The submandibular glands are major salivary glands that sit on each side of the upper neck, just beneath the lower jawbone. Together with the parotid gland and the sublingual glands, they form the three pairs of major salivary glands, which produce saliva and drain it into the mouth through small ducts under the tongue.
A lump, swelling or abnormal growth in or around the submandibular gland does not always come from the gland itself. The submandibular triangle also contains lymph nodes, blood vessels, nerves and soft tissues. An enlarged lymph node, skin cyst or other neck mass can sometimes feel like an enlarged submandibular gland.
Many submandibular lesions are benign, meaning non-cancerous. Some are caused by salivary stones, blocked saliva flow or infection. Others are tumours. Compared with parotid gland tumours, where most salivary gland tumours are benign, submandibular gland tumours are more likely to be malignant. About 50% of submandibular gland growths are cancerous, so a persistent swelling below the jaw should not be ignored.
Symptoms of a submandibular lesion depend on whether the cause is a blockage, infection, inflammation, or a tumour. A stone often causes swelling or pain in the upper neck that worsens with eating. The swelling may decrease after meals, then return.
An infection may cause rapid swelling, tenderness, redness, warmth, fever, a bad taste in the mouth, or pus from the duct under the tongue. Some patients feel generally unwell. A recurrent infection may cause repeated episodes of discomfort and swelling in the same area.
A tumour may be painless at first. It may feel like a firm lump under the jaw that slowly grows over time. Benign tumours are often mobile, but this is not always reliable. A hard, fixed, rapidly enlarging or painful lump needs a prompt medical review.
Red flag symptoms include facial weakness, numbness, tongue weakness, difficulty moving the jaw, difficulty swallowing, persistent neck swelling, an unexplained weight loss or enlarged lymph nodes. These symptoms do not confirm cancer, but they often mean the lesion needs a timely assessment by an ENT specialist.
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You should see an ENT specialist if a lump below the jaw persists, grows, recurs or is associated with pain, infection or nerve symptoms. A short-lived tender swelling during an obvious infection may settle with treatment, but persistent submandibular swelling should be checked.
Arrange an ENT review if swelling becomes worse during meals, if infections keep returning, or if there is discharge or pus in the mouth. These features may point to a salivary stone or a blocked duct.
You should seek a prompt assessment if the lump is hard, fixed, rapidly increasing in size, or associated with numbness, lower facial weakness, difficulty swallowing or opening the mouth or any unexplained neck nodes. These features can occur with a more severe salivary gland disease and may increase the risk of malignancy of the submandibular lesion.
Diagnosis of a submandibular lesion starts with a detailed history, physical examination and an assessment of the mouth and neck. The ENT specialist will ask when the lump appeared, whether it changes with meals, whether it is painful, and whether there have been infections, fever, dry mouth, dental problems or any previous neck lumps.
A physical examination of the gland from inside the mouth and under the jaw at the same time may be performed. This can help assess the gland, duct and any possible stones.
An ultrasound is often a useful first imaging test. It can help distinguish among a solid mass, a cyst, an enlarged lymph node, an abscess, or a stone. It is painless and does not use radiation. A CT scan or an MRI may be recommended when the lesion is deep, complex, suspicious, recurrent, or being considered for surgery. A CT scan is particularly helpful for stones and bony detail, while an MRI can show soft-tissue extent and possible nerve or deep-tissue involvement.
Fine-needle aspiration, which uses a thin needle to collect cells for laboratory testing, may be recommended when a tumour is suspected. It can help guide planning, although it may not always give a definitive diagnosis. In some cases, the final diagnosis is confirmed only after the gland or lesion is removed and examined under a microscope, and the patient is then told whether they have a benign growth or cancer.
Non-surgical management may be appropriate for infection, inflammation or selected obstructive salivary gland problems. Treatment depends on the likely cause and severity.
For an acute infection, treatment may include antibiotics, pain relief, hydration, warm compresses and gentle massage to encourage saliva flow. Patients may be advised to maintain good oral hygiene and, if appropriate, use sour sweets or lemon drops, as these can stimulate saliva production. If an abscess forms, drainage may be needed.
For salivary stones, small stones near the duct opening may sometimes pass or be removed through the mouth. Supportive measures may help when the blockage is mild. However, larger stones, deeply placed stones or recurrent infections may need procedural treatment or removal of the gland.
Non-surgical care is less suitable when a solid tumour is suspected. Medication cannot reliably distinguish benign from malignant tumours or remove a growing salivary gland mass. In these cases, imaging and biopsy help guide the next step, and a tumour is often best treated by removing the gland.
An operation may be recommended when a submandibular lesion is a tumour, recurrent infection, persistent cyst or obstructive disease that does not settle with conservative care. The exact procedure depends on the cause, location and risk profile.
For many submandibular gland tumours, the usual operation is an excision of the submandibular gland with the lesion. This removes the gland through an incision in the upper neck, usually placed in a natural skin crease where possible. Removing the whole gland is often preferred because tumours arise within the gland, and the complete removal reduces the risk of leaving diseased tissue behind.
For benign tumours such as a pleomorphic adenoma, complete excision helps reduce any recurrence. For malignant tumours, the procedure may involve the removal of the gland and tumour, with a careful assessment of margins. If lymph nodes are involved or at significant risk, a neck dissection may be considered. Some patients with salivary gland cancer may also need radiation therapy afterwards, depending on the cancer type, grade, stage, margins, nerve involvement and lymph node findings. These treatment options are discussed individually with your doctor.
If the lesion is due to stones or a chronic infection, the procedure may still involve removing the submandibular gland when the symptoms are recurrent or the gland is no longer functioning well.
Recovery after excision of a submandibular lesion or gland is usually manageable, but careful follow-up is important. The operation is commonly performed under general anaesthesia. Patients may go home the same day or stay overnight, depending on the extent of the operation and their overall health.
Afterwards, there may be mild pain, tightness, bruising or swelling in the upper neck. A small drain may be used for a short time to prevent fluid collection. Stitches may be dissolvable or removed at follow-up. Most patients can eat soft foods soon afterwards and return gradually to normal activity, although heavy lifting and strenuous exercise are usually avoided at first.
Risks include bleeding, infection, fluid collection, scarring, numbness and wound-healing problems. Some risks involve the small nerves near the submandibular gland. These nerves help move the lower lip and tongue and affect sensation and taste in parts of the tongue. Nerve problems are uncommon, but if they occur, they may cause a temporary uneven smile, tongue numbness, taste changes or tongue weakness.
If a cancer is diagnosed, recovery may include further scans, staging discussions and additional care planning.
Barrie Tan ENT Head & Neck Surgery can help patients with a submandibular lesion by providing a careful assessment, imaging guidance, and the appropriate treatment plan. Dr Barrie Tan evaluates neck lumps, salivary gland swelling, suspected stones, recurrent infections and possible salivary gland tumours at Gleneagles Hospital in Singapore.
The consultation focuses on identifying the source of the swelling. This matters because a lymph node, salivary stone, cyst, infection, and tumour can feel similar to a patient, but each requires a different care plan. Dr Tan will assess the neck and mouth, review symptoms, arrange imaging as needed, and discuss whether a Fine-Needle Aspiration (FNA) biopsy or an operation is appropriate.
If the cause is an infection or obstruction, treatment may begin with medication and supportive care. If a tumour is suspected, Dr Tan will explain the diagnostic process, the reason an operation may be advised, and the expected recovery. When cancer is a concern, he can guide patients through the next steps with a clear, measured and patient-first approach.
Early assessments help separate simple causes from conditions that need prompt treatment. If you have a submandibular swelling, recurrent pain after meals, or a neck lump that does not settle, contact Barrie Tan ENT for a consultation.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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