Salivary gland disease - emergency medicine brief
Salivary gland problems commonly present to the emergency department (ED) or urgent care. The two principal acute presentations are obstructive disease from salivary stones (sialolithiasis) and infectious sialadenitis (bacterial or viral).
Emergency clinicians must recognise red flags (airway threat, sepsis, abscess), provide effective initial care (analgesia, fluids, local measures), obtain focused investigations and arrange ENT/specialist referral for definitive management (including sialendoscopy or surgery) when indicated.
“Salivary gland disease” is included in the RCEM/ACP emergency medicine curriculum as an expected ED presentation.
Epidemiology and aetiology
- Sialolithiasis is the most common salivary‑gland disorder in adults in the UK, with an estimated incidence of approximately 10 per 100,000 per year.
- Typical age of presentation is 30-60 years and there is a male predominance.
- Stone location: about 80% are in the submandibular (Wharton) duct, about 20% in the parotid (Stensen) duct and less than 1% in the sublingual glands.
- Predisposing factors include reduced salivary flow (for example dehydration, anticholinergic drugs, diuretics), Sjögren’s syndrome, recent surgery or dental work and smoking.
- Infectious causes include acute bacterial sialadenitis (commonly Staphylococcus aureus and oral flora) and viral parotitis (mumps, CMV, EBV).
- Chronic or recurrent sialadenitis suggests underlying obstruction, ductal stricture or an underlying neoplasm.
Relevant anatomy (clinical implications)
- Major glands are the parotid, submandibular and sublingual glands; minor glands are...