Dysphagia and Submandibular Swelling

A physician referred a 73-year-old man to the ear, nose and throat clinic of the University of Milan in March 2007. The patient complained of recurrent painful swelling of the left submandibular gland, which was associated with dysphagia, odynophagia, foreign body sensation in the pharynx, and otalgia of the left ear during swallowing of six months’ duration. During this period, repeated cycles of anti-inflammatory and antibiotic therapy had been partially successful. The patient’s medical history was uneventful except for a tonsillectomy at age 25 years because of recurrent infections. He also was receiving drug treatment for hypertension. Oropharyngoscopy and fiberoptic videolaryngoscopy showed normal pharyngeal and laryngeal morphology and motility. The clinician (P.C.) did not observe any abnormal scarring or tonsillar residues in the tonsillar fossae; he also did not find any palpable cervical lymph nodes. Digital palpation of the left tonsillar fossa reproduced the pain, and bimanual palpation of the floor of the mouth revealed a painful firm mass with regular borders beneath the mucosa and between the left posterolateral margin and base of the tongue. The left sub-