Submandibular Nodules, Not Moving with the Tongue and without Swallowing

CLINICAL DIAGNOSIS MANUAL

Submandibular nodules can be associated with various pathologies, presenting symptoms ranging from painful inflammation to painless, progressively growing masses. The differential diagnosis includes infectious, inflammatory, obstructive, and neoplastic conditions, requiring a combination of clinical history, physical examination, and complementary tests such as ultrasound, serology, and biopsies. This table serves as a guide for the diagnosis and proper management of these pathologies in clinical practice.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Mumps Sialadenitis	Pain and swelling in the submandibular region, fever, general malaise. Visible and palpable swelling in the submandibular region, tenderness on palpation, fever.	Clinical history and physical examination. Serology for mumps virus (IgM and IgG antibodies).	Ultrasound of the salivary glands.
Non-Suppurative Sialadenitis due to Ascending Ductal Infection	Pain and swelling in the submandibular region, xerostomia. Swelling and tenderness in the submandibular region, absence of pus.	Clinical history and physical examination. Ultrasound of the salivary glands.	Culture of exudate if present.
Suppurative Salivary Infection	Severe pain, swelling, fever, general malaise. Swelling and pain in the submandibular region, possible pus drainage from the salivary duct.	Clinical history and physical examination. Ultrasound of the salivary glands.	Pus culture.
Obstruction of the Salivary Duct	Pain when eating, intermittent swelling in the submandibular region. Palpable swelling, tenderness on palpation, possible palpable salivary stone.	Clinical history and physical examination. Ultrasound of the salivary glands.	Sialography.
Sjögren’s Salivary Syndrome	Xerostomia, xerophthalmia, chronic swelling of the salivary glands. Chronic and bilateral swelling of the submandibular glands, dry mouth and eyes.	Clinical history and physical examination. Serology (anti-Ro and anti-La antibodies).	Minor salivary gland biopsy.
Salivary Sarcoidosis	Painless swelling in the submandibular region, possible systemic symptoms such as cough, fatigue. Painless swelling of the submandibular glands, possible presence of pulmonary nodules on imaging.	Clinical history and physical examination. Chest CT.	Salivary gland biopsy.
Salivary Tumour due to Adenocarcinoma	Painless mass in the submandibular region, possible difficulty swallowing. Firm, non-tender, progressively growing mass in the submandibular region.	Clinical history and physical examination. Head and neck CT or MRI.	Mass biopsy.
Inflammation of Submandibular Lymph Nodes	Pain and tenderness in the submandibular region, fever. Palpable, tender, occasionally erythematous nodes.	Clinical history and physical examination. Ultrasound of the submandibular region.	Fine needle biopsy if inflammation persists.
Neoplasm of Submandibular Lymph Nodes	Painless mass in the submandibular region, possible weight loss, fever. Firm, painless, progressively growing node.	Clinical history and physical examination. Head and neck CT or MRI.	Node biopsy.
Ranula	Painless bump on the floor of the mouth, possible difficulty speaking or chewing. Translucent, fluctuant cyst on the floor of the mouth.	Clinical history and physical examination. Ultrasound of the mass.	MRI if necessary.
Dermoid Cyst in the Submental Area	Painless bump in the submental region. Firm, mobile, painless mass in the submental region.	Clinical history and physical examination. Ultrasound of the submental region.	MRI if necessary.