Management Of Giant Intraglandular Submandibular Sialolith With Neck Fistula

that is made of foreign bodies in the gland. They can be desquamated epithelial cells, degradation proteins of bacteria or the bacteria itself. Calcified structures include calcium phosphate, calcium carbonate and soluble salts present in the stone in addition to organic elements and water (4). Zakaria (5) presented a case of a 70 years old male patient with a 20 years history of stone enlargement manifested at the floor of the mouth as fibrosis and erosion. Management was done via transoral surgical sialolithectomy. Bedner (6) presented 14 male cases with ages ranging from 25 to 61 years old. Stones mean size was 30 x 15 mm. He reported the use of minimally invasive transoral sialolithotomy for Warthon’s ducts’ stones. The case reported by Akin and Esmer (7) showed a giant sialolith located completely inside the submandibular gland that finally led to erosion of floor of the mouth. On the other hand, Asfar et al. (8) reported three cases of giant submandibular intraglandular stones. One of them had eroded through the floor of the buccal cavity forming an orocervical fistula and pus discharge. It was preceded by swelling at the submandibular area and side of the neck. The other two cases led to fibrosis and erosion of the mouth floor. Management of all the previous intraglandular calculi was via extraoral complete surgical excision by gentle extirpation of gland and stone. The clinical picture of frequent swelling and discharging fistula at side of the neck suggests the following differential diagnosis to be considered; Epidermoid cyst, Granulomatous diseases such TB and Sarcoid, Lipoma, Metastatic carcinoma, Salivary glands tumers (submandibular or tail of parotid gland), Cervical lymphoepithelial cyst (Branchial cyst), Cat scratch disease, Lymphoid hyperplasia (reactive lymphodenopathy) (9). The purpose of this article is to describe the condition of a 70 years old Saudi male patient presented with an unusual giant submandibular ABSTRACT