Sir, salivary lithiasis is a condition characterised by the obstruction of the salivary gland or its excretory duct by a calculus or sialolith associated with: swelling, pain, and infection of affected gland, resulting in salivary ectasia and even provoking the subsequent dilatation of the salivary gland. They are classified as 'giant' in any case where the dimension exceeds 15 mm. Giant sialoliths in the submandibular gland is a rare disorder.1,2

A 62-year-old man presented with a painful swelling in the left submandibular region. The patient had noticed swelling in the region about 4 years earlier, but did not seek professional medical attention at that time. The patient reported that the lesion had gradually increased in size and had recently become painful. Intraoral bimanual palpation revealed a hard and tender mass. Extra oral examination revealed that the swelling was localised to the left submandibular region which was tender on palpation. Intraoral examination revealed a slight elevation of the left floor of the mouth, with absent salivary flow from the Wharton's duct. A radiograph revealed a large calcified mass extending from submandibular gland to the Wharton duct (Fig 1).

Figure 1
figure 1

Sialolith involving the submandibular gland

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Submandibular gland resection was performed under general anesthesia. Intraoperatively, it was found that the body of the gland was totally filled with a giant sialolith and the gland parenchyma was atrophic. Pathologic examination confirmed the diagnosis of chronic sialadenitis and a giant sialolith, 30 × 15 mm in size (Fig 2). The postoperative period was uneventful and the patient recovered without any complication. Different treatment options may be selected according to the size and location of the sialolith. Small stones often may be 'milked out' through the ductal orifice using bimanual palpation. If the stone is too large or located in the proximal duct, surgical removal of the stone or gland may be required.2,3

Figure 2
figure 2

The removed gland and sialolith

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