Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Submandibular Gland Problems

The submandibular glands area small paired glands which lie just beneath the mandible (jaw bone).  They produce saliva which passes along the duct to enter into the floor of the mouth, just under the tongue.

Glands can become swollen and or painful and these symptoms can fluctuate.  An Ear, Nose and Throat surgeon will be able to examine and investigate the problem; this can occur because of drainage problems of the duct or the development of stones.  Occasionally other conditions can occur which can produce infection or inflammation to give rise to these symptoms.  A swelling of the associated lymphoid tissue may develop within the capsule of the gland and swelling can occur due to a benign or malignant growth of cells associated with the salivary gland, or – rarely – metastatic cells from a primary growth elsewhere in the head and neck.

Investigations which the ENT surgeon may require includes an ultrasound scan and occasionally a needle test to obtain cells from the gland.  A sialogram (involving the injection of contrast medium into the salivary duct system and subsequent X-ray to assess the drainage of the duct system) may be required.  Further imaging, by MRI or CT scanning, is occasionally necessary.

Such problems with the submandibular gland may not necessarily lead to surgery and can be amenable sometimes to other treatment.  In the event of severe problems with pain or swelling, or to achieve a histological diagnosis to plan further treatment, it may be necessary to remove the gland.  In the case of duct stones reasonably close to the opening of the duct underneath the tongue it may be possible to remove stones through the mouth under local anaesthesia, without the need for incision externally.

Excision of the submandibular gland will leave a scar around 5cms – 7cms long below and parallel with the line of the mandible (jaw bone).  The loss of an individual salivary gland will have no impact on overall production of saliva and will not lead to a dry mouth.  There are, however, specific associated risks largely due to the nerves which lie in very close proximity to the gland.  These are as follows:  weakness of the movement of the angle of the mouth (due to the marginal mandibular nerve), weakness of movement of the tongue towards the side of the surgery (due to bruising or damage to the hypoglossal nerve) and numbness of an area of the tongue (due to bruising or damage of the lingual nerve).  Each of these symptoms may be temporary or permanent although the risk of permanent problems is low, but does exist.

A small drain may be inserted in the neck at the end of the procedure and retained for 24 hours after surgery, with discharge home 6 to 24 hours after its removal.