Submaxilectomía en caliente y exéresis de sialolitos en absceso submaxilar de origen litiásico

Introduction: Sialolithiasis is one of the most frequent pathologies of the salivary glands; it usually affects the major salivary glands, mainly to the submaxillary gland (80-90%), and to a lesser extent to the parotid gland (5-20%); rarely affects the sublingual gland. It consists of the mechanical obstruction of the salivary gland or its excretory duct by the formation of stones or sialoliths in the parenchyma of the same and secondarily gland infection. Materials and methods: Case 1: A 36-year-old male patient with a history of right submaxilectomy and exeresis of lithiasis in the right Wharton duct10 years previously, who went to the emergency department for pain and inflammation in the right submaxillary region. The physical examination shows an increase in volume with local signs of infection. In cervical computed tomography (CT), lithiasis was found in the right sublingual region of 9 mm, probably in the Wharton duct and afterwards, a 2.6 cm collection was observed. In blood tests, he had leukocytosis with neutrophilia. Admission was decided for intravenous (IV) antibiotics treatment and collection drainage that was initially done transoral. In view of the poor evolution CT control is requested, where the persistence and worsening of the collection is objectified, so surgical intervention is decided. Case2: A 76-year-old male patient with a history of recurrent submaxilitis, who went to the emergency room for pain and right submaxillary volume increase, in treatment with amoxicillin - clavulanic acid orally for 1 week, with poor clinical evolution. Physical examination shows an increase in volume and consistency of the right submaxillary gland, pain on palpation and purulent discharge through Wharton's duct. In cervical CT, multiple sialolithiasis and intraparenchymal collection of 11x9x5mm were observed. He is admitted for IV antibiotic treatment. Due to a poor clinical evolution, a control CT was performed, observing an increase in glandular size greater than in the previous study, dilation of the Wharton duct of 4mm secondary to 2 stones of approximately 8mm each, and persistence of collection, so surgical treatment was decided. Results: In both cases, IV antibiotic treatment was started. In the first one, transoral puncture was carried out, draining 4 ml of purulent material. However, in view of the poor clinical course and the worsening of the radiological signs, surgical treatment was decided with cervicotomy, drainage of the abscess and exeresis of lithiasis of approximately 1 cm in length. In the second patient, in the absence of clinical improvement and persistence of abscess in control CT, right submaxillectomy and exeresis of the sialolith were performed. Conclusion: Sialolithiasis is the most frequent benign pathology of the major salivary glands and the main reason for exeresis of the submaxillary gland; its most common presentation is with symptoms of salivary colic and chronic sialadenitis. Occasionally it manifests as acute sialadenitis and / or glandular abscesses.