From the Guidelines
For submandibular lymph node swelling suspected to be due to tuberculous lymphadenitis, a 6-month regimen as described in the American Thoracic Society guidelines is recommended for initial treatment of all patients with drug-susceptible organisms. This approach is based on the most recent and highest quality evidence available, specifically the guidelines from the American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of Tuberculosis 1.
When considering treatment, it's crucial to identify the underlying cause of the lymph node swelling. For cases where tuberculosis is suspected or confirmed, the guidelines emphasize the importance of a 6-month treatment regimen for drug-susceptible organisms. Affected lymph nodes may enlarge during appropriate therapy or after treatment without evidence of bacteriological relapse, and new nodes can appear during or after treatment as well 1.
Key considerations in managing submandibular lymph node swelling include:
- Monitoring for signs of complications or failure of treatment, such as persistent fever, unexplained weight loss, or night sweats.
- Avoiding therapeutic lymph node excision except in unusual circumstances, as it is not generally indicated 1.
- Considering aspiration or incision and drainage for large, fluctuant lymph nodes that appear to be about to drain spontaneously, although this approach has not been systematically examined 1.
- Recognizing that the majority of lymphatic mycobacterial disease in children in the United States is caused by nontuberculous mycobacteria, which may require different management strategies.
Given the potential for serious underlying conditions, prompt medical evaluation is essential if lymph node swelling persists, increases in size, feels hard or fixed, or is accompanied by systemic symptoms. The management of submandibular lymph node swelling must be tailored to the specific cause and may involve collaboration with specialists in infectious diseases, especially when tuberculosis or other complex infections are suspected.
From the Research
Causes of Submandibular Lymph Node Swelling
- Nonmalignant swelling may be caused by mumps, sialadenitis, Sjögren syndrome, cysts, and infections 2
- Submandibular lymphadenopathy may also result from infections of teeth, upper respiratory tract, sinuses, and tonsils or infections like mononucleosis and cat scratch disease 2
- Neoplastic growths in the submandibular area may include tumors of the submandibular gland, the tail of the parotid gland, Hodgkin's disease, and non-Hodgkin's lymphomas 2
Diagnostic Considerations
- Sialolithiasis should always be considered in the diagnostic iter of painful submandibular swelling 3
- A careful evaluation of recurrence and characteristics of signs and symptoms associated with the swelling can help in making the correct diagnosis and planning a proper therapeutic strategy 3
- The physician should always first seek to eliminate a primary site in the head, face, and mouth area, and possible origin from other parts of the body should also be ruled out 2
Immunosuppressive Properties
- Submandibular lymph nodes may have immunosuppressive properties compared to upper jugular lymph nodes, with a higher proportion of regulatory T cells 4
- The differential distributions of regulatory T cells were observed regardless of tumor region, lymph node metastasis, and clinical staging 4
Lymphomas of the Submandibular Gland
- Lymphomas of the submandibular gland are rare and have ambiguous clinical presentations 5
- Extranodal marginal zone lymphoma had a significantly longer overall survival compared to other subtypes, with a median overall survival of 12.4 years 5
- A notable association between extranodal marginal zone lymphoma and autoimmune diseases was observed, particularly with Sjögren's syndrome 5
Autoimmune and Medication-Induced Lymphadenopathies
- Autoimmune disorders such as autoimmune lymphoproliferative syndrome, Kawasaki disease, rheumatoid arthritis, lupus erythematosus, and sarcoidosis can affect the lymph nodes and potentially mimic B and T-cell lymphomas 6
- Medications can also cause lymphadenopathies, ranging from reactive forms of follicular, interfollicular, or paracortical hyperplasia to specific B and T-cell lymphoproliferative disorders 6