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Last reviewed: 30 Oct 2023
Last updated: 19 Jul 2022



History and exam

Key diagnostic factors

  • fever
  • pain and dysphagia
  • facial swelling
  • recurrent painful swellings
  • exudates of pus from salivary gland opening
  • use of xerostomic medications
  • mandibular trismus
  • respiratory distress (stridor, use of accessory muscles, nasal flaring, wheeze)
  • cranial nerve palsy
  • connective tissue disorder or Sjogren syndrome
More key diagnostic factors

Other diagnostic factors

  • episodic swelling during eating
  • recent surgical intervention under general anesthetic
  • dry eyes and mouth
  • oral candidiasis
  • iodine contrast exposure
  • recurrent painless swellings
  • displacement of earlobe
  • prodrome of tingling in the affected gland
  • swelling on the hard palate
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • culture and sensitivities of exudate from duct
  • CBC
  • facial radiographs (occlusal and/or soft tissue films)
More 1st investigations to order

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
  • sialoendoscopy
More investigations to consider

Treatment algorithm


signs of airway compromise


acute bacterial sialadenitis (nonobstructive)

obstructive sialadenitis

autoimmune sialadenitis

subacute necrotizing sialadenitis


chronic sialadenitis: recurrent or sclerosing (<3 times/year or nonsevere)

recurrent sialadenitis: any cause (>3 times/year or severe attacks)



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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