Can megalith of wharton’s duct be treated in outpatient department? a rare case

Introduction: Sialolithiasis is a common salivary gland disease most commonly occurring in submandibular gland. Calculi more than15 mm in size are considered giant or megalith. This case report describes a megalith of Wharton’s duct in 70 years old male, its pathophysiology and subsequent patient management. To our knowledge there are very few cases of megalith of such size has been described and sialolith presented in our study is perhaps the largest ever reported to date so far in the literature. Case Report: 70 years old male patient presented to our ENT outpatient department with complaints of intermittent pain and swelling in right side of floor of mouth since last 6 months. On Intra oral examination, a yellowish, hard mass seen protruding out from Wharton’s duct ostium on right side in floor of mouth. A provisional diagnosis of right submandibular sialolith was made. Sialolith was removed in toto in OPD using Tilley’s forceps and gentle manipulation under local anesthesia. It was measured to be 8x2.5cm which was unusually giant sialolith with smooth surface present in submanibular gland duct. Conclusion: Megalith or giant sialolith are encountered rarely and may be asymptomatic for long time. The diameter value of Wharton duct ranges between 0.2 mm and 2.2 mm. Also this case report highlights the ability of Wharton’s duct to dilate up to large extent to accommodate such giant sialolith up to 8cm. In our patient the sialolith was really huge probably the largest one till reported in literature. Such huge sialolith can be removed with simple manoeuvering and instruments in out patient department under local anesthesia which can avoid major surgical procedure in operation theatre and it is a day care procedure. The Wharton duct has a natural capacity to regain its normal size after removal of such megalolith.