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.