A patient with massive salivary retention in the parapharyngeal space occurring after sialolithotomy

We encountered a patient in whom it was difficult to discriminate between a ranula and salivary retention in the parapharyngeal space after sialolithotomy. The patient was a 19-year-old woman who visited our hospital because of swelling of the left submandibular region. The patient had noticed swelling and pain of the left submandibular region 7 months earlier, visited an otorhinolaryngology clinic, and was given a diagnosis of a salivary stone in the left Wharton’s duct. Excision of the sialolith through an intraoral approach was attempted, but it could not be removed. Swelling of the region increased after several days, and the patient was instructed to press the submandibular region by a otorhinolaryngologist. Swelling and pain of the region repeatedly occurred for 6 months thereafter. The patient consulted a dental office about the swelling of the left submandibular region, and she was referred to our department. She was given a diagnosis of massive salivary retention and a salivary stone in the submandibular region, and imaging was performed. The massive salivary retention extended from the submandibular to parapharyngeal space. When the sublingual gland was removed, and fenestration was performed with the patient under general anesthesia, a large volume of fluid flowed out of the salivary retention space, with which swelling of the submandibular region markedly regressed. As of 1 year 6 months after exteriorization and compression, fluid retention extending to the parapharyngeal space has disappeared, and no recurrence has occurred. The current condition is favorable without any clinical signs or symptoms of sialolithiasis.