Submandibular swelling: tooth or salivary stone?

Submandibular swelling is a common clinical disorder of the maxillo-facial region that may be one of the manifestation of several pathologic disorders including sialolithiasis. A 38-year-old woman experienced a recurrent painful swelling in the right submandibular region for seven years. The symptoms, not always meal-related, gradually became chronic and associated with dysphagia, odynophagia and fever. Ultrasonography of the salivary glands revealed a retained glandular structure and no ductal obstruction or dilatation, and orthopantomography showed the presence of a structure compatible with tooth, but these findings did not correlate with clinical scenario. Only CT dental scan identified the radiological image as a salivary stone. Sialolithiasis should always be considered in the diagnostic iter of painful submandibular swelling. A careful evaluation of recurrence and characteristics of signs and symptoms associated to the swelling can help in making the correct diagnosis and planning a proper therapeutic strategy.