{
  "abstract": "A girl in her middle childhood, previously healthy, presented with multiple swellings in the cervical region that had persisted for 3 months. The parents first noticed the swellings, most prominent in the submental and submandibular areas. There was no history of swelling in other body parts, weight loss, poor appetite, evening fevers, frequent cough, tuberculosis contact or close contact with birds or animals. Clinical examination revealed four lymph node-like swellings in the submental and submandibular regions. The largest swelling was in the right submental area, measuring 1.5×1.5 cm. The swellings were smooth, elastic, non-matted, non-tender and non-fluctuant. No significant lymphadenopathy was detected in other regions. A presumptive diagnosis of reactive lymphadenopathy was made, and she was treated with a 7-day course of oral amoxicillin and clavulanic acid. Subsequently, only the largest swelling in the right submental region persisted. It was intermittent, appearing when the tongue was voluntarily pressed against the floor of the mouth or during the Valsalva manoeuvre, and disappearing spontaneously ( figures 1 and 2; online supplemental video 1). Ultrasound revealed herniation of the right sublingual gland into the submandibular space through a defect in the mylohyoid muscle. No evidence of inflammation, lymphadenopathy or abscess formation was observed. While MRI with dynamic sequences would have provided optimal visualisation of the herniation, this approach was not feasible given the patient’s age and inability to cooperate with the required manoeuvres during imaging. Dynamic ultrasound proved to be an excellent alternative, allowing real-time visualisation of the intermittent herniation during tongue manipulation while being well-tolerated by the child.",
  "authors": [
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Ravi Chirag"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Aditi Das"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Rohit Bhowmick"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Niladri Sekhar Bhunia"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Subhankar Sarkar"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Nupur Bajpai"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Rimjhim Sonowal"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India"
      ],
      "name": "Nihar Ranjan Mishra"
    }
  ],
  "title": "Intermittent cervical swelling in a child due to sublingual gland herniation",
  "uid": "dfacc849-5980-55f9-b1c2-908bfbde2f24"
}