A 21 year old otherwise healthy male presents with 1 week of right swelling and pain at the floor of his mouth. He reports no trouble swallowing, fevers, difficulty opening his mouth, or drooling. He has no changes in speech. On physical exam you see below:

What is your next step in the management of this patient?

A. CT facial bones with IV contrast

B. 10 day course of Augmentin

C. Tart Candies and Analgesia

D. Nasopharyngeal laryngoscopy

Answer: C. Tart candies and analgesia 

This patient is demonstrating signs and symptoms of sialolithiasis. This occurs when calcium stones build up in the salivary glands. Most commonly this occurs in the submandibular gland (as in this patient) however can occur in the other salivary glands as well. On exam, you will see swelling and firmness in the gland, and if stones are present you can massage them out of the gland. Treatment is supportive. Tart candies may help with excretion of the stones from the gland. Antibodies are only indicated if there is concern for superimposed infection.

References: 

1. Lareau SA, Heitz CR. Face and jaw emergencies. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 243.

2. http://entcase.org/manuscript/566/makale/bas-boyun-cerrahisi/an-unusual-case-of-ankyloglossIa-wIth-sublIngual-sIalolIthIasIs.htm