Swollen Necks, Dry Mouths: Diagnosing Salivary Gland Diseases

Gordon H. Sun, MD, MS

Disclosures

June 06, 2019

What Is Causing the Facial Swelling and Pain?

A 67-year-old man has a 3-day history of right-sided facial swelling and pain. He also reports odynophagia and sore throat, but no dyspnea or dysphonia. Although he has been feeling more tired than usual, he denies recent illness or trauma. He did experience a similar episode approximately 1 year ago, shortly after an otherwise successful cholecystectomy. His history includes type 2 diabetes, hypertension, hyperlipidemia, and asthma, all of which are well controlled with medications. He denies tobacco, marijuana, alcohol, and any other recreational drug use. He has no known drug, food, or environmental allergies.

On examination, he is thin and appears to be his stated age. Vital signs were:

  • Temperature: 37.5o C (99.5o F)

  • Heart rate: 84 beats/min

  • Respiratory rate: 16 breaths/min

  • Blood pressure: 138/84 mm Hg

  • Oxygen saturation: 96% on room air

The head and neck exam reveals diffuse moderate edema and erythema over the right cheek with tenderness upon palpation; mild trismus is also present. Mouth is edentulous with normal-appearing tonsils and soft palate, moist mucosa, and a mobile tongue. No purulence is expressed from the Stensen duct upon palpation and massage, and no palpable salivary gland stones are noted. No cranial nerve deficits are observed, and no facial or neck masses are visible or palpated. No stridor or dyspnea is observed. The remainder of the physical exam is unremarkable.

Point-of-care laboratory studies demonstrate an elevated white blood cell count.

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