Article / Clinical Case Reports Artigo / Relato de Caso Clínico 37 Copyright © 2012 Autopsy and Case Reports – This is an Open Access article distributed of terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any médium provided article is properly cited. a Department of Dentistry - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil. b Department of Surgery - Prosthesis and Maxillofacial Trauma - Faculdade de Odontologia - Universidade de São Paulo, São Paulo/SP - Brazil. Autopsy and Case Reports 2012; 2(2): 37-41 3 7 Intra-oral surgical access for the treatment of bilateral submandibular sialolithiasis: case report Ricardo Martins a , Carlos Augusto Ferreira Alves a , Edson Martins de Oliveira Junior a , Fernando Melhem Elias a,b , Antônio Carlos de Campos a,b Martins R, Alves CAF, Oliveira Junior EM, Elias FM, Campos AC. Intra-oral surgical access for the treatment of bilateral submandibular sialolithiasis: case report. Autopsy Case Rep [Internet]. 2012;2(2):37-41. http://dx.doi.org/10.4322/ acr.2012.015 ABSTRACT Sialolithiasis is a disease that affects the salivary glands. It is characterized by the presence of calcifed structures within the duct system or within the glandular parenchyma. Those calculi, or sialoliths, can obstruct normal salivary fow, potentially leading to infectious sialadenitis, with pain, local swelling, and purulent discharge. Treatment typically consists of the surgical removal of the calculus, often in conjunction with sialoadenectomy. The authors report an atypical case of bilateral submandibular gland sialolithiasis treated conservatively, using intra-oral access to remove the calculi. Keywords: Salivary gland calculi; Submandibular gland; Surgical procedures, Operative. INTRODUCTION Salivary duct calculi, also known as sialoliths, constitute the leading cause of salivary gland obstruction. Sialoliths can occur in the glandular parenchyma or in the salivary duct system, obstructing the fow of saliva and causing episodes of local pain and edema, especially during meals. Sialoliths can be single or multiple, can be unilateral or bilateral, and can vary in shape and size. They affect approximately 1.2% of the population, and the most commonly affected site is the submandibular gland (involved in approximately 83% of cases), followed by the parotid gland (in 10% of cases), and the sublingual gland (in 3% of cases). 1 Although some etiological aspects remain unknown, anatomical and biochemical components are certainly involved, 2 leading to calcium salt deposition around accumulations of organic debris in the lumen of the duct or glandular parenchyma. This organic debris consists of condensed mucus, bacteria, desquamated epithelial cells, or foreign bodies. 3,4 The salivary fow obstruction caused by sialoliths can lead to salivary gland infection, which is known as sialolithiasis. As previously mentioned, sialolithiasis is most commonly seen in the submandibular glands, which is due to the anatomical features of these glands—including the fact that the trajectory of the duct is long and tortuous, running counter to the force of gravity— and to the fact that the secretion produced by the glands is predominantly mucous. 5 Although the diagnosis of sialolithiasis is primarily based on clinical fndings, diagnostic