In brief
Salivary glands can swell because of infection, stones or tumours.
Swelling that appears at mealtimes suggests a stone; a slowly growing lump should be assessed with ultrasound and, if needed, fine-needle aspiration.
The major salivary glands are the parotid, in front of the ear, the submandibular, below the jaw, and the sublingual, under the tongue.
Hundreds of minor salivary glands are spread throughout the lining of the mouth and throat.
Inflammation (sialadenitis)
- Viral parotitis: the best known is mumps (paramyxovirus), now rare thanks to vaccination.
- Acute bacterial sialadenitis: a swollen, painful gland with pus at the duct opening; dehydration and reduced saliva flow make it more likely.
- Chronic recurrent sialadenitis: repeated episodes of swelling, often related to narrowing of the duct.
- Systemic diseases: Sjögren’s syndrome, IgG4-related disease and sarcoidosis can involve several glands.
Salivary stones (sialolithiasis)
Stones mostly affect the submandibular gland.
The typical symptom is painful swelling during or just after meals, which settles over the following hours.
Ultrasound detects most stones.
Treatment ranges from medical measures (hydration, sialagogues, massage) to removal of the stone through the mouth; removal of the gland is reserved for cases that do not respond.
Salivary gland tumours
Most parotid tumours are benign; in the smaller glands the proportion of malignant tumours increases.
- Benign: pleomorphic adenoma (the most common, to be removed because it can grow and, over time, become malignant) and Warthin’s tumour (common in smokers, often bilateral).
- Malignant: mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, salivary duct carcinoma and other histotypes.
Warning signs: rapid growth, pain, facial nerve weakness, a hard fixed lump, enlarged neck lymph nodes.
Diagnosis
- Clinical examination with palpation and assessment of the facial nerve.
- Neck ultrasound.
- Ultrasound-guided fine-needle aspiration (cytology, Milan system) or core needle biopsy.
- MRI to define the extent of the lesion and its relationship to the facial nerve.
Treatment
Tumours are treated surgically: parotidectomy (superficial, partial or total) or removal of the submandibular gland.
During parotidectomy the facial nerve is identified and preserved, with the help of intraoperative nerve monitoring.
For malignant tumours, depending on stage and grade, treatment may also include neck dissection and postoperative radiotherapy.
Further reading: TNM staging calculator and treatment options (in Italian).
Author: Dr Puya Dehgani-Mobaraki. Last reviewed: October 2026.