Intraoral approach to removal of Wharton duct large sialolith

B ac K gro UND: Sialolith is a calcareous concretion “calculus” in the salivary ducts or glands, frequently sub - mandibulary gland and its duct. t he presence of a sialolith predisposes for onset of a scialolithiasis, this is a benign a infectious-inflammatory condition. Based on size and degree of calcification , calcification can be visible at x-ray exami - nations. Patients typically report remitting tumefaction, pain, edema, redness of oral floor and the submandibular region. l arge sialoliths can be removed with different types of approaches, intraoral, extraoral, endoscopic depending on its position, shape and size, as well as on the basis of the surgeon’s experience. Met H o DS : i n t his paper we report two cases of large sialolith located in submandibular gland duct removed with intraoral approach, and explain risks and benefits of intraoral approach. t he cases described concern two men of 58 and 62 years, both affected by sialolithiasis of the submandandar gland duct, treated at Maxillofacial Surgery Unit of “Magna g raecia” University of c atanzaro. c linical history of the two patients is practically superimposable, with repeated epi - sodes of tumefaction and pain in submandibular region that increased during meals. c li nical diagnosis was confirmed by radiological diagnosis, (echography, orthopantomogra- phy, tc scan). Patients underwent excision of the calcula - tion with intraoral approach in local anesthesia. Surgery was conducted hi ghlighting distal duct tract and dissecting it with the scalpel. Duct cavity was gently dilating until calculus is found, pay attention to point where duct inclines downwards “comma”. t he procedure ends with the sialoliths removal and packaging of a “neo-stoma” . Postoperative radiographic evaluation was performed confirming complete sialolith removal. c linical follw-up were performed at 7 days, 1 and 6 months and 1 year. r e S U lt S : Procedure was well tolerated, good healing of surgical wound was observed; no infection and well con- trolled pain. Both patients tolerated the procedure well. No hematomas or sialoceles were found in the submandibular and sublingual region. No sequelae were reported to the ductal apparatus of Wharton or lesion of the lingual and / or hypo- glossal nerves. Maintenance of salivary gland activity has been reported in both patients. c o N c l US i o N S: We believe that the intraoral approach is a suitable alternative for removal sialoliths of localized also in the proximal portion of the Wharton duct. i ntraoral approach appears to have a good prognosis without neurological deficit and with the recovery / maintenance of the residual function of the salivary gland.