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]
- [Parotitis: protruding earlobe.
- 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]
- Skin redness
- 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]
- mandibular branch and angle
- 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.