Salivary Gland Inflammation (Sialadenitis): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic and therapeutic steps. Extraoral examination

Inspection

  • Facial asymmetries
    • [Lateral difference visible with swelling of parotid glandulae (parotid glands) and sublingual glandulae (sublingual glands) from extraoral (“outside the oral cavity”)]
    • [bilateral swelling visible]
  • Facial motor function
    • Lateral comparison of facial nerve function [in changes of the parotid gland (parotid gland), especially in tumorous changes, rarely: in deep inflammatory infiltrates of purulent parotitis partial paresis (paralysis) of individual facial nerve branches].
  • Soft tissue swelling
    • [Parotitis: protruding earlobe.
      • In parotitis epidemica (mumps) unilateral or bilateral]
    • [Swelling of the glandular parenchyma.]
    • [Swelling due to collateral soft tissue edema]
  • Constancy of soft tissue swelling
    • Constant [Küttner’s tumor, chronic recurrent sialadenitis of the submandibular gland (submandibular gland) in the terminal stage]
    • Dependent on food intake [sialolithiasis, obstruction (occlusion) of the ductal system]
  • Skin florescences
    • Skin redness
      • [in the regio parotidea (in the region of the parotid gland) in purulent parotitis]
      • [inflammatory sign]
  • Tensions of the musculature
    • [possible lockjaw in purulent parotitis with subsequent abscessation (formation of an abscess cavity/pus cavity) in parotid lodge]

Palpation

  • Findings parameter
    • Location of a change
    • Size of a change
    • Consistency
      • Derb [Küttner tumor, chronic recurrent sialadenitis of end-stage submandibular gland; DD to neoplasia difficult].
      • Soft-edematous
      • Plump
      • Elastic
      • Fluctuating [abscess]
    • Limitation
      • Sharply limited
      • Diffusely overlapping into the surrounding area
    • Palpation dolence (pain sensitivity on palpation).
      • [Purulent parotitis: even careful palpation can be very painful].
      • [Painful in acute bacterial sialadenitis.]
      • [Küttner tumor: only slightly dolent/painful]
      • [Chronic myoepithelial sialadenitis: only slightly dolent]
      • [Parotitis epidemica: unpleasant but only slightly painful]
    • Displaceability against support and skin
  • From extraoral
    • Glandula parotidea to be palpated exclusively from extraoral; hardly palpable (palpable) in healthy state.
  • bidigital – from intraoral with counterpalpation from extraoral.
    • Submandibular gland can be palpated well.
    • Glandula sublingualis is less good to palpate.
    • Excretory ducts
      • Probing
  • bony facial skull
    • mandibular branch and angle
      • [no longer palpable in case of infection of the parotid lodge due to purulent sialadenitis]
  • Lymph nodes
    • Enlargements
    • Hardenings
    • Conglomerates (agglomerated structures).
      • Intraglandular (within the glands).
      • Periglandular (around the gland) – [The submandibular gland cannot be palpated if the periglandular lymph nodes are enlarged].
      • Submandibular (below the gland).
      • Cervical (“belonging to the neck”)

Intraoral examination

Inspection

  • Floor of mouth
    • Protrusions [always raised in inflammatory changes of the sublingual or mandibular glandulae].
    • Color of the mucosa [mucosal redness]
    • Wharton’s duct (excretory duct of the submandibular gland).
    • Papilla salivaria sublingualis [always reddened in inflammatory changes].
  • Labial mucosa
    • Color [mucosal redness]
    • Moisturization [dry in chronic myoepithelial sialadenitis]
    • [atrophic-glossy in chronic myoepithelial sialadenitis]
  • Tongue mucosa
    • [dry in chronic myoepithelial sialadenitis]
    • [atrophic-glossy in chronic myoepithelial sialadenitis]
  • Buccal mucosa
    • Stenon’s duct (excretory duct of the parotid gland) [often swollen in inflammatory changes].
    • Papilla salivaria buccalis (excretory papilla of Stenon’s duct) [often markedly reddened in inflammatory changes]
    • [atrophic in chronic myoepithelial sialadenitis]
  • Saliva or secretion
    • Spontaneous flow [disturbed in the case of outflow obstruction].
    • Quantity [Decreased: Sicca syndrome, Sjögren’s syndrome, Heerfordt’s syndrome, desiccosis (dehydration), sialolithiasis, xerogenic pharmaceuticals]
    • Sticky [to borky in chronic myoepithelial sialadenitis]
  • Rhagades (fissures; narrow, cleft-shaped tear in the skin).
    • [in chronic myoepithelial sialadenitis.]

Palpation

  • Bidigital (from intraoral (inside the oral cavity) with counterpalpation from extraoral (outside the oral cavity):
    • Submandibular gland can be palpated well.
    • Glandula sublingualis is less good to palpate.
    • Excretory ducts
      • Probing [obstruction (occlusion) in sialolithiasis]
  • Exprimate (expressed saliva or secretion):
    • Physiological: after massage or spontaneous flow low-viscosity, clear saliva.
    • [serous: also in viral sialadenitis.]
    • [scanty or absent: salivation reduction (salivary flow reduction), sialolithiasis (salivary stones), also acute bacterial sialadenitis]
    • [higher viscosity: dyschyly; dehydration (lack of fluid); chronic myoepithelial sialadenitis]
    • [thick viscous and sticky in chronic myoepithelial sialadenitis]
    • [milky, cloudy, putrid (purulent), bloody: acute bacterial sialadenitis]
    • [flocculent: undissolved components (calculi, stones)]
    • [cloudy in Sjögren’s or sicca syndrome]
  • [stone, concretions]
  • Palpation dolence (pain sensitivity on palpation).
    • [Purulent parotitis: even careful palpation (touching) can be very painful].
    • [Painful in acute bacterial sialadenitis.]
    • [Küttner tumor: only slightly dolent]
    • [Parotitis epidemica: unpleasant but only slightly painful]

Square brackets [ ] indicate possible pathological (pathological) physical findings.