A 20-year-old woman who had a main symptom of intermittent pain in both mandibular third molar visited our hospital. In CBCT findings, the #38, 48 teeth were located on the lingual side of the inferior alveolar nerve. In addition, a large stone about 12mm in length was observed in the right Wharton's duct in CBCT findings. Neck CT scan was performed and a large stone about 12mm in length was observed, and the accumulation of saliva in the rear of the stone was observed. The patient underwent sialolithotomy and #38, 48 tooth extraction through intraoral approach under general anesthesia. The removed stone was similar in shape and color to a tooth. The removed stone was markedly fragmented and composed of dentin and enamel-like tissue which showed lamellate arrangement in microscopic examination. Patient was presently symptom free after 10-months postoperatively.

Sialolith is a common disease of salivary glands characterized by the development of salivary stones, resulting in the salivary ductal obstruction. The chief complaints of patients with sialoliths are pain and swelling of the involved gland during meals. Most sialoliths are found in the submandibular gland of middle-aged patients. The size of the salivary stones can vary, but most of them are less than 10mm in size, giant sialoliths(larger than 15mm) are very rare. In this case, we report a 68-years old female patient who had removal of a giant sialolith located in left proximal Wharton’s duct by less invasive intraoral surgical technique successfully. We also review related literature.

A patient complaining of severe pain in the right submandibular area showed a huge sialolith in radiogram. During the operation, the submandibular gland was much indurated, and large amount of pus was discharged out at an incision of the salivary gland. The removed salivary gland contained a huge sialolith in the major excretory duct of submandibular gland, which had an intact grayish-white surface in ovoid shape. In the histological examination its excretory ducts were extensively dilated without extravasation of saliva, and the involved salivary gland was almost destroyed by the granulomatous r eaction. Most of a cinar cells were d isappeared and r eplaced by ductal cells filled with exudative materials. The microsections of sialolith showed typical laminar structures of calcification containing amorphous basophilic material in the center, in which a lot of Gram positive and Gram negative microorganisms were found. In the center of sialolith numerous microorganisms were admixed with mucinous materials which were strongly positive for the antibody of mucin-1, and formed multiple colonies. In the periphery of the bacterial colonies proline rich proteins (PRPs) were condensely localized, and followed by the consistent positive reaction of transglutaminase 4 (TGase-4). These data suggest that the sialolith of this study is formed from the primary nidus of bacterial colony aggregated with salivary mucin-1 and PRPs by the crosslinking reaction of TGase-4.