Unusually large sialolith of Wharton's duct
A 55-year-old, edentulous male presented to the department of Prosthodontics of Career post graduate Institute of Dental Sciences and Hospital Lucknow for fabrication of complete denture. During intra oral examination of the patient a firm mass in the canine premolar region of the left side of the floor of the mouth was noticed. The patient was unaware of the swelling and noticed it when it was pointed out by the prosthodontist. The patient was referred to department of Oral and Maxillofacial surgery for the management of this swelling. Oral examination was unremarkable.\nIntraoral bimanual palpation revealed the presence of a hard swelling, approximately 3 cm in length, in the anterior oral floor of mouth []. The entity was not attached to the underlying structures. The oral mucosa was normal in texture and without erythema. A dental occlusal radiograph [] and orthopantomogram [] confirmed that the swelling was radio-opaque structure in the floor of the mouth. In occlusal radiograph the calcified structure was mimicking a canine tooth but the radio opacity was homogenous. In panoramic radiograph lower border of sialolith was showing two extension passing vertically downwards probably into ducts of Rivinus. On the basis of clinical and radiological findings, a diagnosis of left submandibular duct sialolith was made. As it was a large sialolith (megalith), we elected to remove the sialolith surgically under local anaesthesia []. Upward and medial pressure was applied at the submandibular area, and an intra-oral incision was placed directly over the sialolith to expose it. After sufficiently mobilizing the sialolith, it was delivered through the ductal opening taking care that the downward extensions from the sialolith do not break. After successful removal of the sialolith a 2.0-cm-wide opening remained which was marsupialized intraorally with No. 4 vicryl sutures placed along its margins. Postoperatively, the intraoral opening was regularly irrigated, and after 45 days, the ductal opening reduced to 3 mm. Scientific importance of the patient's disease has been explained to him and he consented for publication of his case. The sialolith recovered measured 35 mm in length and 30 mm circumference [].\nNo postoperative complications were noted. Histopathological validation was performed and during decalcification process the lesion showed concentric lamellas. On the basis of clinical, radiographical and histopathological findings, the diagnosis was confirmed as submandibular megasialolith.