A 50-year-old presents with recurrent painful right submandibular swelling that worsens at mealtimes and subsides afterwards. USG reveals a calculus in Wharton's duct. The most appropriate definitive treatment for an anterior duct calculus is:

• A Submandibular gland excision
• B Extracorporeal shockwave lithotripsy (ESWL)
• C Sialoendoscopy alone with basket retrieval
• D Intraoral incision and stone removal via duct marsupialisation (sialolithotomy) ✓

Explanation

Calculi in the anterior portion of Wharton's duct (anterior to the mylohyoid muscle) are best treated by intraoral incision, stone removal, and duct marsupialisation (sialolithotomy) — a simple, effective outpatient procedure preserving the gland. Gland excision (submandibular sialoadenectomy) is reserved for posterior duct stones, recurrent stones, or gland with irreversible damage. Sialoendoscopy is an alternative for smaller stones. ESWL has lower success rates for submandibular 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.