Swollen Necks, Dry Mouths: Diagnosing Salivary Gland Diseases

Gordon H. Sun, MD, MS

Disclosures

June 06, 2019

A Quick Review of Parotid Tumors

About 70% of salivary gland tumors originate in the parotid gland.[10] The majority of parotid gland neoplasms are benign, the most common of which is pleomorphic adenoma. Pleomorphic adenoma, or benign mixed tumor, typically presents in young and middle-aged women and middle-aged men as a slow-growing, unilateral, painless facial mass. These tumors carry a modest risk of malignant transformation that increases over time.[6,10]

The Warthin tumor, also known as papillary cystadenoma lymphomatosum, is the second most common benign parotid neoplasm. This tumor is typically identified in older male patients and patients who smoke cigarettes.[10,11]

The percentage of FNAs of parotid tumors that are nondiagnostic is fairly high; a meta-analysis concluded that the rate ranged between 5.3% and 14%.[12]

When to Worry About Dry Eyes and Mouth

A 51-year-old woman complains of a 3-year history of persistent dry mouth and eyes with discomfort while swallowing. She says she drinks "huge" amounts of water, yet the symptoms persist.

She is also concerned about an increasing number of dental caries despite consistent, good oral hygiene and preventive oral care. On questioning, she says she has noticed recurrent intermittent bilateral swelling of her cheeks.

She reports that despite good nighttime sleep, she is often tired. She denies fevers, dyspnea, or dysphonia. She has no significant medical or surgical history; takes no medications; and has no known drug, food, or environmental allergies. She denies smoking, alcohol consumption, or other recreational drug use.

She is alert, well nourished, in no apparent distress, with normal vital signs. She has obviously inflamed conjunctivae, dry and cracked lips, and dry oral mucosa. Several small dental cavities are noted, and there is mild, symmetric, nontender bilateral cheek and jaw swelling. No neck masses are palpated. The neurologic exam is within normal limits, but the musculoskeletal exam demonstrates mildly stiff and inflamed knee joints. A basic Schirmer test of both eyes is abnormal, with a wetting length of 4 mm (< 5 mm wetting is abnormal; 5-10 mm is equivocal).

Further laboratory evaluation, which included antinuclear antibody testing, is positive for anti-Sjögren-syndrome-related antigen A (anti-SSA/Ro antibodies). The patient is subsequently diagnosed with primary Sjögren syndrome and referred to a rheumatologist and ophthalmologist for management.

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