Submandibular

Question 1

Submandibular swelling
What is your differential diagnosis?

How would you investigate this patient?

Q:where common site of stone in SM gland?

Q: How to differentiate b/w salivary gland and LN?

Q: what else to examine to complete exam?

Answer 1

Submandibular sialolithiasis
Submandibular neoplasm
Carotid body tumor
infection (dental abscess)

• Ultrasound
• Sialogram if a salivary stone is suspected
• X-ray look for stone that are radioopaque
• CT scan (Tumor staging)
• FNA if a neoplasm is suspected

-common in wharton duct in middle one third of duct because lingual nerve cross here

-salivary gland have single swelling while LN has multiple swelling
-salivary gland can’t rolled up the mandible

-other salivary gland

Question 2

Q:How to do sub madibular incision?

Q:where warton duct opened?

What are the treatment options?

What instrument used in sialendoscopy?

Answer 2

Transverse neck incision 2-4 cm below margin of mandible avoiding injury to 3

-on both sides of lingual frenulum at floor of mouth

• Conservative management
Analgesia
• Oral antibiotics
Good hydration
Gland massage
Sialogram can occasionally be therapeutic, as the injection of contrast can ‘wash out’ the gland
• If the stone is within the duct, then the duct can be laid open and the stone retrieved. The duct is then left open as
suturing would result in a stricture
→ do marsopilization
Sialendoscopy: stone retrieval via endoscopic techniques
• Submandibular gland excision

• grasping forces, biopsy forceps, drills, needles, laser fibers, lithotripter