Annals of B Pod - Visual Dx

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A 34 year old male presents to the ED complaining "My jaw hurts and swells when I eat". Exam and CT as below:

What's your diagnosis and management?

Photo of the patient's palpable sub-lingual mass

Photo of the patient's palpable sub-lingual mass

Maxillofacial CT

Maxillofacial CT

Answer: Large Sialolith

Sialoliths most often affect the Submandibular glands (80-90%) with the bulk of the remaining affecting the parotid glands.  As in this patient, submandibular stones often migrate to and obstruct Wharton’s duct.  While the exact cause of stone formation is not known, it is believed that stagnation of calcium rich saliva causes development of stones.  This patient was prescribed sialogogues (Lemon Drops), NSAIDs, and salivary massages.  ENT recommended surgical removal although lithotripsy is an option in stones less than 7mm.