Last reviewed: 28 Oct 2021
Last updated: 23 Sep 2020



History and exam

Key diagnostic factors

  • fever
  • pain and dysphagia
  • facial swelling
  • recurrent painful swellings
  • exudates of pus from salivary gland opening
  • mandibular trismus
  • respiratory distress (stridor, use of accessory muscles, nasal flaring, wheeze)
  • cranial nerve palsy

Other diagnostic factors

  • episodic swelling during eating
  • use of xerostomic medications
  • recent surgical intervention under general anaesthetic
  • dry eyes and mouth
  • oral candidiasis
  • connective tissue disorder or Sjogren's syndrome
  • recurrent painless swellings
  • displacement of earlobe
  • prodrome of tingling in the affected gland
  • swelling on the hard palate

Risk factors

  • volume depletion and malnutrition
  • immunosuppression
  • Sjogren's syndrome
  • connective tissue diseases
  • women aged 50 to 60
  • general anaesthesia
  • xerostomic medications
  • sialolithiasis
  • chronic mechanical obstruction and/or multiple bouts of acute inflammation
  • trauma (cheek biting)
  • dental/orthodontic procedures
  • sialectasis, diverticuli, and strictures

Diagnostic investigations

1st investigations to order

  • culture and sensitivities of exudate from duct
  • FBC
  • facial radiographs (occlusal and/or soft tissue films)

Investigations to consider

  • ultrasound of affected gland
  • CT scan
  • digital subtraction sialography
  • MR sialography
  • scintigraphy using radioisotope sodium pertechnetate Tc-99m
  • SSA/anti-Ro, SSB/anti-La antibodies
  • antinuclear antibodies
  • rheumatoid factor
  • fine needle aspiration cytology of affected gland
  • MRI
  • minor salivary gland biopsy
  • IgG4 and IgE
  • major salivary gland biopsy

Treatment algorithm



Chris Avery, MD, MChir, FDSRCS, FRCS, FRCS (OMFS)

Consultant Oral and Maxillofacial Surgeon

Honorary Associate Professor Senior Lecturer

University Hospitals of Leicester NHS Trust




CA declares that he has no competing interests.


Dr Chris Avery would like to gratefully acknowledge Dr Alfredo Aguirre, Dr Michael N. Hatton, and Dr Ernesto de Nardin, previous contributors to this topic. AA, MNH, and EDN declare that they have no competing interests.

Peer reviewers

Issac van der Waal, DDS, PhD

Professor of Oral Pathology

Head of the Department of Oral and Maxillofacial Surgery and Oral Pathology

VU University Medical Centre and Academic Centre for Dentistry


The Netherlands


IVDW declares that he has no competing interests.

Michael D. Turner, DDS, MD, FACS

Assistant Professor

New York University College of Dentistry

Department of Oral and Maxillofacial Surgery

Department of Periodontics and Implant Dentistry

New York University School of Medicine

New York



MDT declares that he has no competing interests.

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