Foreign bodies of submandibular gland and Wharton’s duct: a review of literature

Waseem Qadir Dar, Jasif Nisar, Qurat Ul Ain Batool, Sajad M. Qazi


Foreign bodies of submandibular duct are rarely but consistently reported in literature. They usually present as obstructive submandibular sialadenitis. The diagnosis can be challenging because of rarity of such an event, and inability of traditional diagnostic methods to detect the foreign body. We sought to assemble the previous published literature to delineate the presentation, investigation and management of submandibular gland foreign bodies. We performed a comprehensive systematic literature review of PubMed, and Google Scholar, databases from 1960 to 2019, and analyzed the case reports and research articles proclaiming detection of foreign body in the submandibular gland or its duct. We also included a case found in our hospital in the review. A total of 28 articles full filled our criteria. The earliest article found was from year 1962 and latest in 2019, amounting to 28 research articles on this topic in last 58 years. The age ranged from 9 years to 78 years, with average age of 38.7 year. The left Submandibular gland was involved in 18 cases (75%), and right in 6 cases (25%). There was a varied array of foreign bodies retrieved. Patients underwent sialadenectomy, duct excision, intervention by milking, probing or with a forceps or more recently interventional sialendoscopy. To approach an early diagnosis, a patient history needs to be believed. High resolution oral ultrasonography with interventional sialendoscopy can become the hallmark of a future approach to submandibular duct foreign bodies.


Wharton’s duct, Foreign body, Salivary gland, Submandibular gland, Submandibular gland duct

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Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg. 2001;127:66-8.

Lustmann J, Regev E, Melamed Y. Sialolithiasis: A survey on 245 patients and a review of the literature. Int J Oral Maxillofac Surg. 1990;19(3):135-8.

Ricciro FJ, Scavo VJ. Unusual foreign body etiology of sialadenitis. Arch Otolaryngol. 1967;86:210-2.

Capaccio P, Torretta S, Ottaviani F, Sambataro G, Pignataro L. Modern management of obstructive salivary diseases. Acta Otorhinolaryngol Ital. 2007;27(4):161-72.

Xie L, Zheng L, Yu C, Yang C, Chen Z, Yun B, et al. Foreign body induced sialolithiasis treated by sialoendoscopic intervention. J Craniofac Surg. 2014;25(4):1372-5.

Derin S, Sahan M, Kule M, Koseoglu S, Celik OI. Fish bone induced sialolith in Warthon duct. J Craniofac Surg. 2015;26:663-4.

Su YX, Lao XM, Zheng GS, Liang LZ, Huang XH, Liao GQ. Sialoendoscopic management of submandibular gland obstruction caused by intraglandular foreign body. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:17-21.

Ardekian L, Klain H, Peled M. Obstructive sialadenitis of submandibular gland due to foreign body successfully treated by sialoendoscopic intervention. J Oral Maxillofac Surg. 2009;67(6):1337-9.

Tabatabaee RM, Sanatkhani M. Obstructive Sialadenitis of Submandibular Gland Due to a Nail-like Fish Bone Foreign Body: A Rare Case Report. J Pharma Res Int. 2019;29(1):1-7.

Pratt LW. Foreign body of Wharton’s duct with calculus formation. Ann Otol Rhinol Laryngol. 1968;77:88-93.

Yu C, Yang C, Zheng L, Wu D. Endoscopic Observation and Strategic Management of Obstructive Submandibular Sialadenitis. J Oral Maxillofac Surg. 2010;68:1770-5.

Walker EA. Foreign Body in Wharton's Duct Arch Otolaryngol. 1962;75(3):274-5.

Baggio G. Chronic Fibrous Inflammation of Submaxillary Gland from Scrap of Grain, Policlinico (Prat.). 1923;30:137-40.

Mead SV. Diseases of the Mouth, 5th Ed. St. Louis: C. V. Mosby; 1940: 560.

Smith RO Jr, Hemenway WG, Harrison GD, Ratzer ER. Hair brush bristle: foreign body of the submaxillary gland. Arch Surg. 1970;100:317-8.

Watkins RM. Submandibular salivary duct calculus secondary to a foreign body. Br J Surg. 1982;69:379.

Su Y, Lao X, Zheng G, Liang L, Huang X, Liao GQ. Sialoendoscopic management of submandibular gland obstruction caused by intraglandular foreign body Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:e17-21.

Su YX, Liao GQ, Kang Z, Zou Y. Application of MR virtual endoscopy as a presurgical procedure before sialendoscopy. Laryngoscope. 2006;116:1899-906.

Su YX, Feng ST, Liao GQ, Zhong YQ, Liu HC, Zheng GS. CT virtual sialendoscopy versus conventional sialendoscopy in the visualization of salivary ductal lumen: an in vitro study. Laryngoscope. 2009;119:1339-43.

Becker M, Marchal F, Becker D. Sialolithiasis and salivary duct stenosis: Diagnostic accuracy of MR sialography with a three-dimensional extended phase conjugate symmetry rapid spin echo sequence. Radiology. 2000;1:217:347.

More S, Mhapuskar A, Hiremutt D. Diagnostic applications of ultrasonography in maxillofacial region Int J Maxillofacial Imaging. 2017;3(2):57-62

Sengupta A, Brown J, Rudralingam M. The use of intraoral ultrasound in the characterization of minor salivary gland malignancy: report of two cases Dentomaxillofacial Radiology. 2016;45:20150354.

Brown JE, Escudier MP, Whaites EJ, Drage NA. Intra-oral ultrasound imaging of a submandibular duct calculus. Dentomaxillofacial Radiol. 1997;26:252-5.

Nahlieli O, Baruchin AM. Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases J Oral Maxillofac Surg. 1999;57(12):1394-401.

Riccio FJ, Scavo VJ. Unusual Foreign Body Etiology of Sialadenitis Arch Otolaryngol. 1967;86.

Brian LW. Foreign body in the submandibular salivary gland. J Larynglo Otol 1972;86(2):210-2.

Tov YS, Talmi Y, Zohar Y, Laurian N. Facial cutaneous fistula due to a foreign body in Wharton’s duct. J Laryngol Otol 1988;102:370-1.

Abe K, Higuchi T, Kubo S, Oka M. Submandibular sialoadenitis due to a foreign body. Br J Oral Maxillofac Surg. 1990;28:50-2.

Francis M, Kurt AM, Pavel D. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg. 2001;127:66-8.

McLoughlin LM, Dornan O. “Bird fancier’s mouth,” an unusual case of obstructive sialadenitis. Ulster Med J. 2002;71:142-3.

Ouellette AL, Slack CL. Shrapnel-induced sialolith—a rare etiology for sialadenitis: case report. J Oral Maxillofac Surg. 2003;61:636-7.

Modi B. Case of foreign body in whartons duct Indian J Otolaryngol Head Neck Surg. 2005;57:322-3.

Chowdhary A, Kalsotra P, Parihar SS, Bhagat DR, Ali N, Rashid A. Foreign Body in the Wharton’s Duct JK Sci. 2005;7(2):1-2.

Yu C, Yang C, Zheng L, Wu D. Endoscopic observation and strategic management of obstructive submandibular sialadenitis. J Oral Maxillofac Surg. 2010;68:1770-5.

Stanescu S, Ciobanu E, Niculescu M. Submaxillaritis due to foreign bodies. J Oral Surg. 1969;27:828

Taneja M, Taneja MK. Foreign Body Wharton’s Duct Indian J Otolaryngol Head Neck Surg. 2011;63(3):300-1.

Sahan M, Çullu N, Deveer M, Sivrioglu AK, Beydilli H, Sözen H. Atypical obstructive submandibular sialoadenitis. Images Clin Radiol. 2013;96:266.

Boynton TT, Lieblich SE. Unusual case of a sialolith: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:e9-e10.

Derin S, Sahan M, Kule M, Koseoglu S. Fish Bone Induced Sialolith in Warthon Duct. J Craniofacial Surg. 2015;26(7):663-4.

Ozturk K, Erdur O, Aksoy C. Foreign Body of Submandibular Gland. J Craniofacial Surg. 2016;27(7):600-1.

Mahabaleshwara CH, Nidyalmale J, Abhishek PT, Ashoka G. Fish bone: the reason behind submandibular sialadentits - a unique case report. Int J Clin Diagnos Res. 2017;5(3):1.

Li P, Zhu HC, Huang DH. Detection of a metallic foreign body in the Wharton duct A case report Medicine. 2018;97:44.

Modlin B. Foreign body (fingernail) as cause of acute submaxillary gland infection. Eye Ear Nose Throat Mon. 1975;54:206-7.

Sato K, Umeno H. Fish bone-induced sialolith. Otolaryngol Head Neck Surg. 2009;141:539-40.