Removal of Large Wharton’s Duct Salivary Stones Using a CO2 Laser: A Report of Two Cases

Introduction: Salivary stones inside the Wharton’s duct adjacent to the mylohyoid muscle are often removed by a little incision of the mouth floor under local anesthesia. However, in the case of relatively large salivary stones, a large incision is required, which is commonly accompanied by hemorrhage and the need for surgical hemostasis, resulting in prolonged surgery. Furthermore, troublesome sequelae such as ranula and lingual nerve paralysis can occur after surgical procedures. Methods: Two patients who had relatively large salivary stones (>1 cm diameter) in the Wharton’s duct were underwent incision of the mouth floor soft tissues with a CO2 laser. Results: In both patients, the stone was removed in a few minutes without causing abnormal bleeding, nerve injury, or sublingual gland disorders and was completely healed. Conclusion: We report the usefulness and safety of the CO2 laser in two patients with relatively large salivary stones, who underwent successful surgical removal.

A Case of Unusual Size Sialolith in the Wharton’s Duct

Sialolithiasis is the common disease of salivary glands. The majority of sialoliths occur in the submandibular gland or the Wharton’s duct. The length of sialolith usually measures from 1 to <10 mm. This article reported a case presenting with sialoliths of a 22mm×15mm in size in the Wharton's duct, which were surgically removed without any complications, and subsequently discusses occurrence factors, signs and symptoms, diagnostic methods and the treatment of sialolithiasis.

Unusual presentation of submandibular lingual nerve sheath tumour as sublingual stone

A 60-year-old woman was referred to the otolaryngologist for 18 months of left-sided tongue pain and taste changes. Surgeon-performed ultrasound of the submandibular region revealed a hyperechoic mass. Wharton’s duct was dilated proximally and the submandibular gland demonstrated normal vascularity. While these findings were highly suspicious for submandibular gland sialolith, an in-office attempt at sialolithotomy suggested an alternate process or mass. After imaging failed to further elucidate an aetiology, surgical exploration revealed a well-circumscribed submandibular mass associated with the lingual nerve. The mass was removed en-bloc and pathology revealed a schwannoma of the lingual nerve.