ABOUT SUBMANDIBULAR SURGERY
What is the submandibular gland?
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
What problems can you have with the submandibular gland?
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. Sometimes the swelling may 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
What investigation are you likely to have?
An X-ray or CT scan of the submandibular gland:
This is to see if there are stones inside the gland or
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.
This test uses sound waves to detect any lumps inside
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.
Why operate on the submandibular gland?
● If stones inside the duct do not come out, the gland may
swell up when you eat. These stones can be removed.
This procedure is done through the mouth either under a
local or general anaesthetic. Your consultant will discuss
the options with you.
● If stones are stuck inside the submandibular gland, the
gland can become permanently inflamed and swollen. Ifit gives you undue discomfort over a longer time, your
specialist may advise to have the gland removed.
● If a lump has developed in the submandibular gland,
your surgeon may recommend removing the gland.
As a fairly high number of submandibular lumps can
be cancerous the whole gland should be removed. By
removing the gland we can find out whether it is
benign or cancerous.
You may change your mind about the operation at any
time, and signing a consent form does not mean that you
have to have the operation.
If you would like to have a second opinion about the
treatment, you can ask your specialist. He or she will not
mind arranging this for you. You may wish to ask your
own GP to arrange a second opinion with another
The operation to remove the gland
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. The operation will take about an hour.
At the end of the operation the surgeon 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.
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.
This is uncommon in the neck but can happen if the
submandibular gland was badly infected. Wound infection
will require antibiotic treatment. Pus collected under the
skin may need to be drained.
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 the face and ear
The skin around the wound may be numb after the
operation. If that happens the numbness will usually
improve over the next three months.
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 will usually go, and 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
Will my mouth be dry?
You are very unlikely to notice any dryness of the mouth.
How long will I be off work?
You will need two weeks off work.
This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information given may not be comprehensive and patients should not act upon it without seeking professional advice. Copyright © 2010 ENT•UK