Giant sialolith after submandibulectomy

Abstract

A 59-year-old Patient presented with cerivical lymphnode and a submandibular swelling on the right side of unknown cause that was not responsive to antibiotic treatment. 16 years ago a submandibulectomy was performed on the right side, nevertheless submandibular swellings had occurred repeatedly. Clinical examination showed a right-sided cervical swelling in the submandibular region. The floor of the mouth was indurated and pus could be squeezed out of the wharton's duct. A computed tomography of the neck revealed a calcified structure of 3.8 x 1.3 cm located anterior of the former submandibular region (A). Therapeutically the residual Wharton duct containing the sialolith was removed (B). Giant sialoliths after submandibulectomy are extremely rare. If parts of the Wharton duct remain, sialolithiasis may occur spontaneously or become evident after growth due to further calcification. The treatment of choice consists of the excision of the residual duct with the sialolith and any remaining gland tissue.

Keywords

• giant sialolith
• submandibulectomy
• wharton duct