Rare case, sialo-oral fistula with giant sialolithies of the wharthins duct

Sialolithiasis: is the most common disease of salivary glands. It is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions, resulting in salivary ectasia and even determining the subsequent dilatation of the salivary gland. The sialolith usually measure from 1 mm to less than 10 mm. They rarely measure more than 15 mm. frequently and rare giant salivary gland calculi >15 mm. In this case male 42 years old have a giant stone in the right submandibular gland duct about 45mm which is represented one of the biggest submandibular duct stone reported in the literature with perforation of the wharthins duct, its diagnosed through the long history more than 20 years with pain, tenderness, dysphagia, difficult in specking. Clinical examination reveal extra oral bulginess of the submandibular gland with intra oral fistula in its duct , extra oral lateral radio graphical examination show large stone extended from the first right lower molar to the first right lower central, Its treated by very small trans-oral surgical incision under local anesthesia through the ductal oral fistula just extended anteriorly and posteriorly and the stone get out spontaneously by the action of the pressure of the discharge following the stone removal, No recurrence was seen on follow-up