A patient presents with a painless, stony hard, mobile submandibular gland swelling that enlarges during meals. Plain X-ray (mandible occlusal view) shows a radio-opaque shadow in the floor of mouth. The most appropriate treatment is:

• A Submandibular gland excision
• B Antibiotics for 10 days
• C Lithotripsy only
• D Intraoral stone removal (sialolithiasis) if stone is accessible in the duct ✓

Explanation

Sialolithiasis of the submandibular duct (Wharton's duct) causes meal-time swelling; 80% of submandibular calculi are radio-opaque. Anterior duct stones are accessible for intraoral incision and stone removal while preserving the gland. Submandibular gland excision is reserved for recurrent sialadenitis, intraglandular stones, or gland that is chronically inflamed and non-functional. Antibiotics alone treat sialadenitis but not the calculus. Lithotripsy is an option for intraglandular stones but is less available than intraoral surgery.

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.