Case History
A 42-year-old man was referred to our hospital for the assessment of an
asymptomatic radiopaque lesion in the left submandibular region.
Panoramic radiography and computed tomography confirmed two calcified
lesions in the posterior and anterior regions of Wharton’s duct,
respectively (Figs 1 and 2). Intraoral examination by bimanual palpation
revealed a small, firm, and non-tender swelling in the anterior floor of
the mouth and a large, firm and non-tender swelling in the posterior
floor. The final diagnosis was sialolithiasis in the left Wharton’s duct
and hilo-parenchymal submandibular area.
In the operating room, the patient was placed in the dorsal decubitus
position. After transnasal intubation and proper oral preparation, the
buccal floor was infiltrated under the mucosa with a saline solution with
2% epinephrine (0.50 mg in 20 cc). An incision was made through the
mucosa of the lateral floor of the mouth, from the orifice of Wharton’s
duct to the lingual side of the retromolar region, leaving a cuff of
normal lingual mucosa to facilitate subsequent wound closure. The
anterior sialolith was pushed out of the duct and removed via manual
manipulation. Careful dissection was performed between Wharton’s duct
and the lingual nerve. External digital pressure was applied to
facilitate the isolation of the duct from the lingual nerve up to the
hilum of the SMG. After localizing the posterior stone with bimanual
palpation, the duct was incised, and the stone was removed (Fig. 3). The
duct was then irrigated with normal saline to clean the region and
remove stone debris. The incised mucosa at the floor of the mouth was
sutured back to its original position, without repairing the incision
site of Wharton’s duct.