Swollen Salivary Gland: Causes and When to Seek Care

01Anatomy

Where salivary glands are

The NIDCR explains that there are three pairs of large (major) salivary glands, plus hundreds of smaller ones. The parotid glands are in front of and just below each ear, the submandibular glands are below the jaw, and the sublingual glands are under the tongue. They make saliva and empty it into the mouth through small openings called ducts.

Saliva keeps food moist, helps chewing, swallowing and digestion, and keeps the mouth clean, since it contains antibodies that kill germs. The NIDCR notes that when glands are damaged or do not make enough saliva, taste, chewing and swallowing can be affected and the risk of cavities, tooth loss and mouth infections increases.

02A symptom

Swelling as a symptom rather than a diagnosis

MedlinePlus and the NIDCR explain that problems with the salivary glands can make them irritated and swollen. Symptoms may include:

• swelling of the face or neck, or under the tongue
• pain in the face or mouth
• difficulty opening the mouth
• a bad taste in the mouth or a dry mouth
• a lump near the ear, cheek, jaw or lip, or inside the mouth
• fluid draining from the ear, or numbness or weakness of the face

Not every swelling in the neck is a salivary gland: lymph nodes, which often swell with a sore throat or cold, lie in the same area. A doctor can tell them apart. Our guide on a lump behind the ear covers other causes of swelling near the parotid gland.

03Obstruction

Obstruction and meal-related symptoms

One of the most common mechanisms is a blockage. The NIDCR explains that small stones can form in the ducts and obstruct the flow of saliva, so the gland may swell, become painful and become infected. Small narrowings or twists in the duct system of the large glands can also reduce the flow of saliva.

Because glands produce more saliva when you eat, swelling and pain linked to a blockage are often noticed around meals. However, not every swollen gland has a stone, and the cause should be confirmed by a professional. Do not try to open a duct yourself by probing it with objects or by forceful massage, as this can cause injury.

04Infection

Infection and inflammatory conditions

Infection can follow a blockage. The NIDCR explains that when saliva pools behind an obstruction in a duct, the gland can become infected, and that an infection of the lymph nodes from a sore throat or cold can also lead to a secondary infection of the salivary glands. MedlinePlus lists mumps, a viral infection, among the causes of salivary gland problems.

Several conditions that affect the whole body can also make the glands inflamed and painful, including HIV, Sjögren’s disease and rheumatoid arthritis. The NIDCR adds that diabetes may cause enlargement of the salivary glands, and that people with an alcohol use disorder may have swelling, usually on both sides of the face.

05Lumps

Persistent lumps and other causes

A lump that does not go away needs assessment. The NIDCR explains that tumors usually appear as painless enlargements in one of the salivary glands, and that most tumors in the parotid area are benign (noncancerous). Cancerous tumors often grow quickly, may or may not be painful, and may cause numbness or loss of movement on the affected side of the face.

Risk factors for salivary gland cancer include older age, radiation treatment to the head and neck, some types of chemotherapy and exposure to certain substances at work. A lump that persists, grows, or comes with facial numbness or weakness should be checked promptly by a doctor.

07Diagnosis

Clinical assessment and selected tests

The NIDCR explains that a doctor uses your medical history, a physical examination and laboratory tests to diagnose a salivary disorder. If pain and inflammation are thought to come from a blockage, X-rays or an ultrasound can show where the obstruction is and what is causing it.

If a lump is found, a CT or MRI scan gives a better view, and a fine needle aspiration biopsy may be used to take a small sample of tissue or fluid to check for cancer cells. A biopsy of the minor salivary glands in the lip may help identify autoimmune conditions such as Sjögren’s disease. Tests are chosen according to what the doctor suspects.

08Treatment

Treatment matched to the cause

The NIDCR explains that salivary disorders are treated according to their cause. If a condition affecting the whole body is responsible, that is treated first, sometimes by a specialist. If a duct is blocked, the doctor may numb the area with a local anesthetic and then probe and widen the duct to remove the stone. Antibiotics are used for bacterial infections, but not for viral causes such as mumps.

If a tumor develops, removal may be recommended, usually by an ear, nose and throat surgeon. Cancerous tumors are removed surgically and the area may be treated with radiation and, in some cases, chemotherapy. In our ENT practice in Bilbao we offer scheduled assessments for adults with salivary gland swelling when there are no urgent signs (consultations are in Spanish).

09Sources

Where the sources differ

The MedlinePlus page is a short summary that links to other resources, while the NIDCR page explains causes, diagnosis and treatment in more detail. Points to note:

• Scope. MedlinePlus lists infections, obstruction, cancer, mumps and Sjögren’s syndrome as causes. The NIDCR adds medicines (dry mouth in older adults taking several), diabetes, HIV, rheumatoid arthritis and alcohol use disorder.
• Dry mouth tips. The NIDCR gives tips to keep the mouth moist, written mainly for dry mouth after treatment such as radiation: drink plenty of fluids, rinse with plain water before and after meals, chew sugarless gum or suck sugarless sweets, take small bites, and avoid acidic and alcoholic drinks, tobacco and commercial mouthwashes. If you have been told to limit fluids, follow your doctor’s advice.
• Gland removal. The NIDCR notes that removing one salivary gland does not affect overall saliva production. This may not apply when several glands are affected or after radiation.
• Timescales. Neither source says how long swelling usually lasts.

10Summary

In summary

A swollen salivary gland is a symptom with several possible causes: a blocked duct, infection, conditions such as Sjögren’s disease, diabetes or mumps, and, less often, a tumor, which is usually benign. A doctor diagnoses the cause through history, examination and, when needed, imaging or a biopsy, and treats the swelling according to that cause.

Before an appointment, note which side and which gland area is swollen, whether it changes with meals, whether you have dry mouth, fever or a bad taste, and how the swelling has changed over time. Seek emergency care for difficulty breathing or swallowing, and prompt review for fever, worsening swelling, a persistent lump or facial weakness.