Solid Swellings of the Anterior Triangle: A Submandibular Gland Swelling

Abstract

The submandibular gland is the second largest major salivary gland and weighs approximately 10 g. It is classified as a “mixed gland” that is predominantly serous with tubular acini. Acute submandibular sialadenitis is usually secondary to obstruction of Wharton’s duct and is often recurrent. Chronic sialadenitis is typically less painful than the acute form and is associated with recurrent enlargement of the gland (often following meals) typically without erythema. Approximately 85% of all salivary calculi occur in the submandibular gland, with approximately 70% of these demonstrable as radio-opacities on routine plain radiography. Sialadenosis refers to a non-neoplastic, noninflammatory swelling in association with acinar hypertrophy and ductal atrophy. Tumors of the submandibular gland are the second most frequent major salivary gland neoplasms after those of the parotid gland. They account for about 10% of all salivary neoplasms, and approximately 50% are malignant. This chapter discusses the clinical, imaging, and endoscopic and histological evaluation of a submandibular swelling. It also addresses the clinical presentation, investigations, diagnosis, and treatment of patients with acute and chronic submandibular sialadenitis, sialolithiasis, sialadenosis, or submandibular gland tumors.