There are many hypotheses on the formation of salivary calculi, such as inflammatory theory, microbiological theory and foreign body theory.
Recently, we experienced an interesting case of a salivary calculus in the submandibular duct which was suspected to be formed with the nucleus of a fish-bone.
The patient, a 37-year-old man, visited our clinic with the chief complaint of swelling in the right submandibular region. Extraoral examination showed a well-defined, smooth swelling and induration in the right submandibular region. Intraorally, a reddened swelling is noted near the orifice of the righ Wharton's duct. Saliva could not be secreted from the right orifice and a small amount of pus was discharged. Roentgenogram disclosed a well-defined radio-opaque picture at a root apical region of lower right second premolar tooth. The routine laboratory findings were within normal limits. From these findings, clinical diagnosis was sialolithiasis of the right submandibular duct and sialoadenitis.
After the infection was controlled by administering antibiotics, the calculus in the submandibular duct was removed by incision intraorally. Two months later, total excision of the salivary gland was carried out because inflammation persisted.
Microscopic examination of the removed submandibular gland showed atrophy or disappearance of acinic cells, and inflammatory cell infiltration. Futhermore, inter-and intralobular fibrosis was observed. As a consequence histopathologic diagnosis was chronic sialoadenitis.
The removed calculus was 6×2mm in size, whitish yellow in color with a fish bone in the center. Microscopic and radiographic examination of the calculus revealed calcareous deposit around this fish bone. Therefore, it was suspected that the salivary calculus was formed around fish bone.
This is considered to be an interesting case which may suggest foreing body theory
