OMFS-0118Salivary gland diseasesSalivary GlandbeginnerSubmandibular gland

Mealtime swelling of the submandibular gland

41-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Painful swelling under the jaw whenever I eat, for 6 months

§Medical & dental history

01Dehydration-prone occupation (outdoor labourer)
02No diuretics
03Nil relevant

§Clinical examination

01Tender, enlarged right submandibular gland that swells within minutes of eating and subsides after an hour
02Hard palpable body in the floor of mouth along the course of Wharton duct
03Scanty saliva expressed from the right duct orifice on bimanual massage
04No pus, no facial nerve or lingual nerve deficit

§ figuresFigures (4)

Sialolithiasis — clinical image: Salivary gland stone (Sialolithiasis) and the operation marks — Fig. 1Salivary gland stone (Sialolithiasis) and the operation marks
“Salivary gland stone removed” · Peternickson · CC0 · Wikimedia Commons

Sialolithiasis — clinical image: Sialolithiasis, Salivary stones — Fig. 2Sialolithiasis, Salivary stones
“Sialolithiasis IMG 2368” · Milorad Dimic MD · CC BY 4.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Sialolithiasis figures pending faculty review.

§Differential diagnosis

Submandibular sialolithiasisClassic mealtime syndrome, palpable stone

Sialadenitis without a stoneConstant swelling, purulent discharge

Sjogren syndromeBilateral, dry eyes and mouth, autoantibodies

Submandibular neoplasmProgressive painless enlargement, not meal-related

§Final diagnosis

Obstructive sialolithiasis of the right Wharton duct

Mealtime syndrome — swelling that reliably appears with salivary stimulation and settles afterwards — is pathognomonic of obstruction. A palpable stone in the floor of the mouth localises it to the distal duct, which is amenable to intraoral removal.

§Investigations

01Lower true occlusal radiograph — radiopaque calculus 8 mm in the distal duct
02Ultrasound — dilated duct proximal to the stone, gland not atrophic
03Sialendoscopy where available

§Treatment plan

01Conservative measures first: hydration, sialogogues, gland massage, warm compresses
02Intraoral surgical removal of the distal duct stone
03Antibiotics only if acute infection supervenes
04Gland preservation — sialadenectomy reserved for a chronically damaged gland

§Surgical procedure

01Suture placed behind the stone to prevent retropulsion
02Longitudinal incision over the duct with lingual nerve identification and protection
03Stone delivered; duct marsupialised rather than sutured closed

§Follow-up & outcome

01Symptoms resolved immediately
02Normal salivary flow at 6 weeks; gland preserved
03Advised on hydration and regular sialogogues

§Clinical pearls / learning points

01Eighty percent of salivary calculi are submandibular because of viscous mucous saliva and an uphill duct course.
02Always secure the stone with a stay suture before incising the duct.
03Marsupialise the duct — primary closure risks stricture.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L3 · Systematic review — 1
L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

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Last literature search: 7 September 2026

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Current Classification