Sublingual Gland Tumors

Tumors of the sublingual gland present as a mass in the floor of the mouth, usually painless and

Figure 9.4a. Adenocarcinoma of right sublingual gland.

Figure 9.4b. Polymorphous low-grade adenocarcinoma of the sublingual gland. Re-published with permission from Blanchaert RG, Ord RA, Kumar D. 1998. Polymorphous low-grade adenocarcinoma of the sublingual gland. Int J Oral Maxillofac Surg 27:115-117.

Figure 9.5. CT scan of large malignant sublingual gland tumor.

a b slow-growing. They may be large enough to impair tongue movement with speech difficulty or to prevent wearing a lower denture (Figure 9.4). Occasionally they may cause obstruction of Whar-ton's duct either due to pressure or malignant infiltration and present with a submandibular swelling. Virtually 100% of these tumors are malignant and involvement of the lingual nerve or hypoglossal nerve with ipsilateral anesthesia or weakness of the tongue may be seen. Examination by palpation reveals a firm to hard mass that may be tender and fixed to the lingual periosteum. Infiltration of the tongue muscles with slurring of speech or dysphagia can occur.

The only other entity on the differential diagnosis is a ranula, which can resemble a cystic tumor.

Imaging is usually by CT or MR. CT scans will be more accurate for early cortical bone invasion (Figure 9.5). In MR imaging T1 weighted signal intensity of carcinomas in and near the sublingual gland is lower than the gland, whereas T2 weighted signal intensity of carcinomas exceeds that of the gland (Sumi et al. 1999).

In the sublingual gland histologic diagnosis is accomplished by incisional biopsy through the overlying oral mucosa.

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