Presentation
A right submandibular mass presents as a painful swelling that has lasted for a few days, with a history of recurrent swelling and mild pain, mainly after eating and relief by conservative treatment.
Patient Data
The right submandibular gland demonstrates mild enlargement, slight hypoechogenicity, intraglandular duct dilatation, dilated main submandibular duct. There are fine internal echoes indicating internal debris, along with a 9 mm stone in the distal duct, and hypervascularity of the gland as assessed by color Doppler.
Case Discussion
The finding of sialadenitis (secondary inflammation) is due to sialolithiasis. Conservative medical management suffices; hydration and moist heat are helpful. Non-steroidal anti-inflammatory drugs (NSAIDs) may be beneficial. Sucking on something sour, such as a lemon, or a sialogogue, may increase salivation and promote the spontaneous expulsion of the stone.
If these measures are unsuccessful, surgical removal of the salivary stone from the duct may be required. In chronic cases, or if the stone is positioned within the parenchyma of the submandibular salivary gland, excision of the gland may be necessary.
I would like to express my gratitude to Yemeni maxillofacial surgeon Dr Mohammed Alklibi, for his informative operative notes.
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