Dear Sirs
Gadodia and colleaguesReference Gadodia, Seith, Neyaz, Sharma and Thakkar1 present excellent radiological images of Bartholin's duct and the greater sublingual gland, which they have interpreted as an accessory submandibular duct and gland.
This error is understandable because the detailed anatomy of the sublingual gland is much more complex than is generally appreciated. LeppiReference Leppi2 discovered that the sublingual gland consists of a constant, lesser sublingual gland and a greater sublingual gland. The latter is posterior to the lesser sublingual gland in the paralingual space and was only found in 10 out of 28 people, and usually only unilaterally. Bartholin's duct runs from the greater sublingual gland to either join or open independently of Wharton's duct. The lesser sublingual gland consists of between eight to 30 small glands, from every one of which a duct of Rivinus passes to open independently on the sublingual fold.
Thus, the sialograms in the paper by Gadodia and colleaguesReference Gadodia, Seith, Neyaz, Sharma and Thakkar1 show Bartholin's duct running parallel to the dilated Wharton's duct, which indicates that these ducts join, and the sublingual gland. The authors mention that there was stasis in Wharton's duct following stimulation by lemon. It would be interesting to know the situation in Bartholin's duct, where stasis would not be expected, particularly as the sublingual gland is a spontaneous secretor and continues to secrete in the absence of stimulation, and also exhibits a great resistance to obstruction.Reference Harrison, Sowray and Smith3
Author's reply
I am grateful for J D Harrison's comments on our article.
We diagnosed our case of accessory submandibular gland and duct on the basis of the presence of two ducts originating from the same orifice, the lower one leading to glandular tissue. Our case is similar to that reported by Towers,Reference Towers1 which this author labelled as duplication of the submandibular duct.
However, we appreciate J D Harrison's comment that the accessory submandibular gland and the sublingual gland can simulate each other. To the best of our knowledge, the features differentiating these two entities have not been described in the literature.
In our case, there was stasis in Wharton's duct and not in Bartholin's duct, as pointed out by J D Harrison. This was secondary to a small calculus just distal to the punctum.
