Swellings and red, white, and pigmented lesionsBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7255.225 (Published 22 July 2000) Cite this as: BMJ 2000;321:225
- Crispian Scully,
- Stephen Porter
It is not unknown for people to discover and worry about oral lumps, but they usually first notice a lump because it becomes sore. Pathological causes include a range of different lesions, but neoplasms are most important (see earlier article).
Causes of salivary gland swelling
Inflammatory (mumps, ascending sialadenitis, recurrent juvenile parotitis, HIV sialadenitis, other infections such as tuberculosis, Sjogren's syndrome, sarcoidosis)
Drugs (such as protease inhibitors)
Deposits (such as amyloid)
Most salivary swellings are caused by mucoceles in minor glands in the lower lip. These are best removed surgically. In the major glands salivary duct obstruction is more common, but sialadenitis, Sjogren's syndrome, and neoplasms are important causes to be excluded. It can be difficult to establish whether a salivary gland is genuinely swollen, especially in obese patients. A useful guide to whether a patient has parotid enlargement is to look for outward deflection of the ear lobe, which is seen in true parotid swelling.
Management —Diagnosis is mainly clinical, but investigations such as serology for autoantibodies or HIV antibodies, liver function tests, and needle or open biopsy may be indicated. Treatment is of the underlying cause.
Lesions which may present as lumps or swellings in the mouth
Maxillary and mandibular tori
Hereditary gingival fibromatosis
Von Recklinghausen's neurofibromatosis
Cysts of infective origin
Pregnancy epulis or gingivitis
Oral contraceptive pill gingivitis
Calcium channel blockers
Leukaemia and lymphoma
Benign and malignant
Red oral lesions
Most red oral lesions are inflammatory in nature, but some are potentially malignant, especially erythroplasia.
Causes of red lesions