Sialolithiasis — ORE Part 1 MCQ

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EasyOral MedicineSialolithiasisORE Part 1

A 28-year-old woman presents with recurrent episodes of sudden, severe, unilateral submandibular swelling and pain occurring during meals. Between episodes, she is asymptomatic. What is the most likely diagnosis?

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Correct answer: E — Submandibular duct sialolith (salivary calculus)

The answer is E. The pathognomonic clinical presentation is the 'meal-time syndrome': recurrent, acute-onset swelling and pain of the submandibular region triggered by mastication, with complete resolution between episodes when salivary flow stimulus is absent. This pattern is diagnostic of duct obstruction by sialolith. Saliva accumulates during eating, pressure increases proximal to the stone, and pain and swelling ensue; once eating stops, saliva production reduces and symptoms rapidly resolve. Option B (tumour) presents with progressive painless swelling, not episodic meal-triggered pain. Option D (infective sialadenitis) typically causes persistent swelling and systemic symptoms; while sialadenitis can complicate sialolithiasis, infectious sialadenitis alone does not show meal-time resolution. Option A (abscess) produces persistent localised swelling with fever and fluctuance. Option C (ranula) is a painless or mildly tender mucous cyst, not meal-dependent pain.

Reference: Arifa SP, Christopher PJ, Kumar S, et al. Sialolithiasis of the Submandibular Gland: Report of Cases. Cureus. 2019;11(3):e4180. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504031/; Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options. PubMed. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9482556/