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Radiology Forum
November 1999

Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 1999;125(11):1270. doi:10.1001/archotol.125.11.1270

A 28-YEAR-OLD Latin American man presented with a 7-month history of a swelling in the right submandibular area. The swelling was painless, soft, and changed size intermittently. There was no history of trauma, dysphagia, dental problems, or neck infections. The patient sought medical attention for aesthetic reasons. Examination revealed a 6×5-cm cystic mass in the right submandibular area that was nontender, mobile, and not attached to any underlying structures. The mass did not move during swallowing or tongue protrusion. Saliva could be expressed from the Wharton duct.There was no intraoral swelling. The findings of fine-needle aspiration were nondiagnostic. A computed tomographic scan revealed a large, homogeneous, well-circumscribed cystic structure lateral and posterior to the submandibular gland (Figure 1). The submandibular gland appeared normal but was displaced medially and anteriorly. The patient underwent en bloc excision of the mass through a submandibular approach. There was no identifiable stalk or fibrous attachment to the mandible (Figure 2). When the large reddish mass was cut open, numerous small cheese ball–like structures were seen floating in a watery fluid (Figure 3).

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