Enlarged Submandibular Lymph Nodes : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 28/09/2022

An increase in the submandibular lymph nodes (submandibular lymphadenopathy) is the presence of lymphoid formations with a diameter of more than 0.5 cm at the edge of the lower jaw. The affected nodes have a rigid or stony texture. The symptom is observed in ARVI, diseases of the tonsils, infectious, dental and oncopathology. To clarify the cause of submandibular lymphadenopathy, ultrasound, lymphography, CT, MRI, biopsy of lymph nodes, laboratory tests, instrumental examinations of specialized specialists are prescribed. To alleviate the condition, analgesics are used, with obvious signs of acute respiratory viral infections, tonsillitis, tonsillitis and stomatitis, mouth rinses with antiseptics are recommended.

Causes of enlarged submandibular lymph nodes

Two groups of 6-1 lymph nodes, located symmetrically on the right and left in the tissue behind the arch of the lower jaw, collect lymph from the salivary glands, palatine tonsils, palate, tongue, cheeks, nose, jaws and lips. Therefore, their increase is observed with the defeat of these organs and tissues. Lymphoid hyperplasia is provoked by infections of the nasopharynx and oropharynx, dental pathology, local tumor processes, and may indicate the development of lymphoma, lymphogranulomatosis. Less often, the defeat of the lymph nodes is complicated by eye diseases - dacryoadenitis, barley on the eyelid.


Infection with pneumotropic viruses is a common and obvious cause of benign lymphadenopathy, in which the submandibular and cervical lymph nodes are simultaneously enlarged. Changes in the lymphoid tissue, through which lymph is filtered from the oropharynx and nasopharynx, are more noticeable with the development of SARS during pregnancy and in children. In the first case, this is due to a physiological decrease in immunity to reduce the threat of abortion, in the second - with the age-related formation of protective mechanisms.

Submandibular lymphadenopathy is more often observed with adenovirus infection, parainfluenza, infection with rhinoviruses, or an association of viral pathogens. Usually, the lymphatic reaction is preceded by the so-called catarrhal phenomena - runny nose, sensation of sore throat, pain when swallowing, dry cough, lacrimation. Often the temperature rises, and to high (febrile) numbers - from 38 ° C and above. Moderately pronounced asthenia is characteristic - weakness, weakness, fatigue. Muscle and joint pains are possible.

With SARS, the skin over the submandibular lymph nodes has a natural color. The increase in lymphoid formations is insignificant (slightly more than 1 cm). Lymph nodes are compacted, but not stony, have a smooth surface, are mobile. During probing, soreness can be determined. As a rule, there is a symmetrical increase in nodes in both submandibular groups, which is associated with the spread of viral particles through the lymphatic system. As the infectious process subsides, the normal size and density of the submandibular lymph nodes are restored.

Angina and chronic tonsillitis

The second most common cause of an increase in the submandibular lymph nodes is an infectious and inflammatory lesion of the palatine tonsils. Lymphadenopathy develops in both acute and chronic processes. With angina, the lymph nodes increase within 1-2 days from the onset of inflammation, in some cases reaching a diameter of up to 2 cm. The symptom occurs against the background of severe intoxication, fever up to 38-40 ° C, intense pain in the throat with painful swallowing and irradiation to the ears, severe headache, muscle and joint pain.

With unilateral acute tonsillitis, the jaw lymph nodes on the corresponding side more often react, with bilateral acute lymphoid reaction, the left and right are detected. Often the cervical lymphatic groups are involved in the process. To the touch, the nodes are dense, painful, mobile. The increase in size can persist for 1-2 weeks after the underlying disease subsides, then the diameter of the submandibular lymph nodes gradually decreases to normal if the process has not become chronic.

Chronic tonsillitis is characterized by a symmetrical moderate increase in the nodes of both mandibular groups without involving the lymphatic formations of the neck. Pain is less pronounced. With a simple form of chronic inflammation of the palatine tonsils, prolonged grade I lymphadenopathy often becomes the most noticeable manifestation of the disease. In patients with toxic-allergic variant of tonsillitis, symptoms of tonsillitis with pain and sore throat, discomfort when swallowing, bad breath are expressed. Persistent subfebrile condition often persists.


Other infectious diseases

The defeat of the submandibular lymph nodes is determined by a number of systemic infections, bacterial, viral and fungal processes that affect the respiratory system and salivary glands. The reaction of the submandibular nodes is due to the performance of the barrier function when pathogens enter the lymphatic system from the mucous membranes of the nose, mouth, and organs of the head. Mandibular lymphadenopathy manifests itself in such general and local infectious diseases as:

  • Infectious mononucleosis . The submandibular nodes are the first to respond to the introduction of the Epstein-Barr virus. Their increase is caused by lymphoid hyperplasia, primarily by the reaction of B-lymphocytes, which are specifically affected by viral particles. At the initial stages of the pathological process, in addition to a local lymphoid reaction, subfebrile condition is noted, a sore throat and nasal congestion are felt. Later, the disease is manifested by angina, a generalized increase in lymph nodes, liver and spleen.
  • Herpetic infection . Hyperplasia of the lymph nodes of the submandibular groups is detected with herpetic stomatitis. Characterized by fever, increased secretion of saliva, erosive and aphthous lesions of the oral mucosa. In addition to hyperplasia, inflammation of the lymphoid tissue is possible with the development of mandibular lymphadenitis. Even more severe is Kaposi's herpetiform eczema, which also affects the occipital, cervical lymph nodes, there are vesicular, pustular, erosive skin lesions.
  • Cytomegaly (CMVI) . The involvement of the submandibular lymph nodes is due to the sensitivity of cytomegaloviruses to the ductal epithelium of the salivary glands with the occurrence of parotid sialadenitis as one of the pathognomonic signs of the disease. Submandibular lymphadenopathy is combined with the neck, high fever, weakness, headache, and other signs of intoxication are determined. A bright clinic is observed in 4-5% of patients, while the manifestation of cytomegalovirus infection in pregnant women is more often observed.
  • Respiratory mycoplasmosis . A moderate increase in the submandibular lymph nodes is characteristic of mycoplasmal infections of the upper respiratory tract. Possible simultaneous defeat of the cervical lymph nodes. Lymphadenopathy is preceded by a short period of catarrhal symptoms - excruciating dry cough, runny nose with copious mucus, sore throat, injection of scleral vessels. In the future, respiratory mycoplasmosis can spread downward to the trachea, bronchi, and lungs.
  • Cat scratch disease . The submandibular nodes are affected when a cat bite or scratch is localized in the face. Lymphadenopathy is quickly complicated by submandibular lymphadenitis. The combination of a lymphoid reaction with a reddish nodule (papule) and then an abscess (pustule) at the site of skin injury is pathognomonic. Inflamed lymph nodes are enlarged up to 1.5-2 cm, sharply painful. Lymphadenitis persists for up to 2 months and is accompanied by febrile temperature, weakness, fatigue, myalgia, and headache.
  • Scrofuloderma . In lymphogenous collicative tuberculosis of the skin, the leading symptom is the formation of dense reddish-purple nodes (tuberculous granulomas) in the region of the submandibular and cervical lymph nodes, from which dissemination of Koch's sticks occurs. An increase in lymphatic formations corresponds to lymphadenopathy I, less often II degree and complements suppurating subcutaneous tubercles that break through fistulas and are slowly replaced by coarse scar tissue.

Dental pathology

The submandibular nodes serve as the main collectors of lymph from the organs located in the oral cavity. Therefore, they are among the first to respond to any inflammation of the oral mucosa, dental tissues, upper and lower jaws. The reason for the enlargement of the lymph nodes is the protective hyperplasia of the lymphoid tissue in response to the presence and reproduction of the pathogen, and in more severe cases with the lymphogenous spread of the process, the infiltration of the stroma with inflammatory elements.

A moderately pronounced increase in the nodes of the submandibular group on the side of the pathology is noted with periodontitis, alveolitis, periostitis of the jaw. Usually, the lymph nodes are hyperplastic against the background of pain in the projection of the lesion, putrid breath, subfebrile or febrile fever, weakness, weakness, and other manifestations of intoxication. Submandibular lymphadenitis, which developed against the background of bright redness, multiple ulcerations, dirty gray plaque and foci of necrosis of the oral mucosa, is a sign of ulcerative necrotic stomatitis.

Malignant neoplasms

Lymphogenic metastases in the submandibular nodes are found in patients with advanced oncological diseases of the head organs. A combination of mandibular lymphadenopathy with an increase in nodes of other groups is characteristic: with lip cancer - with chin and jugular, tongue cancer - chin and occipital, cancer of the lower jaw - cervical, eye melanoma - cervical and parotid. Compaction and enlargement of the submandibular nodes is an important sign of malignant tumors of the salivary glands.

The detection of altered lymphatic formations usually indicates the prescription of the oncological process (early metastasis is typical only for tumors of the lower jaw and melanomas). The diameter of the nodes can reach 2 cm. To the touch, they are defined as hard, stony, sometimes have a bumpy surface, are soldered to each other and the surrounding skin into a single conglomerate. Lymphadenopathy is preceded by pathognomonic signs of the tumor process - outgrowths and ulcerations of the skin, mucous membranes, dense infiltrates, local pain, limitation of movements, etc.


Most often, patients who have identified enlarged lymph nodes in the submandibular zone without other noticeable clinical manifestations turn to hematologists. With an obvious pathology on the part of the head organs or probable signs of an infectious process (fever, skin rash, enlargement of the spleen, liver), the organization of their examination is carried out by doctors of the appropriate profile. Diagnostic search is aimed at both determining the underlying causes of lymphadenopathy and assessing the condition of the affected nodes. The most informative are:

  • Ultrasound . Ultrasound of the lymph nodes is used to quickly determine the size, shape, location, structure of lymphoid formations. The method allows to clarify the involvement of surrounding tissues in the process, as well as to differentiate lymphadenopathy from lesions of the salivary glands.
  • Radio diagnostics . In order to determine the characteristics of the lymph flow in the affected area, lymphography is prescribed using x-ray contrast. In more complex diagnostic cases, CT of the lymph nodes is indicated. A valuable non-invasive method for clarifying diagnosis is MRI of the lymph nodes.
  • Biopsy . Sampling of lymphoid tissue for histological examination is an accurate way to detect inflammatory processes, fibrous degeneration of the lymph node, and the degree of its damage to the oncological process. Biopsy of the lymph nodes of the submandibular zone is performed by puncture and open method.
  • Laboratory tests . The examination begins with a complete blood count, which reveals inflammatory changes and a possible neoplastic change in the composition of cellular elements. To confirm the infectious nature of lymphadenopathy, a throat swab, RIF, ELISA, and PCR diagnostics are performed.
  • Special instrumental diagnostics . To establish the cause of the increase in submandibular lymph nodes, pharyngoscopy, rhinoscopy, and otoscopy are performed. To exclude ophthalmic diseases, an examination of the structures of the eye is indicated. With a possible dental pathology, X-rays of the teeth and jaws, and other instrumental studies are used.

Ultrasound examination of the submandibular lymph nodes


Symptomatic therapy

Prior to the appointment of special treatment for a faster restoration of the size and density of the submandibular lymph nodes with acute respiratory viral infections, tonsillitis, and other inflammatory processes in the oral cavity, rinsing with antiseptic solutions is effective. In the presence of a combat syndrome, analgesics can be taken. In other cases, therapy is selected only after establishing the causes of the condition. The combination of lymphadenopathy with fever, rapid deterioration of health, headache, detection of tumor formations in the head area is an indication for an emergency visit to a doctor.