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Clinical Challenge
August 29, 2019

Solitary Mucus Cast at the Wharton Duct Orifice

Author Affiliations
  • 1Krishna Institute of Medical Sciences, Karad, Maharashtra, India
  • 2Department of Otolaryngology–Head & Neck Surgery, Weill Cornell Medical College, New York, New York
JAMA Otolaryngol Head Neck Surg. 2019;145(10):969-970. doi:10.1001/jamaoto.2019.2252

A woman presented with a 2-year history of recurring left submandibular gland swelling and pain. She reported no associated fevers, chills, dryness of mouth, nausea, vomiting, dysphagia or odynophagia. Her medical history was unremarkable except for allergic rhinitis. On physical examination, she had slight enlargement of the left submandibular gland, which was not tender on palpation. Ultrasonography results revealed normal submandibular and parotid glands bilaterally without any mass or calcifications. Blood examinations and basic metabolic panel results were all within normal limits. Sialoendoscopy of the left submandibular duct was performed under general anesthesia. The patient was found to have a cast at the opening of the Wharton duct, which was removed and sent for pathological evaluation (Figure). Using sialoendoscopy with saline irrigation, the entire duct was examined up to the hilum of the gland. No stones were noted. There were areas of mild partial webbing without complete obstruction. The areas of webbing were broken up with irrigation, and at the end of the procedure steroid instillation and irrigation were performed. There were no complications during or after the procedure.

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