The large paired salivary glands (parotid, submandibular, submaxillary) are subject to generalised enlargement: this may be symmetrical, as in mumps, or variable as in sarcoid, and Sjögren’s and Mikulicz’s syndromes. Like all glands, they are subject to inflammation and neoplasia, while blocking of a duct, by a stone or inspissated debris, may produce intermittent swelling on eating, and progress to retrograde infection and abscess formation. Swellings of the submandibular and parotid glands are easily mistaken for enlargement of the overlying lymph nodes.
The parotid duct opens opposite the crown of the second upper molar tooth (figure 12a). The parotid gland is palpated mainly externally but also bimanually around the anterior border of the ramus of the mandible (figure 12b). The gland extends below and behind the angle of the jaw and parotid lumps in this region may be difficult to differentiate from lymph nodes or submandibular gland enlargement. Abscess formation (figure 13) is less common, and is in children or debilitated adults.
The submandibular ducts open on the sublingual papillae on either side of the midline, adjacent to the frenulum of the tongue (figure 14a). Saliva can be seen to exude from the papillae and occasionally a submandibular calculus becomes lodged at this site. The sublingual and submandibular glands can be palpated bimanually throughout their lengths in the floor of the mouth (figure 14b).