Surgical treatment of a giant sialolith of the Wharton duct

Sialoliths are responsible for the obstruction of the secretion of saliva. They are rarely larger than 15 mm. A 48-year-old man was referred for the assessment of swelling and pain in the submandibular right region during meals. A hard mass was palpable along the right Wharton duct. A panoramic radiograph showed a single, elongated, radiopaque, 22-mm-long mass in the right submandibular region. A diagnosis of giant sialolith in the right Wharton duct was made. Removal of the giant sialolith and sialodochoplasty were performed via an intraoral approach. Six months after the intervention, salivary flow was normal. Diagnosis and management of sialoliths of a remarkable size are challenging for the clinician. Conservative methods of treatment should be considered as an alternative for surgical excision, in particular for little calculi, but for giant sialoliths, transoral sialolithotomy with sialadenectomy or sialodochoplasty still remains the mainstay of management.