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Q. I have a small palpable swelling under the right side of my jaw. Please help.

Answered by
Dr. B Vageesh Padiyar
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Apr 29, 2020
Ten days ago, I was eating some soup when some got under my tongue and I felt a sudden sour twang through the right side of my mouth and jaw. It gradually subsided in intensity and I examined the inside of my mouth for any tender areas or asymmetries under my tongue. There was a very slight swelling of my submandibular duct on the right side, but no tenderness or anything strange palpable. Later that night, I was eating some chips when I noticed rapidly increasing discomfort in my right jaw, earache, and pain when swallowing. I felt my throat and discovered a golfball-sized swelling under my right jaw. On the advice of my father (who said it sounded like a blocked salivary gland, and said he recently had one as well), I used warm salt rinses and external warm compresses. Within a short period of time, the swelling reduced by about half, and with repeated rinses, gradually reduced over the next day until it was minimal.

Since then, I have still had a palpable asymmetry when feeling both sides of my jaw, and my submandibular gland has not returned to its ordinary size. Last night, I felt discomfort in that area and realized on examination that it was beginning to swell again. I quickly used more salt rinses and a compress, and the swelling stopped, but it remains a bit more enlarged than it has been over the past few days. This morning, it seems to be fluctuating slightly in size, but I hit it with more salt rinses and compresses and it appears to be stable for now, though with a slight referred earache.

The submandibular duct has not seemed particularly swollen since shortly after the first day of symptoms, when I noticed a small white spot forming at the head of the duct, which disappeared shortly after using salt rinses. I infer that this may have been a very small salivary stone pushing its way out. I have been eating and drinking somewhat infrequently for the past few weeks due to a major housing disruption that has only recently been resolved, so it's my hope that, due to a combination of dehydration and infrequent stimulation of the salivary glands, I may simply have developed some small salivary stones that could resolve on their own if I am diligent with salt rinses and compresses.

At no point have I had any sort of fever or foul taste in the mouth, nor any symptoms in any other salivary gland besides my right submandibular gland. I also recall eating some hard, sharp food 10-11 days ago that had cut my gums here and there through miscalculated bites, so it also seems possible that I traumatized the duct at that time, although it's strange to me that swelling would be recurring now after relative reduction of symptoms for over a week (though as I noted, the gland has never fully returned to a non-palpable size even at its best).

I suppose it must sound like I've self-assessed the situation reasonably well, but due to the recent resurgence of symptoms (which I confess may be due to getting lax with salt rinses or proper hydration), I just wanted to seek some qualified medical advice as to whether I'm doing the right things so far, and at what point I should seek treatment if it doesn't completely subside. The only local ENT is not available by referral for 6-10 months, so my only alternative would be to go to the ER for assessment or attempt to find a general practitioner in the area (we just moved here, so we had to leave our old GP behind). Both options are bad for exposure, given the current pandemic, and my wife is a very high risk individual, so I'm doing my best to limit exposure unless I can't help it.

Thank you for listening, and for any advice you can lend!

Dr. B Vageesh Padiyar

Otolaryngology (E.N.T)

Hi! You have assessed the condition in the best manner any patient could do!

So considering the problem out there, like you have rightly put it , looks like we are dealing with an infected gland/ sialolith or a traumatised duct. In all three cases, I suggest you to follow the advice mentioned below

1. Hydration is the key, keep drinking 5 to 6 litres of boiled warm water every day whether your thirsty or not. 2. Salt water gargles @8 to 10 times a day for 1 month will definetly go a long way 3. You can consider antibiotic clindamycin 300 MG three times a day for 5 days. This antibiotic has the property of getting excreted majorly through the salive and majorly reaches the salivary glands a shade more than other antibiotics. 4. Please eat on time, spicy, oily and junk food have to be avoided at all times for the next one month. 5. An ultrasound of the glands is definitely mandatory to see if there is any Impacted stone, parenchymal issue etc, but to be done only once the pandemic subsides. (Considering that you shouldn't be going to hospital for risk of acquiring an infection) 6. This will take a while for it to subside, but chiefly depends on how much you happen to follow the above advice!

Hope this helps, get well soon!

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