Clinical Review

Salivary gland swellings

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6794 (Published 23 October 2012) Cite this as: BMJ 2012;345:e6794
  1. Hisham Mehanna, professor and director1,
  2. Andrew McQueen, consultant2,
  3. Max Robinson, senior lecturer3,
  4. Vinidh Paleri, consultant and honorary senior lecturer4
  1. 1Institute of Head and Neck Studies and Education (InHANSE), School of Cancer Sciences, College of Medicine and Dentistry, University of Birmingham, Birmingham B15 2TT, UK
  2. 2Department of Radiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle University, Newcastle upon Tyne, UK
  3. 3Centre for Oral Health Research, Newcastle University
  4. 4Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust and Northern Institute for Cancer Research, Newcastle University
  1. Correspondence to: H Mehanna Hisham.Mehanna{at}inhanse.org
  • Accepted 4 October 2012

Summary points

  • Investigation and management of salivary gland swellings have advanced considerably in the past decade, with an emphasis on less invasive techniques and increased preservation of the salivary glands and adjacent structures

  • Owing to their anatomical position, parotid and submandibular gland swellings are often mistaken for cervical lymphadenopathy, or can be misdiagnosed as chronic sialadenitis, resulting in diagnostic delay

  • The most common causes of salivary lumps are benign neoplasms, malignancy, salivary stones and stenoses, and salivary swelling (adenosis) secondary to systemic diseases such as Sjögren’s syndrome or HIV infection

  • All salivary swellings should undergo assessment and investigation, usually by a head and neck surgeon

  • The main investigations are ultrasonography and fine needle aspiration; magnetic resonance imaging and contrast sialography have a role in specific circumstances

  • Salivary neoplasms are usually managed by excision, and salivary stones managed by removal, most commonly using sialography or sialendoscopy

The investigation and management of salivary swellings have advanced considerably in the past decade, with an emphasis on less invasive techniques and increased preservation of the salivary glands and adjacent structures. Salivary gland swellings usually present on the side of the face, below and in front of the ear (parotid gland), or in the upper part of the neck (tail of the parotid gland and the submandibular gland). A submucosal swelling in the oral cavity should raise suspicion of a sublingual or minor salivary gland neoplasm. Occasionally, intraoral lesions might present with an ulcerated surface.

Because of their anatomical position, parotid and submandibular gland swellings are often mistaken for cervical lymphadenopathy. In addition, salivary neoplasms can be misdiagnosed as chronic sialadenitis, resulting in diagnostic delay. In this article, we aim to provide an overview of the clinical presentation, investigation, differential diagnosis, and contemporary management of salivary swellings.

Sources and selection criteria

We undertook a search of Medline, using the terms “salivary”, …

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