Submandibular Salivary Gland tumours and cancers: History and examination


  • Avoid unnecessary surgery
  • Do appropriate surgery
  • Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
  • Distinguish between submandibular lymph node and salivary mass

Distinguishing lymph node from SMG mass

  • Unlike the parotid, there are no intraglandular lymph nodes
  • Lymph nodes are lateral/superficial to the SMG
  • Palpate the mass between a finger placed on the floor of mouth and another on the neck: lymph nodes are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
  • If still uncertain, proceed to U/S or FNAC

Suspicious for malignancy

  • Malignant tumours may have benign clinical features in 2/3 of cases
  • Rapid growth
  • Pain (30% of malignant tumours)
  • Extra-glandular extension
    • Adherence to mandible
    • Skin
    • Floor of mouth
    • Neurological deficits
      • Hypoglossal nerve
      • Lingual nerve
      • Marginal mandibular nerve
  • Cervical lymphadenopathy
  • Previous salivary cancer
  • Previous radiation to salivary gland region

Index: Clinical Practice Guidelines for Submandibular Gland

Resource Appropriate Submandibular Gland Guideline Scenarios