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Lump with red/white spots under tongue.

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To whom it may concern,

I have had a lump underneath my tongue/on the floor of my mouth for around 5 or 6 days now and it seems to be growing both in size and in discomfort. It is mainly red with some white spots on the top of it as well. While firm it is still relatively soft in nature. I'm currently in China and thus am trying to avoid seeing a doctor here if possible but will go do so if you think its necessary or if it continues to worsen. I am attaching a photo.


Brief medical history, I am a 22 year old male, non-smoker.  I have been in China for the past month or so working.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 21 Doctors Online

Thank you for posting your query at
I understand your concern.
I have seen the picture you sent me and it looks like an infected gland swelling. There are 100s of salivery glands below the tongue, and it can possibly get inflamed due to a lot of causes leading to a condition called sialadenitis. From the picture that seems most probable, however wihout actually feeling the swelling, it is difficult to make a dignosis. It can also be a mucous cyst but that can be confirmed only on palpation by a general surgeon.
Do you have any foul taste in the mouth? How is your salivation? Is there any difficulty in eating? Do you have any fever? Normally these are associated with sialadenitis.
This does not look anything serious. So do not be worried.
I will advise you the following things. Try this for 3-4 days. If it doesn't resolve it is better to be evalauted by a general surgeon.
1) Drink 8-10 glasses of water with lemon.
2) Wash you mouth with warm saline solution ( salt added in water ). It will be soothing for the swelling.
3) Avoid any spicy food for the time being.
4) Tab. Levofloxacin 500 mg twice daily for 7 days after food.
5) Tab. Ibuprofen 400 mg twice daily, in case there is pain after food.
Please continue this for a couple of days and let me know.
Hope this was helpful,

Patient replied :

Thanks for your quick reply, I don't have any foul taste in the mouth and my salivation, temperature, and eating habits are all normal. Thanks for your advice, i'll look for levofloxacin in the morning and will be sure to do all the other things. I'll check back in a couple of days.
In the meantime I have a doctors appointment with the foreign health clinic in town in 4 days, i'll cancel if things start to clear up before then

Thank you for writing back.
I missed out on one thing in the last reply. Sometimes there is a similar swelling called ranula which also occurs under the tongue. It is very soft and cystic. The only thing that is going against that diagnosis in your case is ranula appears slightly bluish in colour.
You continue what i told you. In case it refuses to go down, then a general surgeon appointment will be helpful to find the exact diagnosis.
However i reassure there is nothing to worry about.

Patient replied :

I've been trying to follow your suggestions closely, though I never found the Levofloxacin. The pain has gone away for the most part but i'm struggling to determine whether the swelling has subsided at all. The inflamation has turned almost exclusively white in color. When rubbing my tongue across it, it almost feels like there is a grain of sand stuck inside one of the corners, otherwise it feels pretty much the same as before. I still am scheduled to go get it looked at tomorrow but will not go if you think its not worth it.
I'm attaching more updated pictures.

Thanks for the help

Thank you for follow up.
Yes the swelling has subsided to a large extent, although it definitely looks to be due to an infected cause.
If you're not finding levoflox, you can search for amoxycillin 500 mg and it can be taken twice daily. Before that try to look for metronidazole gel and if you manage to find it, apply that on the swelling 2-3 times a day. In that case there is no need to take amoxycillin. In case there is no metronidazole gel, then take amoxy. It will definitely be available in any pharmacy.
It can be applied for 3 days and the infection should clear up. You can wait for another couple of days, since it has come down, i am hoping it will resolve in a couple of days time and a doctor's appointment won't be necessary. However if not resolving in 2 days, please visit a local doctor who can examine the swelling.
Meanwhile you can continue the same guidelines i gave you before.
Hope this was helpful,

Patient replied :

Hey there again, I ended up going to a doctor who seemed to think this lump was just the result of a mere bacterial infection, as you thought, he prescribed some antibiotics which I have taken every day now for nearly a week, but the lump persists. I was given metronidazole in the pill form. Now it feels more like a fluid filled sac than a lump however (though there it is still raised). It also started bleeding a little bit yesterday. I'm getting slightly concerned and I'm thinking I may need to go back to the doctor over here. Any thoughts?


You seem to be having a mucocoele ( a mucus/fluid filled cyst of a minor salivary gland) as I had suspected earlier. This is benign (harmless) and tends to persist for 2-3 months and then disappear on its own.

The mucous lining over it is usually intact; however, repeated sucking on the lesion may result in a white, rough surface. It can bleed as well, but it is nothing to worry.
Occasionally, an open tract is observed from which mucoid material is expressed.

The definitive treatment for this is surgical removal. Surgical excision of the mucocele along with the adjacent associated minor salivary glands is recommended.

You can consult a general surgeon and undergo the same as it is causing considerable discomfort to you. This will be a minor surgical procedure and can be done under local anesthesia. So please do not worry.

Take care.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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