Chronic Submandibular sialolithiasis
Chronic left neck pain.
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Large calculus at the junction of the left submandibular gland and duct, not at the typical position of the midline papilla in the floor of the mouth. Gross atrophy and fatty replacement of the left submandibular gland (arrow).
Note all that remains are the intraparenchymal ducts radiating towards the calculus - gland has atrophied to fat (arrow) and the normal right submandibular gland (arrow).
Chronic salivary gland duct obstruction causes atrophy and fatty replacement of the gland.