Summary
Definition
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
- DSA sialography
- MR sialography
- scintigraphy using radioisotope sodium pertechnetate Tc-99m
- SSA/anti-Ro, SSB/anti-La
- ANA
- RF
- FNA cytology of affected gland
- MRI
- salivary gland biopsy
Treatment algorithm
Contributors
Authors VIEW ALL
Consultant Oral and Maxillofacial Surgeon
Honorary Senior Lecturer
University Hospitals of Leicester NHS Trust - Leicester Royal Infirmary
Leicester
UK
Disclosures
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 monograph. AA, MNH, and EDN declare that they have no competing interests.
Peer reviewers VIEW ALL
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
Amsterdam
The Netherlands
Disclosures
IVDW declares that he has no competing interests.
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
NY
Disclosures
MDT declares that he has no competing interests.
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