Case history
Case history #1
A 65-year-old man presents with acute pain on the left side of the face. He is being treated for hypertension and recently started taking fluoxetine for depression. He smokes a half pack of cigarettes every day. The patient complains of intense and constant pain on the left side of his face. Head and neck examination reveals a circumscribed swelling in the left preauricular area that extends to the mandibular angle. Outward displacement of the earlobe is noted. The patient has never experienced this before. Gentle manipulation of the left parotid gland results in expression of a purulent exudate from the opening of Stensen duct opposite the upper first molar tooth.
Case history #2
A 42-year-old woman presents to her dentist with acute swelling and pain under the tongue on the left side. She states these symptoms have lasted for 3 days and that the pain increases while eating. Medical history is unremarkable. Examination reveals erythema and edema of the left anterior floor of the mouth. No neurologic deficits are noted. A discrete yellow waxy object is seen through the mucosa in the vicinity of Wharton duct. The pain decreases during the postprandial period.
Other presentations
Chronic recurrent sialadenitis is more common in adults, usually affecting the parotid glands more often than the submandibular glands. However, children may also be affected. It presents as a sudden unilateral or, rarely, bilateral swelling. Patients complain of tenderness and are unable to correlate the development of the swelling with any particular event (e.g., intake of medications, postprandial events). The duration of the episodes can vary from days to months. Chronic sclerosing sialadenitis is more commonly found in submandibular glands. Although it typically presents as a unilateral enlargement of a submandibular gland, there are reports of synchronous involvement of major and minor salivary glands. Clinically, it can be either symptomatic or asymptomatic, and is difficult to differentiate from a tumor. Autoimmune sialadenitis is classically seen in women with Sjogren syndrome, and presents as bilateral symptomatic stable swellings of the parotid glands. Subacute necrotizing sialadenitis is rare but is reported to present as a painful unilateral or bilateral swelling of the hard (rarely soft) palate that resolves spontaneously within days or weeks.
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