There are two submandibular glands underneath the jaw line - one on the left and one on the right side of the neck. Their job is to secrete saliva into the mouth that keeps the mouth and throat moist, and aids digestion.
There are 3 main problems that can occur in these glands:
1)the duct that leads into the mouth can get blocked and saliva backs up into the gland causing swelling.
The gland can be massaged when it swells up, and you can suck on a slice of lemon to promote the flow of saliva. If this does not work, and the stone is palpable in the floor of the mouth, it is possible to do a small operation (under general anaesthetic) to make a cut over the stone and remove it from the duct. Alternatively, it is possible to insert a fine camera, into the duct, to remove the stone (sialendoscopy). It is also possible to perform an excision of the gland under general anaesthetic.
2) the gland can become recurrently infected and inflamed. This is called sialadenitis. You may need surgery to remove the gland if the problem is severe.
3) A lump in the gland
If you feel a lump in the gland, it is possible for me to send you for an ultrasound and needle biopsy of the lump to further investigate this. 50% of lumps in the submandibular gland are cancerous, compared to 20% in the parotid salivary gland. If a benign lump is suspected, it is necessary to excise the submandibular gland.
A submandibular gland excision involves coming into hospital, having a general anaesthetic (so you will be fully asleep). I then make a 7-8cm cut under the jawline. I then remove the gland and send it off to the laboratory for analysis. I put a drain in the neck to remove any excess fluid. This plastic tube is connected to a bottle. When fluid stops draining into the bottle, we take out the drain and send you home. Most of the time you are in hospital for 1 to 2 nights. You need 2 weeks at home after the surgery, not because it is painful, but rather I don’t want you to pick up a wound infection.
The risks of the operation are pain, bleeding, infection, general anaesthetic, collection of blood or fluid under the skin, damage to the nerves that move the tongue, shoulder, or corner of the mouth, reduced sensation to the tongue, recurrent lumps in the area if tumour the tumour splits during surgery, and 20% risk of mortality if COVID positive during the general anaesthetic.
If a cancer is diagnosed in the submandibular gland on needle biopsy, I would recommend a scan of neck, chest and abdomen to make sure it has not spread anywhere else in the neck or body.
If it hasn’t spread to the lungs or liver, it is treatable and curable. I would perform a neck dissection operation to remove the submandibular gland and the surrounding lymph nodes that are affected. Sometimes this operation is followed up by radiotherapy treatment to reduce the chance of recurrence of the cancer.