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You are seeing a 10 year old boy with 3 days of submandibular swelling. On exam, he has a 2cm x 3cm tender swelling in his right submandibular area. The parents report that the has had this twice before, each time treated with amoxicillin-clavulanate and resolved. He is afebrile.
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December 5, 2023 at 10:06 pm
B) Palpable stone in Wharton’s duct
The patient is having recurrent bouts of sialoadenitis due to sialolithiasis of the Wharton’s duct. The stone may be visible / palpable under the tongue, and obstruction by the stone can cause sialoadenitis. Stensen’s duct drains the parotid gland, and swelling would be of the parotid gland, which overlies the angle of the jaw. Otitis media may be associated with periauricular reactive nodes, but not submandibular, and reactive nodes are generally < 1 cm. Mumps often presents as unilateral or bilateral parotitis. Goiter is not typically associated with salivary gland swelling. Sialolithiasis is treated by