Salivary gland swelling and lumps

Stones and blockage

Salivary stones (sialolithiasis) occur most often in the submandibular gland under the jaw. The typical symptom is a painful swelling of the gland that appears when eating, or even thinking about food, and gradually settles over an hour or two. Narrowing of the duct (stricture) can cause similar complaints. If the blockage persists, the gland can become infected.

Infections

Bacterial salivary gland infection (sialadenitis) is seen especially in people who are drinking too little, older adults, those who have recently had surgery, or people with dry mouth; it causes pain, redness and fever in the gland, and sometimes pus from the duct opening. The best-known viral infection is mumps, which usually causes swelling of both parotid glands and is largely preventable by vaccination.

Dry mouth and Sjögren's syndrome

Sjögren's syndrome is a condition in which the immune system affects the salivary and tear glands. Together with dry mouth and dry eyes, it can cause recurrent or persistent swelling of the salivary glands. Some medicines and radiotherapy to the head and neck can also reduce saliva flow and increase the tendency to infection.

Tumours

Most salivary gland tumours are benign and they occur most often in the parotid gland; the large majority of parotid lumps turn out to be benign. However, the parotid is also the gland where malignant tumours most often arise, and tumours of the minor salivary glands and the sublingual gland are more likely to be malignant. For this reason, every salivary gland lump should be assessed, even if it seems harmless.

Urgent / emergency situations

• If swelling in the neck or the floor of the mouth makes breathing or swallowing difficult, call 112 or go to the nearest emergency department.
• Rapidly spreading, red and hardening swelling with high fever, or being unable to open the mouth, may indicate an abscess and needs assessment the same day.
• New weakness or drooping of one side of the face (being unable to close the eye, a drooping corner of the mouth) should be assessed without delay.

Situations needing an appointment within days to weeks

• A lump in front of the ear, under the jaw or inside the mouth that lasts more than a few weeks or keeps growing.
• A lump that is hard, fixed, growing quickly or painful, or a lump accompanied by facial numbness or persistent pain.
• Swelling and pain that keep coming back with meals, a bad taste in the mouth or pus from the duct opening.
• A painful facial swelling with fever that does not improve within a few days, or persistent dry mouth and dry eyes.

Home measures and medication

• Drinking plenty of fluids increases saliva flow and helps clear stones and infected secretions.
• Sour sugar-free sweets, a slice of lemon or sugar-free gum stimulate saliva; gently massaging the gland from back to front and applying a warm compress may help a stone move along.
• Painkillers approved by your doctor can be used for pain and swelling; do not try to remove a stone with a sharp object.
• If there are signs of bacterial infection, your doctor may start antibiotics; severe cases may need fluids and antibiotics through a vein, and an abscess is drained if it develops.

Procedures and surgery

Stones that do not pass on their own can be removed through the mouth with a minor procedure if they lie near the duct opening. Sialendoscopy is a gland-preserving method in which a thin camera is passed into the salivary duct from inside the mouth, allowing the stone to be seen, removed if it is of suitable size, and narrowed segments to be widened; it is not suitable for every stone or every patient.

For recurrent stones or infections, or for tumours, surgical removal of the gland may be considered. Removal is also often recommended for benign parotid tumours, because some continue to grow over time, a few may rarely become malignant over the years, and a definite diagnosis can only be made by examining the whole tissue.

Parotid surgery and the facial nerve

The facial nerve, which moves the muscles of facial expression, runs through the parotid gland. In parotid surgery (parotidectomy) the surgeon aims to find and protect this nerve while removing the tumour; some centres also use nerve monitoring during the operation.

After surgery, temporary facial weakness can occur and usually improves over weeks to months; permanent weakness is less common, and the risk depends on how closely the tumour is related to the nerve. Numbness around the earlobe is common and may lessen over time. Some people develop sweating and flushing of the cheek when eating, months after surgery (Frey syndrome). These risks should be discussed individually before the operation.