[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [ENT](https://durgical.com/en/ent/) › [Throat and neck: approach to complaints](https://durgical.com/en/ent/areas/throat/) › Approach to salivary gland swelling

# 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.

Updated Nov 5, 2026

**See it in 3D:** [Parotid gland](https://durgical.com/en/anatomy/parotid-gland/) · [Submandibular gland](https://durgical.com/en/anatomy/submandibular-gland/) · [Sublingual gland](https://durgical.com/en/anatomy/sublingual-gland/)

## Key points

- Acute, painful, with pus from the duct: bacterial sialadenitis (dehydration, poor oral hygiene, stones).
- Swelling that increases with meals and then settles: a stone (sialolithiasis), most often in the submandibular gland.
- One- or two-sided parotitis with fever in an unvaccinated person: mumps; confirmed by RT-PCR of a buccal swab (CDC).
- Painless, persistent parotid lump: a tumour; the commonest is pleomorphic adenoma (NCI).
- Share of malignant tumours (NCI): parotid 20–25 %, submandibular 35–40 %, sublingual over 90 %.
- Facial weakness or persistent pain with a parotid lump: signs of malignancy.

## 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](https://durgical.com/en/conditions/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](https://durgical.com/en/conditions/acute-suppurative-sialadenitis/) | Pain, redness, pus from the duct; dehydration | Fluids, sialogogues, massage and antibiotic |
| [Sialolithiasis](https://durgical.com/en/conditions/sialolithiasis/) | Swelling with meals, mostly submandibular | Ultrasound; sialogogues; removal or sialendoscopy |
| [Sjögren disease](https://durgical.com/en/conditions/sjogren-disease/) | Dry mouth and eyes, bilateral swelling | Immunological tests and referral to rheumatology |
| [Parotid tumour](https://durgical.com/en/conditions/parotid-gland-tumours/) | 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).

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/approach-to-salivary-gland-swelling/)

## Connections

## See it in 3D 3

The structures of Durgical's 3D anatomy where it is found.

- [Parotid gland](https://durgical.com/en/anatomy/parotid-gland/)
- [Submandibular gland](https://durgical.com/en/anatomy/submandibular-gland/)
- [Sublingual gland](https://durgical.com/en/anatomy/sublingual-gland/)

## Related 4

- [Salivary glands: parotid, submandibular and sublingual](https://durgical.com/en/ent/salivary-glands-parotid-submandibular-and-sublingual/)
- [Facial nerve exam and the House–Brackmann scale](https://durgical.com/en/ent/facial-nerve-exam-and-the-house-brackmann-scale/)
- [The ENT neck exam](https://durgical.com/en/ent/the-ent-neck-exam/)
- [Head and neck cancer: red flags and urgent referral](https://durgical.com/en/ent/head-and-neck-cancer-red-flags-and-urgent-referral/)

## Related conditions 8

- [Sialolithiasis (salivary stones)](https://durgical.com/en/conditions/sialolithiasis/)
- [Acute suppurative sialadenitis (bacterial parotitis)](https://durgical.com/en/conditions/acute-suppurative-sialadenitis/)
- [Parotid gland tumours](https://durgical.com/en/conditions/parotid-gland-tumours/)
- [Mumps](https://durgical.com/en/conditions/mumps/)
- [Sjögren disease](https://durgical.com/en/conditions/sjogren-disease/)
- [Sarcoidosis](https://durgical.com/en/conditions/sarcoidosis/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)

[← All of ENT](https://durgical.com/en/ent/)

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](https://www.cdc.gov/mumps/hcp/clinical-overview/index.html) (Centers for Disease Control and Prevention (CDC), 2025); [Salivary gland infections (MedlinePlus Medical Encyclopedia)](https://medlineplus.gov/ency/article/001041.htm) (U.S. National Library of Medicine, NIH, 2025); [Salivary Gland Cancer Treatment (PDQ) – Health Professional Version](https://www.cancer.gov/types/head-and-neck/hp/adult/salivary-gland-treatment-pdq) (National Cancer Institute (NCI), 2025); [Dry Mouth](https://www.nidcr.nih.gov/health-info/dry-mouth) (National Institute of Dental and Craniofacial Research (NIDCR), NIH, 2024).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/ent/approach-to-salivary-gland-swelling/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/approach-to-salivary-gland-swelling/