Evaluation of a submandibular mass: Key points

  • 50% are malignant
  • Adenoid cystic carcinoma is the most common malignancy
  • Clinical evaluation, cytology and imaging do not conclusively exclude malignancy….hence complete resection of the tumour and histological examination are required, or if surgery is not to be done, a core needle biopsy
  • Objectives of preoperative evaluation
    • Distinguish between a submandibular lymph node and salivary mass
    • Avoid unnecessary surgery
    • Do appropriate surgery
    • Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
  • History and examination are important means to identify non-neoplastic causes e.g. sialadenitis, sialolithiasis, and benign and malignant primary tumours, although 2/3 of malignant tumours are clinically benign
  • FNAC is helpful in selected cases
  • Ultrasound may distinguish a lymph node from a salivary mass, and identify cervical nodal metastases
  • Histological classification of primary salivary gland neoplasms is difficult and complex. Cytological and histological diagnoses should always be treated with caution and viewed in a clinical context, especially if not reported from centers of excellence

Index: Clinical Practice Guidelines for Submandibular Gland

Resource Appropriate Submandibular Gland Guideline Scenarios