Parotid Gland Examination

 

Parotid Gland

Inspection

Number
Site Parotid region
Shape Parotid shape if diffuse parotid enlargement
Size
Surface
Skin and color Scar, fistula
Special signs Relation to chewing food

Palpation

Relations to the surroundings:

Mobility

Relation to skin Freely mobile, Tethered or Fixed
Relation to muscles Masseter “جز على سنانك” and Sternomastoid
Relation to nerves Facial nerve examination
Relation to artery Superficial temporal artery pulse
Ear Elevation of ear lobule
Other swellings
Temperature
Tenderness
Edge
Reducibility ?
Solid, fluid or gas
  • Consistence
  • Fluctuation

Open the mouth to assess

  • Ability to open
  • What happen to the lump?
  • Parotid lump usually diminish in size due to tension of parotid facsia
  • Dryness of the mouth
  • Swellings of submandibular glands and its duct (bimanual examination)
  • Parotid duct
  • Deep part of the parotid gland

TAKING HISTORY FROM A PATIENT WITH parotid PROBLEM

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms Relation to the main complaint

  • Lump
  • Pain
    • Relation to food
  • Sinus or fistula
  • Dryness of the mouth
  • Trismus
  • Symptoms of malignancy
    • Symptoms suggesting spread
      • Local
        • Facial palsy
        • Lymphatic
        • Multiple lumps in the neck
      • Distant
    • General symptoms associated with cancer
      • Malaise
      • Weight loss
      • Cachexia
Differential diagnosis of salivary glands presentations
  • Swellings in parotid region
    • True Parotid enlargement
    • Extra-parotid enlargement
Lymph nodes Lymphadenopathy
Skin and subcutaneous tissue
  • Sebaceous cysts
  • Lipomas
Muscle Masseter hypertrophy
Bone
  • Mandibular and maxillary tumors
    • e.g. adamantinoma of the mandible
Artery Superficial temporal artery aneurysm
Nerve Neurofibroma
Causes of swelling of a salivary gland
  • Acute infection
    • Viral (e.g. mumps)
    • Bacterial (e.g. staphylococcus)
  • Duct obstruction
  • Sialectasis (chronic infection)
  • Tumor
    • Benign
    • Malignant
  • Sarcoidosis
  • Sjogren’s syndrome
Parotid gland tumors
  • Adenomas
    • Pleo-morphic adenoma
    • Mono-morphic adenoma “adeno-lymphoma” or “Warthin’s tumor”
  • Acinic cell tumor (malignant)
  • Muco-epidermoid (malignant)
  • Carcinomas
    • Adeno-epidermoid
    • Adeno-cystic
    • Ex-pleo-morphic
Behavior Site Age Consi. Special features
Pleo-morphic adenoma Benign Cystic
  • Incomplete capsule
  • Epithelial cells arranged in sheets and duct like structures are interspersed by mucoid material
Mono-morphic adenoma

“adeno-lymphoma”

“Warthin’s tumor”

Benign Lower part of the parotid Elderly Cystic
  • Related to smoking
  • 10% bilateral
  • Epithelial lined spaces filled with creamy material
  • Surrounded by lymphoid tissue
Acinic call tumor Malignant Cystic
Muco-epidermoid Malignant Parotid

(from duct epithelium)

Children Hard
  • Mobile
  • Spare the facial nerve in spite of being malignant
Adeno-epidermid Malignant
Adeno-syctic Malignant Minor salivary glands Hard
  • Commonest malignancy
  • Perineural spread
  • Hard
  • Swiss cheese appearance
Ex-pleo-morphic Malignant

The commonest salivary neoplasm is peomorphic adenoma of the parotid

Cystic parotid tumors
  • Adenolymphoma
  • Acinic cell tumor
  • Pleomorphic adenoma
Hard parotid tumors
  • Adenocystic
  • Mucoepidermoid

Summary of Parotid swellings according to the criteria of its swelling

4 common conditions
Acute Bilateral Diffuse
  • Viral parotitis
Chronic Bilateral Diffuse
  • Endemic parotitis
  • Miculicz syndrome
  • Sjogren syndrome
  • Sarcoidosis
Acute Unilateral Diffuse
  • Septic parotitis
Chronic Unilateral Lump
  • Neoplasm
4 less common conditions
Chronic Bilateral Lump Adenolymphoma “papillary cystadenoma lymphomatosum”
Acute Bilateral Lump Very unusual
Acute Unilateral Lump
  • Tumor
  • Abscess
  • Degenerated adenolymphoma
Chronic Unilateral Diffuse Rare form of chronic bilateral diffuse
Summary of Parotid swellings according to the criteria of its pain
Painful diffuse swelling Sialadenitis
Painful swelling which fluctuate with meals Sialolithiasis
Non-painful swelling Tumor
Clinical presentation of different salivary glands disorders

Mikulicz’s syndrome

  • Chronic bilateral diffuse enlargement of salivary glands
  • Enlargement of lachrymal glands
  • Dry mouth

Sjogren’s syndrome

  • As Mikulicz’s syndrome +
  • Dry eye
  • Generalized arthritis

Criteria of malignancy of a parotid swelling

  • Rapid rate of growth
  • Infiltration of nerves
  • Pain or tenderness
  • Classical signs of facial nerve palsy
  • Superficial temporal artery pulse becomes weak
  • Fixed, hard mass
  • Lymph node enlargement (lymphatic spread uncommon)
  • Rarified bone in x ray
  • Biopsy indicates malignancy
Clinical sequelae of salivary calculi (As Any Stone)
Migrate
Irritate
Impact Obstruction
Stasis
Back pressure
Infection
Fistula
Ulceration