There are many causes of bilateral mandibular lymph node enlargement, such as lymphadenitis, lymph node tuberculosis, lymphoma, lymph node metastasis of malignant tumors and so on. It should be treated according to the cause. 1. Lymphadenitis: mandibular lymphadenitis is mostly caused by the spread of infection foci in the surrounding tissues, such as gingivitis, tonsillitis, etc. Usually, the enlarged lymph nodes can subside on their own after the control of the primary infection foci. Commonly used anti-infective drugs are cefaclor, metronidazole, amoxicillin and so on. 2. Cervical lymph node tuberculosis: Cervical lymph node tuberculosis requires the implementation of strict anti-tuberculosis treatment program, commonly used drugs are isoniazid, rifampicin, ethambutol and so on. Surgical resection can be considered for a small number of large, confined, enlarged lymph nodes. When a cold abscess is formed, puncture is needed to drain the pus. 3. Lymphoma: Lymphoma is a malignant tumor originated from lymphatic tissues, and the main treatment modality is chemotherapy combined with radiotherapy. Commonly used chemotherapeutic drugs include vincristine, doxorubicin, etoposide, etc. CD20 positive patients can use monoclonal antibody rituximab. Hematopoietic stem cell transplantation can also be used for eligible patients. 4. Lymph node metastasis of malignant tumor: Thyroid cancer, head and neck squamous cancer and other malignant tumors can present with lymph node metastasis in the jaws, which can be treated by radical resection and lymph node dissection, and then be treated with chemotherapy (e.g., vincristine, doxorubicin, etc.), radiotherapy, targeted therapy, etc., according to the condition of the patient. It is recommended to go to the hospital as soon as possible to clarify the cause of the enlarged mandibular lymph nodes and provide targeted treatment.