Sir, as primary care practitioners charged by the NHS to deliver care at ever decreasing costs, we present this as a novel alternative to surgical interventions for the treatment of salivary gland stones.

A 47-year-old male presented to our clinic having been referred by his local GP who had prescribed 500 mg amoxicillin and 125 mg calvulonic acid for a painful floor of mouth swelling.

The patient presented with pain on the lower left submandibular region, notably worse after eating. The problem had been recurring in the last few months but had become acutely painful and swollen in the last 48 hours.

Examination revealed a 3 cm diffuse swelling in the left submandibular region behind a solid mass palpable in the left submandibular duct.

A provisional diagnosis of acute abscess caused by a submandibular sialolith was made and the gentleman advised to return for review in a week while massaging.

The patient had had a similar occurrence a few years back which resulted in the removal of his RHS submandibular gland.

On presentation after one week the patient had extracted and milked the duct himself to remove the stone. He used copious amounts of lemon juice and actively massaged the duct to remove the stone. It measured 21 × 6 mm (Fig. 1).

Figure 1
figure 1

The extracted sialolith

Full size image

This is an interesting alternative to surgery for the removal of large stones; one we have not been taught to do!