DOI: https://doi.org/10.36347/sjds.2025.v12i09.003

Pages: 141-145

Peri-Whartonitis is an uncommon inflammatory condition involving the periductal tissues surrounding Wharton’s duct, most frequently caused by salivary duct obstruction due to sialolithiasis. Its clinical manifestations often mimic odontogenic cellulitis or infections of the floor of the mouth, leading to potential diagnostic errors and delayed treatment. This report presents the case of a woman in her mid-forties, without relevant medical history, referred to the Military Hospital of Tunis for persistent submandibular swelling initially diagnosed as cellulitis. The patient had received a one-week course of amoxicillin and paracetamol without improvement. Clinical examination revealed a submandibular swelling without obliteration of the lingual vestibule, and bimanual palpation disclosed a mobile, hard structure along Wharton’s duct, associated with mild purulent discharge. A panoramic radiograph showed a radiopaque image resembling a tooth between teeth 45 and 47, while cone-beam computed tomography confirmed an oval calcified structure consistent with a sialolith in the submandibular duct. Based on these findings, a diagnosis of peri-Whartonitis secondary to obstructive sialolithiasis was established. The patient underwent successful transoral sialolithotomy under local anesthesia, followed by a short course of antibiotics, analgesics, and antiseptic mouthwash. The postoperative course was uneventful, with complete resolution of symptoms after 10 days. This case highlights the diagnostic challenges associated with peri-Whartonitis and underscores the importance of careful clinical evaluation and appropriate imaging in distinguishing it from odontogenic infections. Early and minimally invasive surgical management ensures complete healing, preserves glandular function, and prevents unnecessary prolonged antibiotic therapy. Clinicians should consider peri-Whartonitis in cases of submandibular swelling unresponsive to conventional antibiotic treatment.