Last reviewed: August 2020
Last updated: March  2018



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 anesthetic
  • dry eyes and mouth
  • oral candidiasis
  • connective tissue disorder or Sjogren 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 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

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
  • 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
More investigations to consider

Treatment algorithm


Consultant Oral and Maxillofacial Surgeon

Honorary Senior Lecturer

University Hospitals of Leicester NHS Trust - Leicester Royal Infirmary




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 reviewersVIEW 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


The Netherlands


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



MDT declares that he has no competing interests.

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