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Sialadenitis and salivary stones
A stone blocks the salivary duct and causes swelling and pain while eating, usually in the submandibular gland; acute bacterial infection appears mainly in the parotid of an older, dehydrated patient; and the other swellings — viral, autoimmune or metabolic — are recognised by the pattern: one-sided or bilateral, painful or not.
Why it matters in the exam
About 80% to 90% of stones lie in the submandibular gland, because its saliva is more alkaline and viscous and its duct (Wharton) runs upward; most stones there are visible on X-ray. Parotid stones are smaller and less often visible. The classic story: swelling and pain during a meal ("salivary colic") that settle after an hour or two. Work-up is ultrasound or non-contrast CT. A small duct stone is removed by sialendoscopy; a palpable stone in the front part of Wharton duct is removed through an intraoral incision; gland excision is reserved for failure of gland-preserving methods.
Acute suppurative parotitis appears in a dehydrated older patient or after surgery, usually from Staphylococcus aureus: a painful, warm swelling, with pus coming from the opening of Stensen duct on massage. Treatment: fluids, sialogogues (such as sour sweets), massage, local warmth and anti-staphylococcal antibiotics; an abscess is drained. Mumps is a bilateral viral parotitis; a known complication is one-sided profound sensorineural hearing loss.
Bilateral painless parotid swelling (sialadenosis) is linked to alcohol, diabetes, bulimia and malnutrition. A mucocele of the lower lip comes from saliva leaking from a minor gland after duct injury, and is treated by excision with the gland. A ranula is a cyst in the floor of the mouth from the sublingual gland, and a plunging ranula passes through the mylohyoid muscle into the neck; treatment is excision of the sublingual gland. Dry mouth in an older person with a normal rheumatological work-up is usually from anticholinergic drugs. Chronic submandibular inflammation can be part of IgG4-related disease.
Key points
- 80% to 90% of stones are submandibular.
- Pain and swelling at meals.
- Sialendoscopy before excision.
- Bacterial parotitis: dehydrated older patient, S. aureus.
- Ranula — excise the sublingual gland.
Summary table
| Situation | Clue | Treatment |
|---|---|---|
| Submandibular stone | Swelling and pain at meals | Sialogogues, sialendoscopy or intraoral incision |
| Bacterial parotitis | Dehydrated older patient, pus from Stensen duct | Fluids, massage, anti-staphylococcal antibiotics |
| Mumps | Bilateral swelling in a child or young adult | Supportive; check hearing |
| Sialadenosis | Bilateral painless swelling | Treat the cause: alcohol, diabetes, bulimia |
| Ranula | Cyst in the floor of the mouth or neck | Excision of the sublingual gland |
| Mucocele | Bubble on the lower lip | Excision with the minor gland |
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Sources
- Cummings Otolaryngology: Head and Neck Surgery, 7th edition (2021) — Inflammatory disorders of the salivary glands; sialendoscopy
- Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th edition (2018) — Non-neoplastic salivary gland disease
- AAO-HNS Clinical Consensus Statement: Sialendoscopy and salivary stones, 2020 — Indications for gland-preserving treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.