Abstract
The article by Koo et al.3 describes two cases in which a sialolith was present in Wharton's duct and the corresponding submandibular gland had been replaced by fat. In one of the cases, a blind end to Wharton's duct was identified proximal to the sialolith at operation. The authors considered that these cases represent the formation of a sialolith in Wharton's duct of a congenitally absent submandibular gland. However, they mention that ‘atrophy of the submandibular gland resulting from recurrent sialadenitis with a previously formed sialolith should also be considered’, and this is undoubtedly the case; for it is now established that sialadenitis is primary and causes the formation of sialoliths, which sometimes lead to complete atrophy of the corresponding gland and its replacement by fat, which can occur without any symptoms.
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