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A 35-year-old male was referred to the Department of Oral and Maxillofacial Surgery with a chief complaint of pain and swelling in the floor of the mouth on the left side. He also complained of thick fluid discharge from the floor of the mouth [Table/Fig-1]. History dated back to 4-5yrs when the patient first noticed the swelling. Since two months, the patient experienced an exacerbation of the symptoms along with associated swelling in the left submandibular region during meal times. [Table/Fig-1]: Intraoral photograph showing swelling in the floor of the mouth. Extraorally there was no swelling or asymmetry at the time of examination. Intraorally, bimanual palpation revealed inflammation and a hard stone like structure along the left Wharton’s duct in the premolar region. There was thick turbid fluid discharge from the duct orifice. The left submandibular gland was tender on palpation. Occlusal radiograph revealed a large radiopacity located in the region of left Wharton’s duct [Table/Fig-2]. A diagnosis of sialolithiasis of the left Wharton’s duct was achieved. Under local anaesthesia, transoralsialolithotomy was performed via intraoral approach [Table/Fig-3]. [Table/Fig-2]: Mandibular occlusal view X-ray showing a large radiopaque mass in the left floor of the mouth. [Table/Fig-3]: Sialolith from left Wharton’s duct explored out and removed. Traction suture was placed behind the sialolith to prevent its posterior displacement. An antero-posterior incision was made in the mucosa parallel to the duct extending from the canine to the first molar region on the left side. After reflection of tissue, the large stone became visible and blunt dissection was done around it. The giant sialolith was removed and the surgical wound was thoroughly irrigated and checked for any satellite stones. Sutures were placed at the level of mucosa and no attempt was made to suture the duct lining [Table/Fig-4]. [Table/Fig-4]: Surgical wound sutured with interrupted 3-0 silk. The obtained sialolith was a hard, oval, rough and yellowish mass. It measured 22x16mm and weighed 7gms. The patient was followed up for six months and was asymptomatic [Table/Fig-5]. [Table/Fig-5]: Excised giant sialolith, measuring 22x16mm.
salivary stone, salivary gland pathology, R, Medicine, sialolithotomy, swelling on floor of mouth
salivary stone, salivary gland pathology, R, Medicine, sialolithotomy, swelling on floor of mouth
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