Swollen Necks, Dry Mouths: Diagnosing Salivary Gland Diseases

Gordon H. Sun, MD, MS


June 06, 2019

Treating Parotitis

This case is most likely acute parotitis, which is usually bacterial in origin. The pathophysiology of acute bacterial parotitis (ABP) is generally accepted as diminished salivary flow with subsequent retrograde migration of oral bacteria through the Stensen duct into the parotid gland.[1,2] ABP typically presents with acute-onset pain, edema, and erythema over the affected parotid gland, and is sometimes accompanied by fever, trismus, and dysphagia.[3,4] In severe cases, pus may be expressed from the Stensen duct.

Risk factors include advanced patient age, recent surgery, dehydration, poor oral hygiene, periodontal disease, diabetes, hypothyroidism, renal failure, and use of certain classes of medications (eg, anticholinergics).[1,2,3] Initial management includes IV hydration, empiric IV antibiotics, application of warm compresses to the affected area, parotid massage, use of sialagogues such as lemon drops, and discontinuation of any antisialagogue medications.

Although imaging studies are generally not necessary during the initial management of ABP, panoramic radiographs are sometimes ordered if stones are suspected.[1,3] Advanced imaging studies such as MRI and CT are usually reserved for unique circumstances—for example, cases of suspected neoplasm, suspected stone-related obstruction despite failure of radiographs or ultrasonography to detect a sialolith, parotitis refractory to medical management, or purulence at the Stensen duct which may indicate an abscess requiring surgical drainage.[1,2,4]

Evaluating Mouth and Jaw Pain

A 42-year-old woman complains of a 4-week history of intermittent right-sided mouth and jaw pain, sometimes accompanied by facial swelling, which is worse during and after eating. She denies fevers, chills, dyspnea, facial or tongue weakness, and dental pain. Her medical history is unremarkable. She denies past or recent history of smoking, alcohol, or other recreational drug use and has no known environmental, food, or drug allergies.

Physical examination demonstrates a well-appearing woman with normal vital signs. Ocular, nasal, otoscopic, respiratory, and neurologic exams are unremarkable. The intraoral exam demonstrates normal-appearing tonsils and midline uvula, and no mucosal lesions or erythema. The right anterior floor of the mouth is mildly painful and swollen, but no obvious mass or stone is easily seen or palpated. Bimanual pressure at the opening of the Wharton duct do not yield any stone or purulence.


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