Sialolith of unusual size and shape.

A 52-year-old Caucasian female was referred to the Department of Oral Diagnosis and Surgery at the Araraquara Dental School (UNESP) for left sub-mandibular swelling assessment. She reported intermittent episodes of moderate to severe pain and swelling on eating of 6 months duration. However, symptomless sialoliths are common. 1 The severity of symptoms when present depend on the degree of obstruction which is related to the size and location of the sialoliths. 2 Oral examination revealed negligible salivary ¯ow from the left Wharton's duct. Attempts to milk the left submandibular gland produced only minimal amounts of saliva. A ®rm mass was palpable in the anterior portion of the duct (Figure 1). Generally, the most common radiographic techniques to diagnose sialoliths are panoramic and occlusal views. 2,3 In this patient an unusually large radiopacity was observed extending from the left mandibular cuspid to the second molar region (Figures 2 and 3). The di€erential diagnosis of a sialolith included a calci®ed lymph node, an avulsed or embedded tooth, a foreign body, a phlebolith, and myositis ossi®cans. 2 The salivary stone was surgically removed under local anaesthesia and measured 22 millimeters in length with the colour varying from white to yellow (Figure 4). After removal of the sialolith, the duct was cannulated and reconstructed to permit the normal salivary ¯ow. A cylindrical silicon drain was maintained for 6 days and normal salivary ¯ow was observed. Postoperative evaluation of the patient revealed no pain or swelling and normal salivary ¯ow. Figure 1 Intra-oral photograph of swelling of left ¯oor of mouth and displacing midline to right Figure 2 Panoramic radiograph showing a large radiopacity superimposed over the left mandibular cuspid and molar area