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Neuroradiology Case of the Week

Case 128

Per-Lennart Westesson, MD, PhD, DDS

Clinical Presentation: A 52-year-old man presenting with meal related swelling of the right sub-mandible gland.

Radiological Findings: CT Scan (Fig. 1) shows a stone in the distal portion of the right Wharton’s Duct. Sialography (Fig. 2) shows a marked filling defect in the same location.
Figure 1
Figure 2

Treatment: The patient was treated by interventional radiologic techniques to remove the stone. A urologic stone removal basket (Fig. 3) was used to remove the stone (Fig. 4).

Figure 3
Figure 4

Diagnosis: Sialolithiasis in Wharton’s Duct removed with interventional radiologic techniques

Discussion: Principally the procedure starts by dilating the duct by inserting probes to gradually increasing diameter. Then the retrieval basket is inserted proximal to the stone. The basket is opened and pulled back. In order to remove the stone from the duct a small incision into the papilla is often needed. The patient is given prophylactic intravenous antibiotics and a short course of p.o. antibiotics.

References:

  1. Baurmash HD. Submandibular salivary stones: current management modalities. J Oral Maxillofac Surg. 2004 Mar;62(3):369-78. [Medline]
  2. Escudier MP. The current status and possible future for lithotripsy of salivary calculi. Atlas Oral Maxillofac Surg Clin North Am. 1998 Mar;6(1):117-32. [Medline]
  3. Epker BN. Obstructive and inflammatory diseases of the major salivary glands. Oral Surg Oral Med Oral Pathol 1972; 33:2-27. [Medline]
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