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Clinical Challenge
December 2016

Floor of Mouth Swelling

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1241-1242. doi:10.1001/jamaoto.2016.1024

A woman in her 50s presented with a 5-month history of right submandibular swelling and pain, associated with eating and relieved by gland massage. No saliva was expressed on examination. Computed tomography (CT) and ultrasonography showed normal-appearing submandibular glands and neck soft tissues. A sialogram showed high-grade stricture approximately 3 to 4 cm into the right submandibular duct orifice. Complete stricture prevented evaluation of the proximal duct and intraglandular portions. Sialendoscopy showed a widely patent right submandibular duct proximally with a segmental takeoff, consistent with the Bartholin duct draining into the Wharton duct distal to a blind pouch identified 2.5 cm from the intraoral duct orifice (Figure, A). Despite a Wharton ductoplasty to improve sublingual gland drainage through the Bartholin duct, the degree of scarring at the hilum and inability to further dilate warranted submandibular gland (SMG) excision. Four months after SMG excision, she developed a right floor of mouth lesion after “burning her mouth” with high-temperature food. Magnetic resonance imaging demonstrated a cystic lesion in the right sublingual space following the Wharton duct (Figure, B). Recurrent floor of mouth swelling (Figure, C) was addressed by repeated marsupialization and eventual sublingual gland excision. Pathologic analysis identified fragments of squamous mucosa with inflammation, cystic space, and compressed granulation tissues consistent with mucous extravasation (Figure, D).

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