skip to main content
ukmla 2026

Salivary Gland Disorders

Conditions of the major salivary glands — sialolithiasis (80% submandibular), sialadenitis, salivary tumours (80% parotid, 80% benign, 80% pleomorphic adenoma), mumps

Review date
reviewed 2026-04-05
Reading time
5 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
ENTless-commonacute-on-chronic
On this page
Condition details
ENT
less-common
5 min read
reviewed 2026-04-05
practice ukmla questions →

About This Page

This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.

Key points

  • Sialolithiasis: 80% submandibular (longer duct, mucoid saliva, runs uphill) — painful meal-related swelling
  • Sialadenitis: bacterial (S. aureus) or viral (mumps). Treat with antibiotics + hydration + sialogogues
  • Salivary tumours: 80% parotid, 80% of parotid benign, 80% of those are pleomorphic adenoma
  • Pleomorphic adenoma: firm, slow, painless parotid mass — superficial parotidectomy (not enucleation)
  • Facial nerve (CN VII) involvement in parotid mass = MALIGNANCY
  • Investigation: USS + FNA for any salivary lump. MRI for parotid tumours

Overview

Salivary gland disorders include stones (sialolithiasis), infection (sialadenitis), autoimmune (Sjögren's), and tumours. Sialolithiasis most commonly affects the submandibular gland (~80%) — its duct is longer, narrower, runs uphill, and saliva is more mucoid. The 80% rule: 80% of tumours are parotid, 80% benign, 80% of those are pleomorphic adenomas.

Epidemiology

Sialolithiasis affects ~1% of the population. Salivary tumours incidence ~2.5–3 per 100,000/year. The smaller the gland, the higher the malignancy proportion — ~50% submandibular and ~80% sublingual/minor gland tumours are malignant.

Clinical Features

Symptoms
Meal-related painful swelling (sialolithiasis) — worsens eating, subsides between meals
Painful, tender, swollen gland with fever (sialadenitis)
Painless slow-growing parotid/submandibular lump (tumour)
Bilateral parotid swelling + fever (mumps)
Rapid growth, pain, facial weakness in parotid mass — malignancy
Signs
Palpable stone in floor of mouth, purulent discharge from duct on massage
Pleomorphic adenoma: firm, smooth, mobile, painless parotid mass
Facial nerve palsy (LMN) with parotid mass — strongly suggests malignancy

Investigations

First-line
USS salivary glandsFirst-line — identifies stones, masses, draining nodes
FNA cytologyFor any salivary lump — benign vs malignant
Second-line
Plain X-ray (occlusal)Submandibular stones — 80% radiopaque
MRI parotidBest for parotid tumours — deep lobe, facial nerve relationship
Specialist
SialendoscopyMinimally invasive stone retrieval

Management

ENT UK Guidelines
1
Sialolithiasis
  • Conservative: hydration, sour sweets (sialogogues), gland massage
  • Sialendoscopy for stone retrieval
  • Submandibular gland excision for recurrent stones
2
Sialadenitis
  • Flucloxacillin 500 mg QDS (or co-amoxiclav) for 7 days
  • Hydration, sialogogues, warm compresses
  • I&D if abscess forms
3
Salivary tumours
  • Pleomorphic adenoma: superficial parotidectomy with facial nerve preservation
  • Warthin's: superficial parotidectomy or observation if elderly
  • Malignant: total parotidectomy ± neck dissection ± RT
4
Mumps
  • Supportive: analgesia, fluids
  • Notifiable disease
  • Complications: orchitis, meningitis, pancreatitis, SNHL
  • Prevention: MMR vaccination

Complications

  • Facial nerve injury: Risk in parotid surgery — temporary ~20%, permanent <5%
  • Frey syndrome: Gustatory sweating after parotidectomy — aberrant auriculotemporal nerve reinnervation
  • Malignant transformation: Untreated pleomorphic adenoma ~5% over 15 years
  • Salivary abscess
UKMLA Exam Tips
  • 180% rule: 80% parotid, 80% benign, 80% pleomorphic adenoma
  • 2Facial nerve palsy + parotid mass = MALIGNANCY until proven otherwise
  • 3Sialolithiasis: 80% submandibular. Meal-related swelling is the classic history
  • 4Frey syndrome: gustatory sweating after parotid surgery — commonly tested
  • 5Pleomorphic adenoma: EXCISE with margin (parotidectomy), NOT enucleation — multifocal recurrence
  • 6Warthin's: second most common benign parotid tumour, bilateral 10%, smokers
  • 7Mumps: bilateral parotid swelling in unvaccinated child

Put your reading into practice

Topic-specific question practice is not linked for this article yet.

Choose UKMLA questions from the existing bank. General exam practice covers your selected topics; it is not filtered to this article. Your usual question-bank access applies.

Choose UKMLA practice

After your session, return to this section to revisit the reading and choose your next review.

Verified Sources & References

ENT UK — Salivary gland disorders
Your learning path

Save your place and choose what comes next

sign in to save your learning

ENT · Article 15 of 17