Emergency Medicine

Further Reading

Maxillofacial and Dental Emergencies 435

Submandibular swellings

DIAGNOSIS AND MANAGEMENT

Look for the following possible causes:

1 Submandibular stone
This intermittently blocks the submandibular duct, causing pain and swell-
ing aggravated by food. The stone is palpable on bimanual examination in the
floor of the mouth and is seen on X-ray. Refer the patient to the oral surgery
team.

2 Submandibular abscess
The pain is constant with associated malaise, swelling in the angle of the jaw,
and trismus. Refer the patient to the oral surgery team.

3 Dental abscess
This may point downwards from a molar tooth to the submandibular area.
Treat with antibiotics and analgesia and refer to the oral surgery team.

4 Lymph node enlargement
The most common causes of cervical adenopathy in this area are tonsillitis
and pharyngitis.

5 Mumps
This affects the parotids and is usually bilateral, but can affect the sub-
mandibular glands. Remember the association with orchitis. Give the patient
paracetamol elixir, and reassure them.

6 Rare
These include carcinoma, lymphoma, sarcoid, tuberculosis, osteomyelitis,
and a bony cyst or fibrous dysplasia. Refer to the appropriate specialty team.

FURTHER READING

Cochrane Collaboration. http://www.cochrane.org/reviews/en/topics/84.html
(Cochrane review topics: Oral Health).