A 25-year-old presents with recurrent painful swelling of the submandibular gland during meals. Plain X-ray shows a radiopaque shadow at the floor of the mouth. The best initial treatment step is:

• A Submandibular gland excision
• B Extracorporeal shockwave lithotripsy
• C Systemic antibiotics and analgesics
• D Sialendoscopy with stone retrieval or intraoral stone removal ✓

Explanation

Submandibular calculi (sialolithiasis) are common (80% in Wharton's duct) and most can be removed by intraoral incision over the stone in the floor of mouth if the stone is palpable and anterior. Sialendoscopy allows minimally invasive retrieval of stones not amenable to simple intraoral removal. Gland excision is reserved for multiple intraglandular stones or when minimal gland function remains. Antibiotics treat secondary sialadenitis but do not remove the stone. ESWL is used more for parotid stones.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.