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Description : Primary Case Presentation Of Oral Medicine

Tags : pedo,Oral Medicine,Case Study,Dental

Published on : Apr 03, 2025 | Views : 264 | Downloads : 0

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Primary Case Presentation Of Oral Medicine Faculty of DentistryCairo university Section: 2 group:
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Team members Rakan Amgad Mohamad jawad Mohanad saleem Abed alrahman Yahya Amjad Majed
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Patient Identification Gender: Age: Marital status: Occupation: Female 50 years old Housewife Married
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Patient’s chief complaint Swelling in floor of the mouth in left side.
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History of chief complaint
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Health History
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1.Medical history: Hypertension
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2.Family History There are no hereditary or infectious diseases running in the family. 3.Personal Habits Oral hygiene habits: -she brushes once per 3 days. Other habits:-teeth grinding
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Dental History
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Frequency of dental care -Irregular "brushes her teeth once every 3 days” Past dental treatment -extraction only.
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Clinical Examination
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Extra-oral Examination 1-General appraisal: Physical appearance gait and posture Extremities fingers and skin Clinically normal 2-Head and neck examination: Face is symmetrical Muscle of mastication is normal Cranial nerves (V,VII,IX,XII) is normal in response upon examination
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TMJ examination: Normal mouth opening No deviations during opening and closing No clicking sound Normal upon palpation
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3-Lymph node examination: Non-tender, non-palpable
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Intra-oral Examination 1.Oral hygiene status: bad oral hygiene 2.Examination of area of chief complaint Swelling in the floor of the mouth . In the left side related to 1st & 2nd premolars. Solitary- fluctuant –duct of submandibular salivary gland- normal color and tender on palpation. And full lesion description will be discussed later
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Dorsal surface of the tongueis normal Ventral surface of the tongueis normal Both right and left lateral surfaces of the tongue are normal
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Presence of caries in upper and lower teeth \no mobility in upper and lower. 3.Hard tissue examination:
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Lesion Description
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Diagnosis Differential Diagnosis: Hemangioma with calcification. Phlebolith. Dystrophic calcification.
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Final (definitive) diagnosis Sialolithiasis (salivary gland stones)
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Treatment plan Patient education. Aim of TTT: Milking the duct. Take lubricant. Massage. Anti-inflammatory Drug.
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Clinical Photos Pre-Treatment photo Post-Treatment photo
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Case report Presentation Submandibular sialolithiasis: A series of three case reports with review of literature. Clin Pract. 2019 Mar 20
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Introduction
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Sialolithiasis is considered to be the most common salivary gland disorder. Submandibular gland has the highest predilection for sialolithiasis with 80% occurrence rate, followed by the parotid (19%) and the sublingual (1%) glands. Males are affected twice as much as females. The clinical symptoms include swelling and pain in the affected gland. If the blockage of the duct is complete, the symptoms will be severe. Pain and swelling, may be recurrent and most pronounced during meals.
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Conventional Treatment In this paper we present three cases of large (>8mm) sialoliths of the submandibular gland, treated with transoral sialo lithotomy.
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Case #1: A 40-year-old male patient reported to our institute with a chief complaint of recurrent episodes of pain, difficulty in swallowing and swelling in the neck (Figure 1A), for the last 2-3 years. The last episode occurred 1-2 months prior to the visit and the pain has been persistent since.
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-Extraoral examination : diffuse swelling over the left submandibular region was found. -Intraoral: duct opening was inflamed and erythematous along with a diffuse swelling and discharge of pus. -Occlusal radiograph : a single ovoid radiopacity extending from 36 tooth to the distal aspect 37 tooth. The patient was under antibiotic coverage. Under local anesthesia, an intraoral incision was made in the floor of the mouth. The duct was opened and the sialolith was removed in a single piece. Sutures were placed to close the area.
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Case #2 A 26-year-old male patient reported with swelling below the tongue, which was associated with pain for 1 week (Figure 2A).
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-Clinical examination: a superficial, 5 mm hard swelling situated near the lingual frenum, which was extremely tender on palpation. no associated discharge or bleeding -Occlusal radiograph: radiopacity extending from the lateral incisor to the second premolar area.
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Case #3 A 75-year-old man visited us with a chief complaint of swelling and pain during swallowing on the right side of the face.
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Secondary Outcome Pain -Extraoral examination: revealed no facial asymmetry but firm and tender right submandibular lymph nodes. -Intraoral examination: showed mild elevation of the tongue with swelling and the stone was visible at the right Wharton’s duct opening -Occlusal radiograph: A diffused radiopacity was seen from the mesial surface of the first molar to the distal surface of the second molar in the mandibular
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Sialoliths are thought to occur as a result of deposition of mineral salts around an initial nidus consisting of salivary mucin, bacteria or desquamated epithelial cells. Etiology Factors like dehydration, and change in salivary and physical trauma to salivary duct or gland may predispose to calculus formation.
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Treatment & Detection Sialography. Sialendoscopy. Ultrasonography. Computed tomography (CT). Magnetic resonance imaging (MRI). Drawback of this procedure is that smaller calculi (>2mm) remain undetected most of the times.
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Conservative management When stones are small, moist warm heat application with the administration of sialogogues and gland massage help in flushing the stone out of the duct. Small sialoliths can be removed through the duct orifice using bimanual palpation. The infection should be treated with antibiotics.
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Due to the size of the stones and their location, the Sialoliths can be treated by open surgical approaches. These include transoral duct incision, purely external approaches, or a combination of approaches. An Endoscopy assisted trans-oral removal technique for larger or impacted stones can also be of utility. Surgical techniques
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Conclusion Sialoliths should be always considered in submandibular and facial pain particularly when it is related to mealtime. A careful history and correct imaging techniques are required to confirm the clinical diagnosis and to define the precise location of the calcification. Though advanced and more efficient methods are available occlusal radiographs are still useful in diagnosing sialoliths. Small stones can be treated conservatively but for larger stones, sialolithotomy.
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