Salivary Gland Swellings

MM Carr DDS MD MEd

 

 

What causes salivary gland swellings?

Differential Diagnosis includes:
  1. Non-neoplastic disorders
      Infectious
      • Acute sialadenitis
      • Chronic recurrent sialadenitis
      • Parotid abscess
      • Viral parotitis
        • Paramyxovirus
        • CMV
        • Coxsackievirus
      • Granulomatous parotitis
        • Tuberculosis
        • Cat scratch disease
      • Actinomycosis
      Non-infectious
      • Sialectasis
      • Sialolithiasis
      • Sjogren's syndrome
      • Sarcoidosis
        • Uveoparotid fever of Heerfordt
      • Benign lymphoepithelial lesion
      • Radiation sialadenitis
      • Ptyalism
      • Sialadenosis
        • Vitamin deficiency
        • Malnutrition
        • Bulimia
        • Diabetes
        • Hypothyroidism
        • Alcoholic cirrhosis
        • Drugs: Thiourea, Clonidine, a-Methyldopa
        • Hemangioma
        • Cysts
  2. Neoplastic disorders
      Benign
      • Pleomorphic adenoma
      • Monomorphic adenoma
      • Warthin's tumour
      • Oncocytoma
      Malignant
      • Mucoepidermoid
      • Acinic cell
      • Adenocarcinoma
      • Adenoid cystic
      • Malignant mixed
      • Squamous cell
      • Malignant oncocytoma
      • Lymphoma
      • Metastases
        • Melanoma
        • Squamous cell carcinoma
        • Mets to intraparotid lymph nodes

 

Evaluating a Patient with a Salivary Gland Swelling

  1. History
    • Onset, duration, course
    • Is it painful?
      • Painful diffuse swelling suggests sialadenitis
      • Painful swelling which fluctuates with meals suggests sialolithiasis
      • Non-painful swelling suggests tumour
    • Other concurrent symptoms
  2. Physical exam
    • Is the mass unilateral/bilateral
    • Is it diffuse or well-circumscribed
    • Is it tender
    • Are there associated head and neck findings
      • Enlarged lymph nodes
      • Pus from salivary duct opening
      • Palpable calculi
    • Other signs of disease
  3. Investigations
    • See the specific entity in the differential diagnosis for specific work-up.
    • In general
      • Plain X-rays (occlusal view, lateral view) may show salivary calculi
      • Fine needle aspiration if you suspect a tumour
      • CT scan if you suspect a tumour or abscess