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Salivary Calculus: Report of a Case
1736
The Journal o f the Am erican Dental Association and T h e Dental Cosmos
Salivary Calculus: Report of a Case By W. I. J o n e s , D.D.S., Columbus, Ohio T he following case illustrates some of the complications that may follow the extraction of teeth and emphasizes the necessity for a correct diagnosis of lesions in or around the oral cavity even though the teeth may not be directly involved. REPORT OF CASE
History.— Mr. M. consulted his physician, because of a swelling in the submaxillary tri angle on the left side of the neck. The physi
cian discovered a decayed third molar in the lower jaw of the affected side and sent him to his dentist, who extracted the tooth. Two days later, he returned to the dentist with an acute exacerbation of the previous symptoms: an increased swelling, trismus and hardening of the submaxillary and lingual glands extending into the floor of the mouth, sharp stabbing pains on swallowing, and an occasional discharge of saliva and pus into the mouth. The patient was then referred to me for treatment. Examination.— A careful physical examina tion of the tooth socket and the tissues im mediately adjacent to it, including the taking of small films, together with a lateral roent genogram of the entire mandible and submaxillary region, disclosed no pathosis and failed to demonstrate the presence of a stone. However, when the history of the case was taken, three symptoms were complained of that were very significant and which led me to suspect the presence of a salivary calculus: i. The swelling was of long standing (about twelve years). 2 . The swelling came and went
intermittently. 3 . The sight or odor of food produced a sense of fullness in the region of the sublingual gland and caused pain to a de gree that eating was an ordeal. Treatment.— The patient was treated by applying hot moist compresses to the outside of the face and irrigating the mouth fre quently with hot boric acid solution. After twenty-four hours, the trismus and swelling had subsided enough to permit the introduc tion of a film, 2 J by 3 inches, into the mouth on a plane with the occlusal surface of the lower teeth. In this way, a roentgenogram of the floor of the mouth was obtained, disclos ing a radiopaque area in the region of the submaxillary gland about 2 inches posteriorly to the opening of Wharton’s duct, as shown in the illustration. This proved to be a salivary calculus, the cause of the intermittent swelling and pain during a period of over twelve years. Under a local anesthetic, the stone was re moved by introducing a probe into the duct until the calculus could be felt. The mucous membrane together with the probe was grasped with artery forceps and an incision was made through the mucous membrane and the wall of the duct down to the calculus. The stone was removed without fragmentation. The probe used was made of stainless steel wire, gage 2 3 , with the head 0 .0 3 2 inch in diameter. It is advisable to have several probes of various sizes, as it is important to enter and follow the duct to its beginning in the gland. In this case, the calculus was al most within the body of the submaxillary gland, and also it is difficult to judge with accuracy from a roentgenogram alone the depth of the stone in the tissue. Outcome.— Recovery was rapid and un eventful. The swelling and pain quickly sub sided and in three months there has been no return of untoward symptoms. 327 East State Street.
Ludw ig’s A n gin a: Report of a Case By J o s e p h N. J.
K
u ssy,
Ph.G., D.D.S., Newark,
T his case is being reported because of the remarkable course it ran with its many ramifications. Seldom do we experience such a favorable termination of so serious an infection as in this, a case unanimously viewed as most probably fatal by all con
The Journal o f the Am erican Dental Association and T h e Dental Cosmos
Salivary Calculus: Report of a Case By W. I. J o n e s , D.D.S., Columbus, Ohio T he following case illustrates some of the complications that may follow the extraction of teeth and emphasizes the necessity for a correct diagnosis of lesions in or around the oral cavity even though the teeth may not be directly involved. REPORT OF CASE
History.— Mr. M. consulted his physician, because of a swelling in the submaxillary tri angle on the left side of the neck. The physi
cian discovered a decayed third molar in the lower jaw of the affected side and sent him to his dentist, who extracted the tooth. Two days later, he returned to the dentist with an acute exacerbation of the previous symptoms: an increased swelling, trismus and hardening of the submaxillary and lingual glands extending into the floor of the mouth, sharp stabbing pains on swallowing, and an occasional discharge of saliva and pus into the mouth. The patient was then referred to me for treatment. Examination.— A careful physical examina tion of the tooth socket and the tissues im mediately adjacent to it, including the taking of small films, together with a lateral roent genogram of the entire mandible and submaxillary region, disclosed no pathosis and failed to demonstrate the presence of a stone. However, when the history of the case was taken, three symptoms were complained of that were very significant and which led me to suspect the presence of a salivary calculus: i. The swelling was of long standing (about twelve years). 2 . The swelling came and went
intermittently. 3 . The sight or odor of food produced a sense of fullness in the region of the sublingual gland and caused pain to a de gree that eating was an ordeal. Treatment.— The patient was treated by applying hot moist compresses to the outside of the face and irrigating the mouth fre quently with hot boric acid solution. After twenty-four hours, the trismus and swelling had subsided enough to permit the introduc tion of a film, 2 J by 3 inches, into the mouth on a plane with the occlusal surface of the lower teeth. In this way, a roentgenogram of the floor of the mouth was obtained, disclos ing a radiopaque area in the region of the submaxillary gland about 2 inches posteriorly to the opening of Wharton’s duct, as shown in the illustration. This proved to be a salivary calculus, the cause of the intermittent swelling and pain during a period of over twelve years. Under a local anesthetic, the stone was re moved by introducing a probe into the duct until the calculus could be felt. The mucous membrane together with the probe was grasped with artery forceps and an incision was made through the mucous membrane and the wall of the duct down to the calculus. The stone was removed without fragmentation. The probe used was made of stainless steel wire, gage 2 3 , with the head 0 .0 3 2 inch in diameter. It is advisable to have several probes of various sizes, as it is important to enter and follow the duct to its beginning in the gland. In this case, the calculus was al most within the body of the submaxillary gland, and also it is difficult to judge with accuracy from a roentgenogram alone the depth of the stone in the tissue. Outcome.— Recovery was rapid and un eventful. The swelling and pain quickly sub sided and in three months there has been no return of untoward symptoms. 327 East State Street.
Ludw ig’s A n gin a: Report of a Case By J o s e p h N. J.
K
u ssy,
Ph.G., D.D.S., Newark,
T his case is being reported because of the remarkable course it ran with its many ramifications. Seldom do we experience such a favorable termination of so serious an infection as in this, a case unanimously viewed as most probably fatal by all con