Wharton's Duct Stone — ORE Part 1 MCQ

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EasyOral MedicineWharton's Duct StoneORE Part 1

A 50-year-old woman presents with recurrent episodes of swelling beneath the tongue on the right side. Each episode lasts approximately 30 minutes and occurs during meals. What is the likely anatomical location of a stone causing this obstruction?

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Correct answer: D — Wharton's duct (submandibular duct)

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

The correct answer is A: Wharton's duct (submandibular duct). The clinical presentation—swelling beneath the tongue during meals lasting 30 minutes—is pathognomonic for submandibular duct obstruction by sialoliths. Wharton's duct is the main duct of the submandibular gland and exits into the floor of the mouth; it is the site of >80% of all salivary stones because of mucous composition and duct geometry. Option B (Stensen's duct/parotid) would cause facial swelling anterior to the ear. Option C contains an anatomical error: Bartholin's glands are not salivary glands but are located in genital anatomy; the sublingual gland has no single eponymous duct. Options D and E are anatomically incompatible with floor-of-mouth obstruction.

Reference: NHS salivary-gland-stones guidance; Right Decisions Scotland ENT referral guidance; SDCEP Salivary Gland Obstruction pathway at https://madp.sdcep.org.uk/content/conditions-library/salivary.html