Chronic sialadenitis due to the stone inside the accessory duct of submandibular gland.
OBJECTIVE
Sialolithiasis is the most common cause of chronic sialadenitis. In this case report, intraoperative finding of an accessory submandibular duct, obstructed with stone, originating from the same gland nearby the main Warthon's duct, is presented.


METHODS
A 22-year-old male patient, suffering from eating-related pain and swelling in his left submandibular region, was diagnosed with left sublandibular gland sialadenitis with radiologically manifested sialolithiasis, and gland excision was advised. Surgery was performed under general anesthesia. When the full anatomical scenery was delineated before excision of the gland, we surprisingly encountered two submandibular ducts originating from ipsilateral gland, one of them was obstructed with stone. After two ducts were ligated, the gland with sialolith was excised. According to histopathologic examination, the duct obstructed with stone was identified as the accessory duct and the other one was the main Wharton's duct. Postoperative days were uneventful; no neurologic complication was observed.


CONCLUSIONS
Otolaryngologists should be aware of anatomic variations of the submandibular duct(s) to avoid possible complications, especially intraoperatively, because rutine preoperative radiologic preparation does not include investigation of possible accessory ducts.
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Etlik, 06018, Kecioren, Ankara, Turkey. mbinar4@yahoo.com.
Murat
M
Binar
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Etlik, 06018, Kecioren, Ankara, Turkey.
Mert Cemal
MC
Gokgoz
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Etlik, 06018, Kecioren, Ankara, Turkey.
Umit
U
Aydin
Department of Pathology, Gulhane Medical School, Ankara, Turkey.
Ibrahim
I
Yavan
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Etlik, 06018, Kecioren, Ankara, Turkey.
Serdar
S
Karahatay
D006801:Humans; D008297:Male; D015494:Salivary Gland Calculi / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012793:Sialadenitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013363:Submandibular Gland / Q000002:abnormalities*; D013364:Submandibular Gland Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D055815:Young Adult
Anatomic variation; Salivary duct calculi; Submandibular gland