Large Asymptomatic Submandibular Sialolith Mimicking a Premolar Tooth: A Case Report with Comprehensive Literature Review on Diagnostic Imaging and Management

Abstract

Objectives: To report a rare case of an asymptomatic giant submandibular sialolith mimicking a tooth and to emphasize the diagnostic value of cone-beam computed tomography (CBCT) in distinguishing salivary gland calculi from dental structures. Methods: A 36-year-old male undergoing CBCT imaging for dental implant planning was incidentally found to have a 21 × 11 mm radiopaque lesion in the left mandibular lingual mucosa. Imaging analysis and differential diagnosis were conducted using CBCT. Surgical excision was performed via a trans-oral sialolithotomy under local anesthesia, and the specimen was examined. Results: CBCT revealed a mixed radiolucent-radiopaque lesion with concentric layering, consistent with a giant submandibular sialolith rather than an ectopic tooth. The lesion was surgically excised and confirmed to be a hard, calcified mass resembling a tooth. The patient remained asymptomatic and experienced an uneventful recovery. Conclusion: Giant, asymptomatic submandibular sialoliths are rare, particularly those mimicking dental anatomy. CBCT played a crucial role in accurate diagnosis, enabling appropriate surgical intervention. This case highlights the importance of advanced imaging in identifying atypical presentations of salivary gland calculi. © 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.