The submandibular glands are a pair of salivary glands under the jaw bone. Each gland produces saliva which goes through a long duct to its opening under the tongue at the front of the mouth. The production of saliva increases when we eat. The saliva secreted by the submandibular gland is a bit thicker than that produced by other salivary glands. Because of its thickness this saliva can sometimes form little stones.

The commonest problem is blockage of the salivary duct. This can be caused by the presence of stones or simply a narrowing of the salivary duct. Blockage of the salivary duct can cause a painful swelling of the gland when you eat. In most cases the swelling will settle on its own. When the blockage is severe, it can lead to persistent inflammation of the gland. Occasionally, a painless lump may develop within the submandibular gland. Those lumps are often benign but need thorough checking, as up to half of them may be or become cancerous. Even benign lumps can get gradually bigger.

An X-ray or CT scan of the submandibular gland: This is to see if there are stones inside the gland or the duct.

Sialogram: The doctor fills the duct at the front of the mouth with some contrast liquid and then takes x-rays. This will show up stones or narrowing inside the duct.

Ultrasound: This test uses sound waves to detect any lumps inside the gland.

Fine needle aspiration: This can help to find out the nature of the lump. The doctor uses a fine needle to draw some cells out from the lump. The cells are sent to the laboratory for analysis.

The commonest reason for recommending removal of submandibular gland is presence of stone that blocks its duct. If stones inside the duct do not come out, the gland may swell up when you eat. If the stone is in the part of the duct under your tongue, these can be removed through the mouth either under a local or general anaesthetic.

However, if the stones are stuck inside the submandibular gland or there is narrowing of its ducts causing inflammation or enlarged gland, I would advise to have the gland removed.

The other disease when I recommend removal of this gland is if a lump has developed in your submandibular gland. By removing the gland we can find out whether the lump is benign or cancerous.

The operation is performed under general anaesthetic, which means that you will be asleep throughout. An incision will be made in the neck below the jaw where the submandibular gland lies that leaves a scar that will get faint with time. The operation will take about 2-3 hours. At the end of the operation I will place a drain (plastic tube) through the skin in order to prevent any blood clot collecting under the skin. Most patients will require 24-48 hours in hospital after the operation before the drain can be removed and they can go home.

The skin around the wound will be numb for some weeks after the operation. It usually improves over weeks/ months.

Serious complications are very rare after this operation but may include

  • Blood clot -A blood clot can collect beneath the skin (this is called a haematoma). This occurs in up to 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.
  • Weakness of the lip - There is an important nerve that passes under the chin close to the submandibular gland. It makes the lower lip move. If it is damaged during the surgery it can lead to a weakness of the lower lip. In most cases this nerve works normally after the surgery, however in some cases weakness of the lower lip can occur, particularly when the gland is badly inflamed or if the nerve is stuck to a lump. This weakness is usually temporary and can last for 6 - 12 weeks. Occasionally there is a permanent weakness of the lower lip following this surgery.
  • Numbness of tongue - The nerve which gives sensation and taste to one half of the tongue runs close to the duct of the gland. It very rarely gets injured. However, if this nerve is damaged your tongue may feel numb immediately after the operation. This numbness will usually recover. Permanent numbness of the tongue is rare.
  • Injury to the nerve that ‘moves’ the tongue - Another nerve runs close to the submandibular gland that supplies the muscles of the tongue on that side (and hence helps with movement of the tongue).It would be very unusual for this nerve to be damaged in this surgery. If it were to occur, it is unlikely to produce any noticeable disability.


Northampton General Hospital
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Northampton NN1 5BD
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