Discussion
Due to its distinct anatomical features, the submandibular gland is believed to be more prone than other glands to the development of salivary stones.[5] Since the submandibular duct is longer and winding, there are more possibilities for saliva to become stagnant and calcify, which might result in the production of stones. Additionally, the submandibular gland releases saliva with a greater concentration of calcium and phosphate ions, which promotes the growth of stones.
Another risk factor for stone formation in the case under discussion is the patient’s history of betel nut use. Chewing betel nuts increases salivation, which has been associated to an increased prevalence of sialolithiasis and can result in the deposition of calcified material within the salivary ducts. Additionally, the patient’s habit caused submucosal fibrosis around the duct entrance, limiting mouth opening and creating difficulties for intubation and surgery.
Sialendoscopy has become a useful diagnostic and therapeutic technique for treating instances with restricted mouth opening or problematic access.[6] Sialendoscopy makes the salivary ductal system directly visible, making it easier to spot and remove stones precisely. Compared to conventional surgical methods, it provides the advantage of scarless operations and shorter hospital stays. Sialendoscopy, which reduces surgical invasiveness and preserves glandular function, would have been an option in this case to examine and remove the submandibular stone. A dormia basket can be used for extraction of tiny stones (4 mm).[7] Larger stones may necessitate additional procedures like extracorporeal shock wave lithotripsy (ESWL) or laser-assisted fragmentation.
In order to diagnose and treat submandibular sialolithiasis, it is essential to be aware of predisposing factors, such as anatomical differences and certain behaviors like eating betel nuts. Sialendoscopy is a sophisticated method that may be used in clinical practice to increase patient satisfaction, improve results, and lessen the risk of problems from more invasive procedures.