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.