Presentation
This 43-year-old male presented to the ED with odynophagia and fever 1 week after he "broke his tooth." Physical exam reveals swelling of the lingual frenulum and tender cervical lymphadenopathy.
Patient Data
There are multiple large calculi along right Wharton's duct. The largest most anterior stone measures 1.7 x 0.7 cm in greatest axial dimension. Notable regional edema within the sublingual space and floor of mouth. There is intraglandular ductal dilatation within the right submandibular gland which appears mildly hyper-enhancing.
Mildly prominent right level I lymph nodes are identified, likely reactive. The airway remains patent.
No soft tissue fluid collection is identified within the neck. No destructive bony lesions are identified.
Case Discussion
The patient was diagnosed with sialadenitis secondary to sialolithiasis. He underwent sialolithectomy and sub-mandibular gland excision by ENT with no complications and minimal blood loss. The surgeon noted at least three separate stones measuring in total about 15 x 35 mm. The most distal stone was the largest and most solid. After removal of this first stone, the rest of the sialoliths were friable (almost chalky) and followed by purulent drainage.
Almost certainly the formation of this stone was a chronic process exacerbated by bacterial infection incited by the patient "breaking his tooth."
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