At what point should I refer a patient with sialadenitis to secondary care for further evaluation or management?

You should refer a patient with sialadenitis to secondary care for further evaluation or management in the following circumstances:

• Persistent and/or Unexplained Swelling: If there is a parotid or submandibular gland swelling that is persistent and/or unexplained, an urgent referral (for an appointment within 2 weeks) should be arranged to an ear, nose, and throat (ENT) surgeon ¹. This approach is supported by expert opinion, noting that surgery is the most common initial treatment for salivary gland tumours, and urgent referral is recommended if malignancy is suspected ¹. A suspected cancer pathway referral should be considered for a persistent and unexplained neck lump ⁴.
• Suspected Salivary Gland Calculus: If a salivary gland calculus is suspected, a referral should be arranged to an ENT surgeon or a maxillofacial surgeon, with the urgency depending on clinical judgement and local service provision ¹. Additional investigations such as salivary gland ultrasound or CT may be needed, and surgical removal of the stone or gland excision may be required ¹.