From the Guidelines
Submandibular gland swelling is typically treated with surgical removal of the stone or tumor, and in some cases, antibiotics may be prescribed to manage infection.
Causes and Treatment Options
- The most common cause of submandibular gland swelling is a salivary stone, which can be diagnosed through imaging and ultrasound 1.
- Surgical removal of the stone or tumor is often the recommended treatment, especially if the stone is blocking the duct and causing infection 1.
- In cases of infection, antibiotics may be prescribed to manage the infection, and in severe cases, incision and drainage may be necessary 1.
- For tumors, the treatment depends on the stage and grade of the tumor, and may include surgical excision, radiotherapy, or a combination of both 1.
Diagnostic Approach
- Bimanual palpation can help diagnose a salivary stone, and imaging such as ultrasound can confirm the diagnosis 1.
- Gram-stained smears and anaerobic cultures can help identify the cause of infection, especially in cases of odontogenic infection 1.
Management
- Referral to an oral/maxillofacial surgeon is often necessary for further management of submandibular gland swelling, especially if surgical removal of a stone or tumor is required 1.
- Pain management may also be necessary, and can include medications such as amitriptyline or botulinum toxin 1.
From the Research
Treatment Options for Submandibular Gland Swelling
The treatment for submandibular gland swelling depends on the underlying cause of the condition. Some possible treatment options include:
- Rehydration and oral antistaphylococcal antibiotics, as well as hygiene and repeated massaging of the gland, for acute sialadenitis 2
- Conservative therapies like milking of ducts with palliative therapy for small and accessible stones in sialolithiasis, with surgical management considered for inaccessible or large stones 3
- Botulinum toxin type A injections for benign submandibular gland hypertrophy, which can provide safe and long-lasting results with a high satisfaction rate 4
- Gland-preserving therapy, such as miniature endoscopy (sialendoscopy), for sialolithiasis 5
- Sialendoscopy (SE) for recurrent salivary gland swelling, which can be an effective interventional option with a high response rate, especially for submandibular gland swelling 6
Specific Treatment Approaches
For sialolithiasis, treatment may involve:
- Conservative therapies for small stones
- Surgical management for large or inaccessible stones
- Sialendoscopy for gland-preserving therapy For benign submandibular gland hypertrophy, treatment may involve:
- Botulinum toxin type A injections to shrink the affected tissue
- Intraglandular injections using a specific dilution and dosage of neurotoxin preparations For recurrent salivary gland swelling, treatment may involve:
- Sialendoscopy as a first-line intervention
- Balloon dilation or stone removal as part of the SE procedure
- Steroid injection, although its beneficial effect is still being determined 6