma de México). His main complaint was a painful tumor located in the right side of the floor of the mouth of 12 years’ duration. No other abnormal data were found in his clinical history. Intraoral examination revealed the pres- ence of a soft, edematous, tender swelling with no color changes of the surrounding mucosa, painful with pressure, with a whitish, nonfetid, insipid material obtained under slight pressure (Fig 1). A long radiopaque mineralized body located within the Wharton’s duct was seen with occlusal radiograph (Fig 2). Clinical history revealed that the patient was in good health; no other signs, symptoms, or abnormal- ities were found. Under regional anesthesia the sialolith was carefully dissected and a cylindrical, hard, yellow, 3.6 cm- long specimen was obtained. The sialolith weighed 12 g, and the surface showed multiple nodules of different size, some of them coalescent combined with few wrinkled zones and smooth areas (Fig 3). The submandibular salivary gland was not resected. Three years after the surgical excision of the sialolith, the patient has no signs or symptoms of sialadenitis or xerosto- mia and he has a normal, undisturbed salivary gland flow. Discussion Sialolithiasis is an uncommon disease. Males are more frequently affected than females and children are rarely involved. 14 Submandibular salivary glands are more commonly affected than parotids. The sub- lingual or minor salivary glands are involved in only 1% to 2% of the cases. This disease can occur at any age, but it appears more frequently in patients in the third to sixth decades of life. Sialolithiasis in children is considered rare. 17-19 Giant sialoliths are a rare finding in clinical oral pathology, as can be seen in Table 1; their sizes vary from approximately 3.5 cm to 7 cm, and every one of them occurred in male patients. All the cases except ours (34-year-old male) were patients older than 42 years. With the exception of 1 case, all the giant sialoliths were located in the submandibular gland (94.4%) and only an isolated case was found within the Stensen’s duct of the parotid salivary gland. 2-14 Other cases of large calculi cited by Zakaria 15 and Brusati and Fiamminghi 16 are known by their weight only: Thorowgood (93 g), Tawse (52 g), Powder (44 g), and Haydar (20 g). Weight of the giant sialo- Received from the División de Estudios de Posgrado e Investi- gación, Facultad de Odontología, UNAM, Circuito Institutos, México. *Professor, Clinical Oral Pathology Laboratory. †Professor, Clinical Oral Pathology Laboratory. ‡Professor, Oral Clinical Diagnosis Service. §Professor, Oral and Maxillofacial Surgery Clinic. Professor. Address correspondence and reprint requests to Dr Ledesma- Montes: División de Estudios de Posgrado e Investigación, Facultad de Odontología, UNAM, Circuito Institutos, Col. Copilco-CU, México, D.F. 04510; e-mail: cotita@avantel.net © 2007 American Association of Oral and Maxillofacial Surgeons 0278-2391/07/6501-0024$32.00/0 doi:10.1016/j.joms.2005.10.053 128