Unusual pathology of unusual location: a case of a palatal sialolith.

To cite: Gupta DS, Bumb SS, Jurel SK, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-206830 DESCRIPTION Sialolithiasis is a pathological disease involving the major salivary glands and their ducts. More than 80% of sialoliths occur in the submandibular gland, 4–10% in the parotid gland and 17% in minor salivary glands. Among the minor salivary glands, the most common locations are upper lip (49.2%), inner aspect of cheeks (37.3%), lower lip (5.5%), vestibule (4.7%), palate and tongue (1.6%). 2 However, the presence of a sialolith in palatal minor salivary glands is extremely rare. Only two to three cases have been reported in the literature during 1970–1980. A 26-year-old man presented to the department with difficulty in swallowing and pain in the throat region of 1 month duration. On palpation, presence of a firm swelling on the mucosal surface of the soft palate was discovered. The patient also had limited tongue movement as the mass pressed against it. Clinical examination revealed the presence of a firm swelling in the left posterolateral area of the soft palate (figure 1). Occlusal and lateral oblique radiographs were taken and appeared normal. A differential diagnosis of tonsilolith or peritonsillar abscess (Quinsy) was performed. The surgical site was prepared with antiseptic solution and transoral sialolithotomy was performed. The sialolith was oval and hard in consistency measuring approximately 0.5 cm in diameter and 1.7 cm in length (figure 2). Histopathological examination of the specimen revealed a calcified mass exhibiting a lamellated appearance with alternating eosinophilic and basophilic bands, with a more homogeneous central part, indicative of a sialolith (figure 3). Regular follow-up was maintained and the surgical site healed properly without any postoperative recurrence or complications (figure 4).