A modern view of diseases requiring prompt access to the submandibular region

Inflammation of the submandibular region occurs quite often in dental practice. The ethology and clinical manifestations of this pathology are diverse and despite the great possibilities of conservative therapy, in some cases it is necessary to perform surgical intervention. The causes of inflammation in the submandibular region are odontogenic diseases, lymphadenopathies, sialorrhea, neoplasms of submandibular salivary glands and sialolithiases. The odontogenic abscesses (88.9 % of cases) and phlegmon (2.7–3.4 % of cases) of the maxillofacial region account for 88.9 % of oral infections. Odontogenic diseases are accompanied by impaired colonization resistance of the oral cavity and are of a big problem. Lifadenopathies in the submandibular region occur in 70 % of cases, while surgical treatment is required for 4 % of patients with this pathology, intensive postoperative medical therapy – 1.7 %, lethality occurs in 0.12 % of cases. Sialorrhea often develops in patients with mental retardation, cerebral palsy, autism, and neuromuscular or sensory dysfunctions. with low efficacy of anticholinergic drugs or botulinum toxin arministration, the main treatment is submandibular resection. Benign neoplasms of the submandibular salivary glands occur in 13 % of cases and are malignancies more often than tumors of the parotid gland. Neoplastic diseases of the submandibular glands of the maxillofacial region account for 34 to 54 %. The most common pathology of these glands is salivary stone disease which occurs in 80–90 % of cases.

Aim. To analyze the main causes of inflammation in the submandibular region, requiring surgical intervention

1. Borner U., Anschuetz L., Caversaccio M. at al. A retrospective analysis of multiple affected salivary gland diseases: diagnostic and therapeutic benefits of interventional sialendoscopy. Ear Nose Throat J 2024;103(11):NP662–70. DOI: 10.1177/01455613221081911

2. Kochurova E.V., Nikolenko V.N. Monitoring of patients with tumors of the maxillofacial region on stages of complex treatment. Voprosy onkologii = Oncology Issues 2017;63:90–4. (In Russ.). DOI: 10.37469/0507-3758-2017-63-1-90-94

3. Global oral health status report: towards universal health coverage for oral health by 2030. Thumbnail. View/Open.

4. Lozano C.P., Faustova M.O., Loban G.A. Editorial: odontogenic infection as a complication of dental caries: microbiological and molecular aspects. Front Oral Health 2024;5:1385026. DOI: 10.3389/froh.2024.1385026

5. Kim S.Y., Park I.H., Byun C.S. at al. Associations between peritonsillar abscess and deep neck infection in chronic periodontitis patients: two nested case-control studies using a national health screening cohort. J Clin Med 2024;13(8):2166. DOI: 10.3390/jcm13082166

6. Park J.O., Kim J.H., Joo Y.H. et al. Guideline for the surgical management of locally invasive differentiated thyroid cancer from the Korean society of head and neck surgery. Clin Exp Otorhinolaryngol 2023;1(16):1–19. DOI: 10.21053/ceo.2022.01732

7. Moghaddam L.F., Vettore M.V., Bayani A. et al. The Association of Oral Health Status, demographic characteristics and socioeconomic determinants with oral health-related quality of life among children: a systematic review and meta-analysis. BMC Pediatr 2020;20(1):489. DOI: 10.1186/s12887-020-02371-8

8. Sharafutdinova N.Kh., Mukhamadeeva O.R., Khalfin R.M. Improvement of the organization of dispensary observation of patients with chronic dermatosis. Menedzher Zdravoohraneniya = Health Manager 2024;8:18–25. (In Russ.). DOI: 10.21045/1811-0185-2024-8-18-25

9. Kaushik A., Rana N., Ashawat M.S. et al. Alternatives to β-lactams as agents for the management of dentoalveolar abscess. Curr Top Med Chem 2024;24(21):1870–82. DOI: 10.2174/0115680266289334240530104637

10. Ghasemi S., Mortezagholi B., Movahed E. et al. Neutrophil to lymphocyte ratio in odontogenic infection: a systematic review. Head Face Med 2024;20(1):21. DOI: 10.1186/s13005-024-00421-5

11. Dudhe P., Burse K., Kulkarni S. et al. Clinical profile and outcome of head and neck abscesses in 68 patients at a tertiary care centre. Indian J Otolaryngol Head Neck Surg 2023;75(2):668–74. DOI: 10.1007/s12070-022-03409-2

12. Mahmoud R., Arbel S., Ianculovici C. et al. Antimicrobial therapy in the management of odontogenic infections: the penicillin-allergic patient. Int J Oral Maxillofac Surg 2024;53(3):251–7. DOI: 10.1016/j.ijom.2023.09.001

13. Derruau S., Bogard F., Exartier-Menard G. et al. Medical infrared thermography in odontogenic facial cellulitis as a clinical decision support tool. A technical note. Diagnostics (Basel) 2021;11(11):2045. DOI: 10.3390/diagnostics11112045

14. Lingl J.P., Böhm F., Wiegel T. et al. PSMA-PET und “radio-guided surgery” bei zervikaler lymphadenektomie [PSMA-PET-MRI and radio-guided surgery in cervical lymphadenectomy]. HNO 2022;70(12):907–10. (In German). DOI: 10.1007/s00106-022-01197-3

15. Al-Khafaf A.E., Al-Shahrestani F., Baysal Y. et al. Lymphomas of the salivary glands: a systematic review. Acta Otolaryngol 2023;143(7):610–6. DOI: 10.1080/00016489.2023.2226689

16. Taylor R.R., Pandey S.K., Smartz T. et al. Lymphedema of the head and neck – where do we stand and where we are headed. J Craniofac Surg 2024;35(7):2045–8. DOI: 10.1097/SCS.0000000000010505

17. Gelfand I.M., Kropotov M.A., Isaeva M.T., Podvyaznikov S.O. Significance in clinical practice of sentinel lymph node biopsy in squamous cell carcinoma of the skin of the head and neck. Opukholi golovy i shei = Head and Neck Tumors 2023;13(4):116–23. (In Russ.). DOI10.17650/2222-1468-2023-13-4-116-123

18. Paskiewicz A., Niu J., Chang C. Autoimmune lymphoproliferative syndrome: A disorder of immune dysregulation. Autoimmun Rev 2023;22(11):103442. DOI: 10.1016/j.autrev.2023.103442

19. Mallo-Miranda M.V., Morales-Angulo C. Otorhinolaryngological manifestations of autoinflammatory diseases. Systematic review. Acta Otorrinolaringol Esp (Engl Ed) 2024:2025;76(2):116-29. DOI: 10.1016/j.otoeng.2024.09.005

20. Obeidat A., Al-Moussally F., Al Aruri D.O. et al. Unmasking the culprits: a case of epstein-barr virus-associated hemophagocytic lymphohistiocytosis presenting with mouth ulcers and nosebleeds. Cureus 2024;16(6):e61822. DOI: 10.7759/cureus.61822

21. Kim J., Wood C., Sandkovsky U., Rokadia H. Actinomyces lymphadenitis. Proc (Bayl Univ Med Cent) 2020;33(3):444–5. DOI: 10.1080/08998280.2020.1744792

22. Bickford D.D., Johnson P., Brahmbhatt N., Kroft S. Cervical syphilitic lymphadenitis in a 29-year-old female: a case report. Cureus 2023;15(3):e36065. DOI: 10.7759/cureus.36065

23. Kauke-Navarro M., Sadigh S., Lee C.A.A. et al. Lymphadenopathy and lymph node rejection following facial vascularized composite allotransplantation. J Plast Reconstr Aesthet Surg 2024;91:268–75. DOI: 10.1016/j.bjps.2024.02.024

24. Yan M., Xiao L.Y., Gosau M. et al. The role of herpes simplex virus infection in the etiology of head and neck cancer – a Mendelian randomization study. Front Immunol 2024;15:1278327. DOI: 10.3389/fimmu.2024.1278327

25. Willemse S.H., Oomens M.A.E.M., Karssemakers L.H.E. et al. Evaluation of anti-glycopeptidolipid-core immunoglobulin a antibody detection for the diagnosis of nontuberculous mycobacterial cervicofacial lymphadenitis. Pediatr Infect Dis J 2024;43(11):e416–8. DOI: 10.1097/INF.0000000000004462

26. Arliny Y., Yanifitri D.B., Utami W.A., Geraldine S. Case report: tuberculosis lymphadenitis with systemic lupus erythematosus in a young woman: a case report. F1000Res 2023;12:763. DOI: 10.12688/f1000research.135076.2

27. Omer K., Algaly G., Mohamed Salih O.A. Disseminated tuberculosis complicating Bacillus Calmette–Guérin (BCG) vaccine as only presentation of severe combined immunodeficiency (SCID): a report of 3 cases. Qatar Med J 2023;2023(2):9. DOI: 10.5339/qmj.2023.sqac.9

28. Avgeri C.T., Sideris G., Margaris I., Tapponi L. Silicone cervical lymphadenopathy: a rare complication after breast augmentation. Cureus 2023;15(12):e50453. DOI: 10.7759/cureus.50453

29. Furuholm J., Rautaporras N., Uittamo J. et al. Health status in patients hospitalised for severe odontogenic infections. Acta Odontol Scand 2021;79(6):436–42. DOI: 10.1080/00016357.2021.1876916

30. Dorf S.R., Fonseca A.R., Sztajnbok F.R. et al. The state of the art in therapeutic administration of botulinum toxin in children with cerebral palsy: an integrative review. Rev Paul Pediatr 2024;42:e2023093. DOI: 10.1590/1984-0462/2024/42/2023093

31. Gandhi K., Strychowsky J.E., Chen B.A. Pediatric sialorrhea (drooling). CMAJ 2024;196(18):E624. DOI: 10.1503/cmaj.231550

32. Head and Neck Tumours. WHO Classification of Tumours. 5th edn. 2024. Vol. 9.

33. Swid M.A., Li L., Drahnak E.M. et al. Updated salivary gland immunohistochemistry: a review. Arch Pathol Lab Med 2023;147(12):1383–9. DOI: 10.5858/arpa.2022-0461-RA

34. Ginat D.T. Imaging of benign neoplastic and nonneoplastic salivary gland tumors. Neuroimaging Clin N Am 2018;28(2):159–69. DOI: 10.1016/j.nic.2018.01.002

35. Campolo González A., Ramírez Skinner H., Vargas Díaz A. et al. Perfil epidemiológico de neoplasias epiteliales de glándulas salivales [Epithelial tumors of salivary glands. Review of 286 pathology reports]. Rev Med Chil 2018;146(10):1159–66. (In Spanish). DOI: 10.4067/S0034-98872018001001159

36. Ingleby F.C., Woods L.M., Atherton I.M. et al. An investigation of cancer survival inequalities associated with individual-level socioeconomic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales. BMC Public Health 2022;22(1):90. DOI: 10.1186/s12889-022-12525-1

37. Hu S., Gong J., Zhu X., Lu H. Pulmonary salivary gland tumor, mucoepidermoid carcinoma: a literature review. J Oncol 2022;2022:9742091. DOI: 10.1155/2022/9742091

38. Grzywa-Celińska A., Chmielewska I., Krusiński A. et al. Residential radon exposure in patients with advanced lung cancer in Lublin Region, Poland. Int J Environ Res Public Health 2022;19(7):4257. DOI: 10.3390/ijerph19074257

39. Soldati G., Ciaccio M.G., Cannelli V. et al. Assessment of indoor radon levels at multiple floors of an apartment building in the historic center of Rome (Italy): a comprehensive study. Environ Sci Pollut Res Int 2024;31(52):61660–76. DOI: 10.1007/s11356-024-35266-7

40. Eidy M., Regina A.C., Tishkowski K. Radon toxicity. 2024 Jan 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.

41. Ibrahem H.M. T cell roles and activity in chronic sclerosing sialadenitis as IgG4-related disease: current concepts in immunopathogenesis. Autoimmune Dis 2022;2022:5689883. DOI: 10.1155/2022/5689883

42. Veneroni M.V., Festa B.M., Costantino A. et al. Prognostic impact of tumor immune microenvironment and its predictive role in salivary gland cancer. Head Neck Pathol 2023;17(2):515–27. DOI: 10.1007/s12105-023-01528-y

43. Lavareze L., Scarini, J.F., de Lima‐Souza R.A. et al. Clinicopathological and survival profile of patients with salivary gland myoepithelial carcinoma: a systematic review. J Oral Pathol Med 2023;2(52):101–8. DOI: 10.1111/jop.13395

44. Reinheimer A., Vieira D.S., Cordeiro M.M., Rivero E.R. Retrospective study of 124 cases of salivary gland tumors and literature review. J Clin Exp Dent 2019;11(11):e1025–32. DOI: 10.4317/jced.55685

45. Kochurova E.V., Nikolenko V.N. Estimation of expression of oral fluid biomarkers in the diagnosis of pretumor diseases of oral mucosa. Bulletin of Experimental Biology and Medicine 2017;163(1):87–91. DOI: 10.1007/s10517-017-3744-8

46. Jałocha-Kaczka A., Kolary-Siekierska K., Miłoński J., Olszewski J. Own experience in the treatment of major salivary gland tumors. Otolaryngol Pol 2020;74(3):17–22. DOI: 10.5604/01.3001.0013.6605

47. Jiang Y.W., Xu X.J., Wang R., Chen C.M. Radiomics analysis based on lumbar spine CT to detect osteoporosis. Eur Radiol 2022;32(11):8019–26. DOI: 10.1007/s00330-022-08805-4

48. Faur A.C., Buzaș R., Lăzărescu A.E., Ghenciu L.A. Current developments in diagnosis of salivary gland tumors: from structure to artificial intelligence. Life (Basel) 2024;14(6):727. DOI: 10.3390/life14060727

49. Wang C., Yu Q., Li S. et al. Carcinoma ex pleomorphic adenoma of major salivary glands: CT and MR imaging findings. Dentomaxillofac Radiol 2021;50(7):20200485. DOI: 10.1259/dmfr.20200485

50. Baer A.N., Grader-Beck T., Antiochos B. et al. Ultrasound-guided biopsy of suspected salivary gland lymphoma in Sjögren’s syndrome. Arthritis Care Res (Hoboken) 2021;73(6):849–55. DOI: 10.1002/acr.24203

51. Brooks J.K., Macauley M.R., Price J.B. Concurrent giant sialoliths within the submandibular gland parenchyma and distal segment of Wharton’s duct: Novel case report. Gerodontology 2021;38(4):437–40. DOI: 10.1111/ger.12544

52. Moore J., Simpson M.T.W., Cohen N. et al. Approach to sialadenitis. Can Fam Physician 2023;69(8):531–6. DOI: 10.46747/cfp.6908531

53. Sánchez Barrueco A., López-Acevedo Cornejo M.V., Alcalá Rueda I. еt al. Sialolithiasis: mineralogical composition, crystalline structure, calculus site, and epidemiological features. Br J Oral Maxillofac Surg 2022;60(10):1385–90. DOI: 10.1016/j.bjoms.2022.08.005

54. Mortazavi H., Tizno A., Azadi A. et al. What is the impact of previous cholelithiasis on sialolithiasis: a systematic review and meta-analysis. Saudi Dent J 2024;36(1):44–51. DOI: 10.1016/j.sdentj.2023.08.010

55. Dokania V., Ibrar M., Vishwakarma M. Early clinical mapping of submandibular gland fistula: a case report and systematic review. Int Arch Otorhinolaryngol 2023;28(3):e537–42. DOI: 10.1055/s-0043-1767801

56. Azizyan R.I., Isaeva M.T., Stelmakh D.K., Podvyaznikov S.O. Extended resections for locally advanced laryngeal cancer: a clinical case. Opukholi golovy i shei = Head and Neck Tumors 2024;14(2):85–91. (In Russ.). DOI: 10.17650/2222-1468-2024-14-2-85-91

57. Fang Y., Peng Z., Wang Y. et al. Current opinions on diagnosis and treatment of adenoid cystic carcinoma. Oral Oncol 2022;130:105945. DOI: 10.1016/j.oraloncology.2022.105945

58. Kandula S., Nagi R., Nagaraju R. Sialography: a pictorial review. Oral Radiol 2023;39(2):225–34. DOI: 10.1007/s11282-022-00668-1

59. Ungari C., Cicconetti A., Cerbelli E. et al. Giant submandibular sialolith: a case report. Clin Ter 2022;173(3):217–21. DOI: 10.7417/CT.2022.2421

60. Lanjekar A., Kukde M.M., Madne I. et al. pivotal role of ultrasonography and radiology in diagnosing a case of sialolith. Cureus 2023;15(12):e51269. DOI: 10.7759/cureus.51269

61. Reddy R. Role of ultrasonography supplemented by sialendoscopy in submandibular steinstrasse sialolithiasis. Cureus 2021;13(12):e20286. DOI: 10.7759/cureus.20286

62. Beumer L.J., Vissink A., Gareb B. et al. Success rate of sialendoscopy. A systematic review and meta-analysis. Oral Dis 2024;30(4):1843–60. DOI: 10.1111/odi.14662