Question
A 55-year-old woman comes to the physician because of a 2-week history of painful swelling on the right side of her face. The pain worsens when she eats. Examination of the face shows a right-sided, firm swelling that is tender to palpation. Oral examination shows no abnormalities. Ultrasonography shows a stone located in a duct that runs anterior to the masseter muscle and passes through the buccinator muscle. Sialendoscopy is performed to remove the stone. At which of the following sites is the endoscope most likely to be inserted during the procedure?
| A. |
Lateral to the superior labial frenulum
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| B. |
Lateral to the lingual frenulum
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| C. |
Into the foramen cecum
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| D. |
Lateral to the second upper molar tooth
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Show Answer
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Correct Answer � D
Explanation
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Answer D) Lateral to the second upper molar tooth
Explanation: Ultrasonography shows that the stone is located in the parotid duct.
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The parotid duct emerges from the anterior edge of the parotid gland, turns medially at the anterior edge of the masseter muscle, and, after piercing through the buccinator muscle, enters the oral cavity lateral to the second upper molar.
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Sialolithiasis, which affects the parotid gland or duct in approx. 20% of cases, typically manifests with acute pain while eating and tender swelling of the affected gland, both of which are seen here.
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Risk factors include dehydration, certain medications (e.g., anticholinergics), and trauma.
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Sialolithiasis is usually treated conservatively, e.g., with NSAIDs and stimulation of salivary flow by gland massage or warm compresses.
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In severe cases or if conservative treatment fails, salivary stones can be removed via sialendoscopy or open surgical procedures.
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