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Clinical Problem Solving
August 2013

Submandibular Swelling

Author Affiliations
  • 1Tulane School of Medicine, New Orleans, Louisiana
  • 2Veterans Administration Hospital in Biloxi, Biloxi, Mississippi
JAMA Otolaryngol Head Neck Surg. 2013;139(8):853-854. doi:10.1001/jamaoto.2013.3830

An 87-year-old man presented with a 1-month history of submandibular swelling on the right side. The patient reported that the area was quite painful and was enlarging. He had been using sialogogues with no success. He denied any other constitutional symptoms.

The patient was placed on a 2-week course of amoxicillin-clavulanate. The pain and swelling continued to increase, and he reported new painful swelling in the area of the contralateral submandibular gland. A postcontrast computed tomographic (CT) imaging scan (Figure, A) revealed a 2.3-cm mass abutting and involving the right submandibular gland with surrounding inflammatory changes with associated lymphadenopathy in level IIA on the left side of the neck. A CT scan of the chest did not reveal any abnormality. Fine needle aspiration (FNA) results were read as indeterminate, containing few cells with scant cytoplasm, lymphocytes, and red blood cells.

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