Submandibular Gland 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

little stones.

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

gradually bigger.

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 duct.


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

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.

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.

Possible Complications

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.

Wound infection

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.

Facial weakness

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