Sialolithiasis due to giant stones of the submandibular gland duct

Background. The sialolithiasis is more frequent in the submandibular gland (Wharton duct) than in the parotid gland because the larger mucous component of the saliva and the tortuosity of the duct. Moreover relatively uncommon is to find intraductal stones larger than 1 cm. The clinical symptoms and signs of so bigger stones are sometime atypical and include apparent dento-alveolar abscess, periodontitis, acute suppurative cellulites, etc. The complications of this kind of stones include: oral salivary fistula, cutaneous fistula, salivary colic, sialoadenithis. Study design. The Authors report two cases of sialolithiasis due to giant stones (length 3,5 and 2,5 cm; weight 12 and 16 gr) in the submandibular gland duct. Both the patients were men of 56 and 64 years old. The stones were located in the duct and created a sialo-oral fistola due to ulceration of the duct. The diagnostic study was completed by Rx examination and MR evaluation to avoid the presence of parenchimal involvement. Then intraoral approach was choosed to remove the stones from the ducts. Surgery was performed under general anaesthesia in the first case and under local anaesthesia in the second one. Both the stones were whole removed. Results. The follow up at one year was satisfied for both the patients. Conclusions. Giant stones of the Warthon’s duct are infrequent. They are due to the progressive growth of the calculus in absence of symptoms and complications for a long period of time. Intraoral surgical approach permits to remove stones of this size in a smooth way. Both, general or local anaesthesia, can be used.