Wharton Kanalı Megaliti: Literatür Derlemesi ve Bir Olgu Sunumu

Yıl 2025, Cilt: 42 Sayı: 1, 36 - 42, 03.01.2025

Sercan Küçükkurt

Öz

Tükürük bezlerini etkileyen en yaygın hastalık olan siyalolitiyazis, kalsifiye oluşumların kanalları veya bezleri tıkamasıyla ortaya çıkar. Tipik olarak, sialolit olarak bilinen bu oluşumlar 5 ila 10 mm arasındadır; ancak 15 mm’yi aşanlar megalit olarak sınıflandırılır. Sialolitler herhangi bir tükürük bezi kanalında gelişebilirken, en sık olarak submandibular bezlerde, özellikle de submandibular bezin Wharton kanal ağzında ortaya çıkar. Salgı sistemi içindeki kalsifiye organik materyalden oluşan bu taşlar ağrıya, şişmeye ve tükürük akışında bozulmalara yol açabilir. Tükürük bezlerindeki akut ve
kronik enfeksiyonlara birincil katkıda bulunan kronik siyalolitiyazis, taş oluşumuyla yakından ilişkilidir. Kesin nedeni tam olarak bilinmemekle birlikte, kronik siyaladenit ve kısmi tıkanıklıkla bağlantılıdır. Aksine, megalitler son derece nadirdir ve erkek hastalarda daha sık görülme eğilimindedir. Bu makalede, sol submandibular bezin kanal ağzında tespit edilen ve cerrahi müdahale ile tedavi edilen 19 mm uzunluğunda megalit içeren bir olgu sunulmuştur. Ayrıca, konuyla ilgili kapsamlı bir literatür taraması yapılmıştır.

Anahtar Kelimeler

Tükürük Bezi Taşları, Sialolitiazis, Submandibuler Bez, Wharton Kanalı

Megalith of the Wharton's Duct: Review of Literature and a Case Report

Öz

ABSTRACT
Sialolithiasis, the most common disorder affecting salivary glands, occurs when calcified formations obstruct the ducts or glands. Typically, these formations, known as sialoliths, measure between 5 and 10 mm; however, those exceeding 15 mm are classified as megaliths. While sialoliths commonly manifest in the submandibular glands, they can develop in any salivary gland duct, with
the Wharton’s duct of the submandibular gland being a frequent site. These stones, formed from calcified organic material within the secretory system, can lead to pain, swelling, and disruptions in saliva flow. Chronic sialolithiasis, the primary contributor to acute and chronic infections in salivary glands, is closely associated with stone formation. The precise cause remains unclear, yet
it is linked to chronic sialadenitis and partial obstruction. On the contrary, megaliths are exceptionally rare and tend to occur more frequently in male patients. The present article presents a case involving a 19 mm long megalith detected at the duct mouth of the left submandibular gland, which was treated through surgical intervention. Additionally, a comprehensive literature review on this
specific topic was conducted.

Anahtar Kelimeler

Salivary Gland Calculi, Sialolithiasis, Wharton

Kaynakça

• Wang YH, Chen YT, Chiu YW, Yu HC, Chang YC. Time trends in the prevalence of diagnosed sialolithiasis from Taiwanese nationwide health insurance dental dataset. J Dent Sci 2019;14:365-9.
• Omezli MM, Ayranci F, Sadik E, Polat ME. Case report of giant sialolith (megalith) of the Wharton’s duct. Niger J Clin Pract 2016;19:414-7.
• Zenk J, Koch M, Klintworth N, Konig B, Konz K, Gillespie MB, et al. Sialendoscopy in the diagnosis and treatment of sialolithiasis: a study on more than 1000 patients. Otolaryngol Head Neck Surg 2012;147:858-63.
• Gupta A, Rattan D, Gupta R. Giant sialoliths of submandibular gland duct: Report of two cases with unusual shape. Contemp Clin Dent 2013;4:78-80.
• Anicin A, Urbancic J. Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis. Radiol Oncol 2021;55:284-91.
• Chaidas K, Lialiaris S, Pavlou AV, Katotomichelakis M, Papouliakos S. A Rare Case of a Giant Sialolith Within Wharton’s Duct. Cureus 2023;15:e35969.
• Brooks JK, Macauley MR, Price JB. Concurrent giant sialoliths within the submandibular gland parenchyma and distal segment of Wharton’s duct: Novel case report. Gerodontology 2021;38:437-40.
• Rai M, Burman R. Giant submandibular sialolith of remarkable size in the comma area of Wharton’s duct: a case report. J Oral Maxillofac Surg 2009;67:1329-32.
• Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman EC, Brand HS. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J 2014;217:E23.
• Pachisia S, Mandal G, Sahu S, Ghosh S. Submandibular sialolithiasis: A series of three case reports with review of literature. Clin Pract 2019;9:1119.
• Mao JS, Lee YC, Chi JC, Yi WL, Tsou YA, Lin CD, et al. Longterm rare giant sialolithiasis for 30 years: A case report and review of literature. World J Clin Cases 2023;11:5382-90.
• Abraham ZS, Mathias M, Kahinga AA. Unusual giant calculus of the submandibular duct: Case report and literature review. Int J Surg Case Rep 2021;84:106139.
• Oteri G, Procopio RM, Cicciu M. Giant Salivary Gland Calculi (GSGC): Report Of Two Cases. Open Dent J 2011;5:90-5.
• Mohsin SF, Riyaz MA, Alqazlan AA. Detection and Management of Giant Submandibular Gland Sialolith. Pak J Med Sci 2022;38:2030-3.
• Singh AK, Yeola M, Raghuvanshi P, Singh N. Giant Wharton’s duct sialolithiasis causing sialo-oral fistula: a rare case report with literature review. J Family Med Prim Care 2020;9:5793-5.
• Iqbal A, Gupta AK, Natu SS, Gupta AK. Unusually large sialolith of Wharton’s duct. Ann Maxillofac Surg 2012;2:70-3.
• Babu LK, Jain MK. Giant Submandibular Sialolith: A Case Report and Review of Literature. Int J Head Neck Surg 2011;2:154-7.
• Koch M, Mantsopoulos K, Muller S, Sievert M, Iro H. Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature. J Clin Med 2021;11:231.
• Parkar MI, Vora MM, Bhanushali DH. A Large Sialolith Perforating the Wharton’s Duct: Review of Literature and a Case Report. J Maxillofac Oral Surg 2012;11:477-82.
• Thong HK, Othman IA, Ramli R, Sabir Husin Athar PP. Painless Giant Submandibular Gland Sialolith: A Case Report. Cureus 2021;13:e19429.
• Rodrigues GHC, Carvalho VJG, Alves FA, Domaneschi C. Giant submandibular sialolith conservatively treated. Autops Case Rep 2017;7:9-11.
• Oliveira Tde P, Oliveira IN, Pinheiro EC, Gomes RC, Mainenti P. Giant sialolith of submandibular gland duct treated by excision and ductal repair: a case report. Braz J Otorhinolaryngol 2016;82:112-5.
• Ashindoitiang JA, Nwagbara VIC, Ugbem T, Odoks RK, Udo Solomon A, Akpan SO, et al. Huge sialolith of the submandibular gland: a case report and review of literature. J Int Med Res 2023;51:3000605221148443.
• Arslan S, Vuralkan E, Cobanoglu B, Arslan A, Ural A. Giant sialolith of submandibular gland: report of a casedagger. J Surg Case Rep 2015;2015.
• Goncalves M, Schapher M, Iro H, Wuest W, Mantsopoulos K, Koch M. Value of Sonography in the Diagnosis of Sialolithiasis: Comparison With the Reference Standard of Direct Stone Identification. J Ultrasound Med 2017;36:2227-35.
• Corvino A, Caruso M, Varelli C, Di Gennaro F, Pignata S, Corvino F, et al. Diagnostic imaging of parotid gland oncocytoma: a pictorial review with emphasis on ultrasound assessment. J Ultrasound 2021;24:241-7.
• Rzymska-Grala I, Stopa Z, Grala B, Golebiowski M, Wanyura H, Zuchowska A, et al. Salivary gland calculi - contemporary methods of imaging. Pol J Radiol 2010;75:25-37.
• Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg 2001;127:66-8.
• Harrison JD. Causes, natural history, and incidence of salivary stones and obstructions. Otolaryngol Clin North Am 2009;42:927-47.
• Teymoortash A, Wollstein AC, Lippert BM, Peldszus R, Werner JA. Bacteria and pathogenesis of human salivary calculus. Acta Otolaryngol 2002;122:210-4.
• Brady JM, McKinney L, Stanback JS. Scanning electron microscopy of submandibular sialoliths: a preliminary report. Dentomaxillofac Radiol 1989;18:42-4. Akinyamoju AO, Adisa AO. Non-surgical extraction of a massive sialolith in the Wharton’s duct of a Nigerian. Afr J Med Med Sci 2015;44:177-80.
• Badash I, Raskin J, Pei M, Soldatova L, Rassekh C. Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options. Cureus 2022;14:e28147. Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L. Modern management of obstructive salivary diseases. Acta Otorhinolaryngol Ital 2007;27:161-72.
• Faizal B, Gangadharan S, Thankappan K. Comparison between Sialendoscopy and Conventional Methods in the Treatment of Sialolithiasis. Malays J Med Sci 2017;24:94-100. Boffano P, Gallesio C. Surgical treatment of a giant sialolith of the Wharton duct. J Craniofac Surg 2010;21:134-5.
• Springborg LK, Moller MN. Submandibular gland excision: longterm clinical outcome in 139 patients operated in a single institution. Eur Arch Otorhinolaryngol 2013;270:1441-6. Escudier MP, Brown JE, Drage NA, McGurk M. Extracorporeal shockwave lithotripsy in the management of salivary calculi. Br J Surg 2003;90:482-5.
• Capaccio P, Ottaviani F, Manzo R, Schindler A, Cesana B. Extracorporeal lithotripsy for salivary calculi: a long-term clinical experience. Laryngoscope 2004;114:1069-73.
• Zenk J, Bozzato A, Winter M, Gottwald F, Iro H. Extracorporeal shock wave lithotripsy of submandibular stones: evaluation after 10 years. Ann Otol Rhinol Laryngol 2004;113:378-83.
• Rauso R, Gherardini G, Biondi P, Tartaro G, Colella G. A case of a giant submandibular gland calculus perforating the floor of the mouth. Ear Nose Throat J 2012;91:E25-7.
• Shahoon H, Farhadi S, Hamedi R. Giant sialoliths of Wharton duct: Report of two rare cases and review of literature. Dent Res J (Isfahan) 2015;12:494-7.
• Lim EH, Nadarajah S, Mohamad I. Giant Submandibular Calculus Eroding Oral Cavity Mucosa. Oman Med J 2017;32:432-5.
• Sakthivel P, Yogal R, Singh S, Sharma P, Singh CA. Giant Sialolith of Submandibular Duct. JNMA J Nepal Med Assoc 2017;56:262-4.
• Bodner L. Giant salivary gland calculi: diagnostic imaging and surgical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:320-3.
• Fowell C, MacBean A. Giant salivary calculi of the submandibular gland. J Surg Case Rep 2012;2012:6.
• Iwai T, Izumi T, Ohya T, Oguri S, Tohnai I. Giant Sialolith of the Submandibular Gland. J Clin Diagn Res 2017;11:ZJ03-ZJ4.
• Pandarakalam C, Goebel WM, Seyer B. Chronic sclerosing sialadenitis or Kuttner’s tumor associated with a giant sialolith: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e38-40.
• Mathew J, Pothanikat JJK, Vinod Kumar RB, Padikadan NO, Arakkal NJ. Extremely Large Submandibular Sialolith Removal – A Case Report. Ann Maxillofac Surg 2022;12:237-9.
• Ledesma-Montes C, Garces-Ortiz M, Salcido-Garcia JF, Hernandez-Flores F, Hernandez-Guerrero JC. Giant sialolith: case report and review of the literature. J Oral Maxillofac Surg 2007;65:128-30.
• Chan EK, Patel ND. Giant calculus of the submandibular salivary duct. Ear Nose Throat J 2006;85:306, 8.
• El Gehani R, Krishnan B, Shehoumi MI. Submandibular giant sialoliths: report of two cases and review of the literature. Ear Nose Throat J 2010;89:E1-4.
• Emir H, Kaptan ZK, Uzunkulaoglu H, Dogan S. A rare case of asymptomatic bilateral submandibular gland sialolithiasis: a giant, fistulized calculus on the right and multiple calculi on the left. Ear Nose Throat J 2010;89:502-4.
• Goh LC, Chitra BK, Shaariyah MM, Ng WS. Transcervical approach to the removal of a deep-seated giant submandibular calculus and the submandibular gland. BMJ Case Rep 2016;2016.
• Raveenthiran V, Hayavadana Rao PV. Giant calculus in the submandibular salivary duct: report of the first prepubertal patient. Pediatr Surg Int 2004;20:163-4.
• Krishnan B, Gehani RE, Shehumi MI. Submandibular giant sialoliths-2 case reports and review of the literature. Indian J Otolaryngol Head Neck Surg 2009;61:55-8.
• Alkurt MT, Peker I. Unusually large submandibular sialoliths: report of two cases. Eur J Dent 2009;3:135-9.
• Bhullar RS, Dhawan A, Bhullar K, Malhotra S. Giant submandibular gland duct sialolith mimicking an impacted canine tooth. Natl J Maxillofac Surg 2015;6:89-92. Cottrell D, Courtney M, Bhatia I, Gallagher G, Sundararajan D. Intraoral removal of a giant submandibular sialolith obstructing Wharton’s duct: a case report. J Mass Dent Soc 2011;60:14-6.
• Demircan S, Isler S. Case reports: Giant sialolith. Br Dent J 2015;219:48.
• Yildirim A. A case of giant sialolith of the submandibular salivary gland. Ear Nose Throat J 2004;83:360-1.
• Al-Hussona AA. Unusually large submandibular gland stone. Kulak Burun Bogaz Ihtis Derg 2015;25:56-8.
• Kumar ND, Sherubin JE, Bagavathy K. Sialolithiasis: An Unusually Large Salivary Stone. J Maxillofac Oral Surg 2021;20:227-9. Shetty BN, Sharma P. Unusual case of a projecting intraoral giant sialolith. Indian J Surg 2010;72:155-7.
• Biddle RJ, Arora S. Giant Sialolith of the Submandibular Salivary Gland. Radiol Case Rep 2008;3:101.
• Gadve V, Mohite A, Bang K, Shenoi SR. Unusual giant sialolith of Wharton’s duct. Indian J Dent 2016;7:162-4.
• Soares EC, Costa FW, Pessoa RM, Bezerra TP. Giant salivary calculus of the submandibular gland. Otolaryngol Head Neck Surg 2009;140:128-9.
• Rivera-Serrano CM, Schaitkin BM. Bilateral giant submandibular sialoliths and the role for salivary endoscopy. Am J Otolaryngol 2011;32:85-7.
• Ungari C, Cicconetti A, Cerbelli E, Sulpasso A, Filiaci F. Giant submandibular sialolith: a case report. Clin Ter 2022;173:217-21.
• Graziani F, Vano M, Cei S, Tartaro G, Mario G. Unusual asymptomatic giant sialolith of the submandibular gland: a clinical report. J Craniofac Surg 2006;17:549-52.
• Arunkumar KV, Garg N, Kumar V. Oversized submandibular gland sialolith: a report of two cases. J Maxillofac Oral Surg 2015;14:116-9.
• Nilesh K, Kothi HS, Vande A, Reddy S. Giant sialolith mimicking an impacted tooth. BMJ Case Rep 2020; 13: e233434.
• Ben-Shoshan M, Lacroix Y. A giant sialolith in a 16-year-old boy presenting to the emergency room. Arch Dis Child 2014;99:883.