A lump under the jaw
Sealing under the edge of the lower jaw, which does not hurt and does not disappear.
CONDITION / JAWS, MOUTH AND NECK
Tumor of the submandibular gland.
A tumor of the submandibular gland is a lump in the salivary gland under the lower jaw. Pleomorphic adenoma is the most common of the benign ones, but there are many malignant ones, so the diagnosis is clarified before surgery.
CONCEPTUAL VISUALIZATION- What it is
- Neoplasm in the salivary gland under the edge of the lower jaw.
- How common
- In a series of 796 salivary gland tumors, 9.3% were submandibular, and 79.4% were parotid.
- Malignant
- The authors of the study from Helsinki write that approximately half of such tumors are malignant; in their series of 83 tumors — 30%.
- Who treats it
- Head and neck surgeon; if it is cancer, together with an oncologist.
01 / WHAT IS ITWhat is
What is
tumor of the submandibular gland.
The submandibular gland is a salivary gland under the edge of the lower jaw, one on each side. Three nerves pass nearby: the facial branch, which moves the lower lip, the lingual branch, which gives sensitivity to the tongue, and the sublingual branch, which moves the tongue.
The gland increases not only because of the tumor. In a series of 87 patients who underwent submandibular gland removal, stones were the cause in 73.5%, benign tumors in 18.5%, and malignant tumors in 8%.
Pleomorphic adenomas predominate among benign tumors of this gland: in the series from Helsinki — 54 out of 58 (93%). About salivary gland cancer - a separate page.
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSHow
How
a tumor presents.
Sealing under the jaw can be a tumor, a stone, or an inflammation of the gland. In appearance, they are indistinguishable, so ultrasound and puncture are needed.
Swelling for more than 2 weeks
Swelling on the side of the neck that does not go away in 2 weeks is a reason to see a doctor.
Pain while eating
Severe pain during eating lasting 1-2 hours may indicate a stone that has blocked the duct of the gland.
Salivary stone diseaseAlarming signs
Pain in the area of the breast, numbness of the face, difficulty swallowing or opening the mouth - do not postpone the examination.
Malignant tumors of the salivary glands03 / REASONSWhat affects
What affects
for treatment
The plan depends on what the tests show and how completely the tumor can be removed.
Many are malignant
In a series of 83 submandibular tumors, 30% were malignant, and 40% required additional, more extensive surgery.
Puncture can be wrong
In a study of 42 patients, a puncture found cancer in only half of the cases, if even vague findings were considered suspicious.
Tumor capsule
In a series of 72 patients, all pleomorphic adenomas of the submandibular gland had an intact capsule, and there were no recurrences during a mean follow-up of 82 months.
Complete removal
The French SFORL guideline advises removing the submandibular gland tumor completely, as a single block, rather than excision.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A tumor of the submandibular gland usually does not require emergency care - it is examined routinely. It is necessary to act immediately if the swelling interferes with breathing, or if there is bleeding after surgery.
103 immediately if:
- the bottom of the mouth or neck quickly swells, and it becomes difficult to breathe or swallow;
- it is very difficult to breathe - a person gasps for air, suffocates or cannot utter words;
- lips or skin suddenly turned pale, blue or gray;
- bleeding from the wound does not stop after the operation, although you press the wound tightly;
- the blood spurts, bright red and hard to stop.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery, pain or swelling under the jaw increases. On the same day: the wound is reddened, pus is released from it, or the temperature has risen; without swelling, it became difficult to swallow, a person coughs or chokes while eating; after the operation, the lower lip is crooked or half of the tongue is numb - tell the surgeon; without surgery, swelling under the jaw hurts, reddened, fever or pus in the mouth - see a doctor; without surgery, the lower lip or half of the face weakens, and there are no other signs of a stroke. In the coming days: the lump is growing, hard and does not move, it hurts, a part of the face is numb - to the doctor, and if he suspects cancer, to the oncologist without delay. Planned: the lump under the jaw does not hurt and remains for more than 2 weeks - make an appointment for a consultation.
05 / DIAGNOSTICSAs it turns out,
As it turns out,
what kind of tumor is this
- Review
The doctor feels the gland from the outside and the side of the mouth, checks the movements of the lower lip, tongue and sensitivity.
- Ultrasound and puncture
British guidelines recommend fine needle aspiration under ultrasound guidance for all salivary gland tumors. In a meta-analysis of 35 studies, it distinguished cancer from benign tumors with a sensitivity of 88.0%, but a benign finding does not exclude cancer.
- MRI
Shows the borders of the tumor and lymph nodes of the neck; the SFORL guideline advises MRI when pleomorphic adenoma is suspected.
- Analysis during surgery
Urgent Histology: In a study of 54 submandibular gland tumors, it detected cancer with a sensitivity of 81.3% and reduced the need for repeat operations.
- Final histology
An accurate diagnosis is made after examining the entire removed tumor.
06 / TREATMENTHow we treat
How we treat
tumor of the gland.
The main treatment is surgery. Classically, the entire gland is removed along with the tumor through an incision under the jaw. The authors of the Helsinki study advise always, whenever possible, to leave a wide margin of healthy tissue, even if the puncture showed a benign tumor.
01
Volume of operation
Depends on the histology and size of the tumor.
- Removal of the entire gland
- Standard surgery for a tumor of the submandibular gland. If the tumor is malignant, the volume may be larger: in the Helsinki series, 40% of malignant tumors required additional, more extensive surgery.
- Preservation of the gland
- For benign tumors, some centers remove only the tumor with part of the gland. In a meta-analysis of 7 studies (399 patients) after such surgery, there were fewer complications from nerves and dry mouth, and no difference in recurrences was found; but confidence in these conclusions is low.
- Experience of individual centers
- In a cohort of 105 patients with pleomorphic adenoma after gland-sparing surgery, one (0.9%) relapsed at a median follow-up of 96 months. In a comparison of 50 patients without randomization after such surgery, the contour of the neck was more satisfactory, and there were no recurrences after a median of 55 months in any group.
02
Risks of surgery
Associated primarily with the nerves next to the gland.
- Lower lip
- The branch of the facial nerve that moves the lower lip is often temporarily weakened after surgery. In a series of 139 patients who were operated on for benign gland lesions, 18.7% initially, and 2.7% later.
- Tongue
- In the same series, persistent weakening of the lingual nerve (numbness of the tongue) was present in 4.4%, there were no injuries to the hyoid nerve.
- Dry mouth
- After removal of the entire gland, dry mouth was noted in 22.1% of patients in a series of 139 people.
- Wound
- Reoperation due to infection or hematoma was required in 4.3% of patients in the same series.
03
If it's cancer
- Oncologist and radiation therapy
- British guidelines recommend postoperative radiation therapy for all malignant tumors of the submandibular gland, except for small, low-grade tumors that have been completely removed. Plan the treatment together with the oncologist.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Tumors of the submandibular gland at Dr. Valikhnovskyi's Institute of Surgery are conducted in the direction of "Oncosurgery of soft tissues": first they find out what kind of tumor it is. The surgeon decides what volume of surgery is needed based on the results of the examinations. If it is cancer, the plan is made together with the oncologist and radiation therapist; the clinic is responsible for its part.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- MRI and biopsy — the diagnosis is made by histology; it is desirable to do the biopsy where the operation will be performed.
- 3D modeling — if necessary, the MRI and CT images are converted into a three-dimensional model so that even before the operation you can see where the vessels and nerves pass nearby.
- Consilium — if cancer is confirmed, the surgeon, oncologist, and radiation therapist decide whether preoperative treatment is necessary.
- Closure of the defect with a flap — if after removing a large tumor, the wound cannot be simply sewn up, it is closed with its own tissues, often in the same operation.
- Supervision — after treatment of a malignant tumor — regular examinations and MRI of the surgical site.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend the results of ultrasound, MRI, puncture or histology, if they are available - the doctor will pre-evaluate the situation.
- ConsultationReview, talk about how long the seal has been there, does it hurt and does it change while eating.
- ExaminationThe doctor will tell you what tests are needed: usually an ultrasound with a puncture and an MRI, if necessary, a biopsy to know the diagnosis before surgery.
- PlanWhat to do with the gland; if it is cancer — a joint decision with the oncologist.
- SupervisionThe doctor explains the results of the histology and monitors the healing and functioning of the nerves.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is a submandibular gland tumor a cancer?
Not necessarily, but there are a lot of malignant ones: in a series of 83 tumors - 30%. Therefore, ultrasound with puncture and MRI are performed first, and the final diagnosis is made by histology.
A puncture showed a benign tumor. Is it possible not to operate?
A puncture can miss the cancer, so the guidelines recommend removing the tumor completely. You make a decision together with the surgeon after all the examinations.
Is it necessary to remove the entire gland?
Classic yes. With benign tumors, some centers retain part of the gland; data on this is encouraging, but confidence in them is still low.
Will the mouth be dry without one gland?
Maybe: in a series of 139 patients after removal of the gland, dry mouth was noted in 22.1%.
Can the lip be crooked after surgery?
Temporary weakness of the lower lip occurs often, but mostly passes: in a series of 139 patients — 18.7% initially and 2.7% in the long term. In another series (124 operations in the submandibular area without malignant tumors), weakness was present after 29.8% of operations, and in all of them it passed.
Will there be a noticeable scar?
An incision is made under the jaw. In a series of 139 patients, 2.5% were dissatisfied with the appearance of the scar; problems with the scar more often occurred after a wound infection.
Can the tumor come back?
Pleomorphic adenoma of the submandibular gland rarely recurs: there were no recurrences in a series of 72 patients, and one recurrence in a cohort of 105 patients.
Sources
20 sources · clinical guidelines, meta-analyses, patient cohorts and series, NHS and Cancer Research UKshowCollapse
- Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenomaEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2021doi:10.1016/j.anorl.2020.09.002 ↗
- Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology, 2016doi:10.1017/S0022215116000566 ↗
- Preoperative evaluation and surgical planning of submandibular gland tumorsHead & Neck, 2017doi:10.1002/hed.24691 ↗
- Relative Frequency of Primary Salivary Gland Tumors: Multicenter Study of 796 Cases from Riyadh, Saudi ArabiaMedicina, 2024doi:10.3390/medicina60122022 ↗
- Extracapsular dissection versus total excision for benign submandibular gland tumorsEuropean Journal of Surgical Oncology, 2024doi:10.1016/j.ejso.2023.107928 ↗
- Comparisons between partial and total sialoadenectomy for benign submandibular gland tumors: A systematic review and meta-analysisJournal of Cranio-Maxillofacial Surgery, 2025doi:10.1016/j.jcms.2025.03.017 ↗
- Functional gland-preserving surgery for submandibular gland pleomorphic adenomaJournal of Cancer Research and Clinical Oncology, 2022doi:10.1007/s00432-021-03844-8 ↗
- Submandibular gland pleomorphic adenoma: Histopathological capsular characteristics and correlation with the surgical outcomeAnnals of Diagnostic Pathology, 2018doi:10.1016/j.anndiagpath.2018.04.002 ↗
- The role of frozen section biopsy for submandibular gland tumorsActa Oto-Laryngologica, 2021doi:10.1080/00016489.2021.1946137 ↗
- Frozen Section Analysis in Submandibular Gland Tumors: Optimizing Intraoperative Decision-MakingCancers, 2025doi:10.3390/cancers17050895 ↗
- Application of the Milan System for Reporting Salivary Gland Cytopathology: A systematic review and meta-analysisCancer Cytopathology, 2022doi:10.1002/cncy.22604 ↗
- Transcervical extirpation of the submandibular gland: the University of Marburg experienceEuropean Archives of Oto-Rhino-Laryngology, 2014doi:10.1007/s00405-013-2720-9 ↗
- Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institutionEuropean Archives of Oto-Rhino-Laryngology, 2013doi:10.1007/s00405-012-2175-4 ↗
- Nerve paralysis after surgery in the submandibular triangle: review of University of Tokyo Hospital experienceHead & Neck, 1997pubmed.ncbi.nlm.nih.gov/9030945 ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Salivary gland stonesNHS, 2023nhs.uk/conditions/salivary-gland-stones ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Swallowing problems (dysphagia)NHS, 2023nhs.uk/symptoms/swallowing-problems-dysphagia ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Symptoms of salivary gland cancerCancer Research UK, 2026cancerresearchuk.org/about-cancer/salivary-gland-cancer/symptoms ↗
The figures on the page are from these sources.
Sealing
under the jaw?
Send the findings of the ultrasound or MRI, if available. The doctor will tell you what tests are needed and where to start.