Non-surgical extraction of a massive sialolith in the Wharton's duct of a Nigerian.

Background: Sialolithiasis is the most common salivary gland disorder characterized by calculi formation within the gland and/or its duct. The submandibular gland is most frequently affected due to the peculiar anatomy of the duct and the nature of its secretion. Varying sizes have been described for salivary calculi and unusually large sialoliths measuring above 3.5cm have been reported. Similarly, a few giant sialoliths have been reported in Africans. We therefore report the case of a large sialolith in the Wharton's duct of a Nigerian male. CASE PRESENTATION AND MANAGEMENT: A 54 year old Nigerian man presented with a hard, painless, left floor of mouth swelling of one year duration. There were recurrent episodes of moderate pain at meal times. Intraoral examination revealed a hard, mobile, non tender, creamy mass on the left side of the floor of the mouth protruding out of the Wharton's duct orifice. A lower occlusal radiograph revealed a large radio-opacity in the floor of the mouth and a diagnosis of left submandibular sialolithiasis was made. The sialolith was removed non-surgically and measured 4.4 cm by 1.8 cm. The patient was discharged and follow up period was uneventful.
Conclusion: Large sialoliths are rarely reported in Africans, non-surgical extraction can be attempted for accessible and mobile sialoliths after full evaluation. Complex cases should be referred to the oral and maxillofacial surgeon.