Approach to salivary gland swelling
- Approach to a complaint
A swollen salivary gland may be infection, a stone, autoimmune disease or a tumour; the key is whether it is acute, swells with meals or persists.
See it in 3D: Parotid gland · Submandibular gland · Sublingual gland
What it is
The major salivary glands are the parotid, submandibular and sublingual glands. Swelling is sorted by its course: acute and painful (mumps, bacterial sialadenitis), recurring with meals (a stone blocking the duct), bilateral and chronic with a dry mouth (Sjögren, HIV, sarcoidosis), or a persistent lump within the gland (tumour). Most parotid tumours are benign, but the smaller the gland, the higher the share of malignant tumours. Facial weakness with a parotid lump is a sign of malignancy.
Key questions in the history
- Sudden or chronic onset? One side or both?
- Does it swell with meals?
- Fever, pus in the mouth, dehydration or recent surgery?
- Vaccinated with MMR? Contact with mumps cases?
- Dry mouth or eyes, joint pain (Sjögren)?
- Facial weakness, pain, rapid growth or a fixed lump?
- Drugs that dry the mouth, or previous radiotherapy?
Causes and classification
- Infectious: mumps and other viruses; acute bacterial sialadenitis; abscess.
- Obstructive: sialolithiasis and duct stricture.
- Autoimmune and systemic: Sjögren disease, sarcoidosis and HIV.
- Tumours: pleomorphic adenoma, Warthin tumour, salivary gland carcinomas and lymphoma.
Step-by-step approach
- Decide whether it is diffuse swelling of the whole gland (inflammatory) or a lump within it (tumour).
- Establish the course: acute, recurring with meals, or persistent and progressive.
- Examine the duct opening (Stensen or Wharton): pus or a palpable stone.
- Examine the facial nerve in every parotid lump.
- If mumps is suspected: buccal swab for RT-PCR, isolation and notification.
- Infection or stone: ultrasound; CT if an abscess is suspected.
- Persistent lump: ultrasound and fine-needle aspiration; MRI is the preferred imaging for salivary tumours.
- Dry mouth and eyes with bilateral swelling: investigate Sjögren disease.
Causes of salivary gland swelling
| Cause | Clues | First step |
|---|---|---|
| Mumps | Fever, one- or two-sided parotitis, unvaccinated; peaks in 1 to 3 days | RT-PCR of a buccal swab; supportive care and isolation |
| Bacterial sialadenitis | Pain, redness, pus from the duct; dehydration | Fluids, sialogogues, massage and antibiotic |
| Sialolithiasis | Swelling with meals, mostly submandibular | Ultrasound; sialogogues; removal or sialendoscopy |
| Sjögren disease | Dry mouth and eyes, bilateral swelling | Immunological tests and referral to rheumatology |
| Parotid tumour | Painless lump that persists | Ultrasound or MRI and fine-needle aspiration; referral |
Red flags
- Facial weakness or paralysis.
- Hard, fixed or rapidly growing lump.
- Persistent facial pain with a lump.
- Associated neck lymph nodes.
- High fever with trouble breathing or swallowing: abscess or deep infection.
- Persistent parotid swelling in a person with Sjögren: rule out lymphoma.
Next step / Initial management
- Sialadenitis or stone: fluids, sugar-free sour sweets (sialogogues), gland massage, warm compresses and good oral hygiene; antibiotic if there is pus or fever.
- Mumps: supportive care, isolation and notification; antibiotics do not help.
- Abscess: surgical drainage or needle aspiration.
- Refer as a priority (within days) to ENT or head and neck surgery any salivary lump that persists, and urgently if there is facial weakness.
- Urgent same-day referral for an abscess, or high fever with trouble breathing or swallowing.
- Recurrent stones: ENT referral for removal or sialendoscopy.
Test yourself
Think of the answer, then tap the question to see it.
A 45-year-old man notices painful submandibular swelling every time he eats. Likely diagnosis?
Sialolithiasis: a stone in Wharton's duct. Ultrasound, sialogogues and fluids; removal if the stone does not pass.
A 50-year-old woman has a painless, slow-growing parotid lump with no facial weakness. Most likely tumour?
Pleomorphic adenoma, the commonest salivary tumour; it is assessed with imaging and aspiration and referred for surgery.
Which sign in a parotid lump strongly suggests malignancy?
Facial nerve weakness or paralysis; also persistent pain, fixation and neck lymph nodes.
How is mumps parotitis confirmed?
With RT-PCR of a buccal swab, or viral culture; a negative IgM does not rule it out (CDC).
Connections
See it in 3D3
The structures of Durgical's 3D anatomy where it is found.
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Clinical Overview of Mumps (Centers for Disease Control and Prevention (CDC), 2025); Salivary gland infections (MedlinePlus Medical Encyclopedia) (U.S. National Library of Medicine, NIH, 2025); Salivary Gland Cancer Treatment (PDQ) – Health Professional Version (National Cancer Institute (NCI), 2025); Dry Mouth (National Institute of Dental and Craniofacial Research (NIDCR), NIH, 2024).
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Representative model, for educational purposes only.