According to the British Medical Journal (The BMJ) Best Practice on<unk> , there are multiple factors to consider during the diagnosis of<unk> , including history, presenting signs and symptoms, followed by appropriate investigations in relation to the presenting case. Other factors to also consider include the type of gland affected as well as underlying conditions such as an autoimmune disease or ductal stones. Acute bacterial<unk>  May present with a history of recent surgical intervention or use of medications such as antihistamines, antidepressants, or anticholinergic agents. These medications may lead to objective hypofunction or subjective feeling of a dry mouth without hypofunction. There may also be a history of decrease in salivary volume secondary to a systemic disease. A unilateral or bilateral painful swelling of the parotid or submandibular regions may be present upon a physical examination. This could be accompanied by an external displacement of the earlobe usually adjacent to an inflamed parotid gland. Pus suppuration from major salivary gland duct openings may occur spontaneously or after manipulation of the affected gland. Mandibular trismus is a rare finding but may be present with larger swellings. Dysphagia may also be present in some cases. Fever may also be noted, whilst spiking temperatures may be suggestive of an abscess formation. Chronic recurrent<unk>  The occurrence of chronic recurrent episodes may be due to underlying Sjogren's syndrome or ductal abnormalities. Prodrome of tingling in the gland preceding pain and swelling may be reported in such cases. Chronic sclerosing<unk>  Typically presents unilaterally in submandibular gland that cannot be differentiated clinically from a neoplasm, with pain an inconsistent finding. Obstructive<unk>  Formation of stones in glandular ducts (sialoliths) can result in the development of obstructive<unk> . There may be a history of abrupt episodic swelling of the parotid or submandibular gland which is usually painful. These episodes typically occur around meal times, lasting 2 – 3 hours and gradually subsides. Autoimmune<unk>  Characterised by persistent, asymptomatic bilateral swelling of parotid glands, and may represent as a manifestation of more widespread systemic disease. Dry eyes and dry mouth are commonly present and may be indicative of concomitant connective tissue disease (e.g. SLE, RA, or scleroderma). Oral candidiasis may also be present. Common key diagnostic factors 1. Fever – may present with an acute infective<unk>  or autoimmune aetiology suggestive of an infection or inflammation. 2. Pain and dysphagia (ie. difficulty swallowing) – usually unilateral affecting the parotid or submandibular regions, with worse pain during eating and swallowing. 3. Facial swelling – usually unilaterally and affecting parotid region, under the tongue, or below the jaw. May have acute onset and may have a history of repeated episodes. 4. Recurrent painful swellings – indicative of chronic recurrent<unk> , may have similar signs and symptoms to an acute episode. 5. Pus exudation from salivary gland openings – indicative of bacterial infection, may occur on manipulation of the affected gland or spontaneously. Other common diagnostic factors to consider 1. Episodic swelling during meal times – may present as an acute salivary gland swelling without visible salivary flow from ductal openings. While palpation of affected glad may reveal an indurated salivary gland and presence of a sialolith. 2. Use of xerostomic medications – these medications will result in a decreased salivary flow rate which can predispose to infections of glands. Examples of medications that may contribute to this include antihistamines, antidepressant, and anticholinergic agents. 3. Recent surgical intervention under general anaesthetic – this could predispose to<unk>  due to direct effects of anaesthetic agents used and volume depletion from surgery. 4. Dry eyes and mouth – dryness affecting the eyes and oral cavity are key symptoms of Sjogren’s syndrome and may be seen in combination with a connective tissue disease such as rheumatoid arthritis, scleroderma, or dermatomyositis. 5. Oral candidiasis – may be present in cases of Sjogren’s syndrome or in associate with a connective tissue disorder. Key factors to also consider which are less common 1. Mandibular trismus – restricted mouth opening to its full extent (of approximately 40mm) may be present with large swellings typically due to acute bacterial infection of affected gland. 2. Respiratory distress – this could present in the form of stridor, use or reliance on accessory muscles of respiratory, nasal flaring, or wheeze. These signs may develop if glandular swelling is significant enough, resulting in airway obstruction. 3. Cranial nerve palsy – swelling increases the risk of compression of cranial nerves VII, IX and XII. Other diagnostic factors which are less common 1. Connective tissue disorder or Sjogren’s syndrome – history of Sjogren’s syndrome, or a concomitant connect tissue disorder such as systemic lupus erythematosus, rheumatoid arthritis, or scleroderma. 2. Recurrent painless swellings – indicative of underlying autoimmune aetiology. 3. Displacement of earlobe – may be present when swelling of the parotid gland is present. 4. Prodrome of tingling in the affected gland 5. Swelling on hard palate Diagnostic tests Tests available as part of diagnosing<unk>  include: # Culture and sensitivity testing of exudate from salivary duct. Culturing of purulent discharge is advisable in acute presentations of<unk>  to allow targeted antibiotic therapy. # Full blood count if infection is suspected. # Facial radiographs such as dental radiographic views should be taken to exclude an obstructive element due to presence of sialolith or evolving abscess. However, sialoliths with low calcium phosphate content may not be visible.
Sialadenitis
Laryngitis
Phlegmon
Tonsillitis
Pharyngitis
Posthitis
Sinusitis
Placentitis