Diseases of the submandibular gland (下頜下腺疾病)

The superficial portion of the gland lies on the mylohyoid muscle; the deep portion extends around the posterior edge of muscle into the floor of the mouth. Wharton’s duct leaves the deep part of the gland and runs forward to open into the anterior floor of the mouth, just lateral to the midline.

Swelling of the gland may be due to inflammation or tumour.

Inflammatory diseases

Clinical features:

A tense, tender swelling usually results from a stone in the duct. This may be palpable bi-manually or evident on X-ray. There are several lymph nodes in the submandibular triangle and enlargement of these may mimic disease in the gland.

Management:

Treatment is with antibiotics and excision of the stone perorally. If this cannot be achieved , the whole gland may need to be removed by an external approach. Established infection may proceed to abscess formation.

Tumours

Fine-needle aspiration of the mass should be performed. About 50% of tumours are benign, most commonly pleomorphic adenomas.

Management:

These should be excised with the entire gland, taking care to preserve the marginal mandibular branch of the facial nerve. Malignant tumours necessitate excision of the whole gland, with a radical neck dissection in certain cases.