The swelling returns
The gland near the ear or under the jaw occasionally enlarges and hurts, and then subsides.
CONDITION / JAWS, MOUTH AND NECK
Chronic sialoadenitis and sialosis.
Chronic sialoadenitis is a long-term inflammation of the salivary gland, due to which it repeatedly swells and hurts. Sialosis is different: the glands are enlarged without inflammation, and about half of the cases are related to general illness. Both conditions are usually treated conservatively, initially without surgery.
CONCEPTUAL VISUALIZATION- What it is
- Prolonged inflammation of the salivary gland with repeated exacerbations or its increase without inflammation is sialosis.
- What glands?
- Sialosis most often affects the parotid glands; more than 80% of salivary gland stones are on the submandibular.
- How we treat
- First without surgery. If it does not help - sialendoscopy; it is necessary to remove the gland less often.
- Who treats it
- A surgeon, and if the cause is a general illness, then together with a specialized doctor.
01 / WHAT IS ITWhat is
What is
sialoadenitis and sialosis.
Humans have three pairs of large salivary glands: parotid — in front of the ears, submandibular — under the lower jaw, and sublingual — under the tongue. Saliva from them flows into the mouth through thin ducts.
Sialoadenitis is an inflammation of the salivary gland. It is called chronic when exacerbations return again and again: the gland swells, hurts, then subsides. Researchers describe chronic parotitis as a recurring inflammation that eventually destroys the parotid gland.
Sialosis, or sialoadenosis, is another. This is an increase in glands without inflammation and without a tumor: usually on both sides and most often parotid; often it does not hurt. About half of the cases are related to general illness.
Stones in the ducts and tumors of the salivary glands are separate conditions, we talk about them on separate pages.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow is it
How is it
presents.
Sialoadenitis is indicated by exacerbations, and sialosis by a gradual enlargement of the glands, which is often painless.
Pain while eating
If the duct is blocked by a stone, severe pain may appear during meals and last for 1-2 hours.
Salivary stone disease (sialolithiasis)Signs of infection
During an exacerbation, the gland hurts, the skin over it reddens, the temperature rises, and pus may come out of the duct into the mouth.
Both glands are enlarged
The parotid glands on both sides have gradually increased in size, but do not hurt - this is what sialosis usually looks like.
Dry mouth and eyes
Dry mouth and eyes, along with enlarged glands on the cheeks, neck, or under the jaw, occur in Sjogren's syndrome. In the cohort of 668 patients with this syndrome, the parotid glands were enlarged in 36.2%.
03 / REASONSWhy the gland
Why the gland
ignites again.
There are many reasons, and the treatment depends on them. Therefore, first they find out what exactly is interfering with the gland.
Obstruction in the channel
Saliva stagnates if the duct is blocked by a stone, a narrowing or the consequences of an injury.
Salivary stone diseaseJuvenile mumps
Children have recurrent parotitis — a rare recurrent inflammation of the parotid glands. Its cause is still unclear.
Radioactive iodine
After treatment of the thyroid gland with radioactive iodine, according to a review of studies, salivary gland dysfunction occurs in up to two thirds of patients. The parotid glands are more often affected.
Autoimmune diseases
In Sjögren's syndrome, the immune system attacks the glands that produce saliva and tears. IgG4-associated disease is less common and is often confused with infection or tumor.
General diseases
Type 2 diabetes and long-term alcohol use are among the causes of sialosis. With bulimia, an increase in the parotid glands also occurs, although in a minority of cases.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Chronic sialoadenitis and sialosis usually do not require emergency care - they are treated regularly. But an exacerbation can turn into an acute infection, and then it is important not to delay.
103 immediately if:
- it is difficult to breathe;
- difficulty swallowing or speaking;
- in the mouth, under the tongue or on the neck, a large swelling that grows quickly;
- it became difficult to open my mouth.
Do not postpone the visit if:
On the same day: there are signs of an infection of the gland — it hurts and turns red, pus comes out of the duct into the mouth, the temperature rises or it freezes. Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery, pain or swelling increases on the gland. Temperature of 38 °C and above or pus from the wound after surgery - on the same day to the surgeon. In the near future: the swelling is firm, does not move, grows or does not go away for more than 2 weeks - it should be distinguished from a tumor. Planned: the gland regularly swells, both parotid glands have gradually increased in size, the mouth and eyes are dry for a long time.
05 / DIAGNOSTICSAs they find out
As they find out
the reason
- Discussion and review
How often and after what does the gland swell, what medicines do you take, are there any common diseases. The doctor examines the glands and duct opening in the mouth.
- Ultrasound, CT or MRI
Examinations are chosen depending on the situation: ultrasound, CT or MRI with MR sialography, which shows the ducts. They confirm the diagnosis, show the prevalence of changes and complications.
- Analyzes
If Sjögren's syndrome is suspected: blood tests, eye examination, measurement of the amount of saliva, sometimes a biopsy of the salivary glands of the lip. If an IgG4-associated disease is suspected, the diagnosis is made based on an examination, blood tests, imaging and biopsy.
06 / TREATMENTHow we treat
How we treat
chronic sialoadenitis.
According to a 2024 review, most salivary gland disorders are treated without surgery: they eliminate the cause, provide pain relief, and help saliva flow. Other methods are connected if exacerbations do not stop.
01
Without surgery
The first step.
- Saliva should flow
- Drink enough water, chew gum or suck sugar-free lollipops, gently massage the gland, apply heat, take care of oral hygiene.
- Aggravation
- If the infection is bacterial, the doctor prescribes an antibiotic; the most common causative agent is Staphylococcus aureus.
- Medicines and common diseases
- The doctor will review medications that may reduce saliva production and advise which general illness should be better controlled.
02
Sialendoscopy
A thin endoscope is introduced into the duct through its opening in the mouth. The method preserves the gland.
- Without stones
- In a meta-analysis of 30 studies of chronic sialoadenitis without stones after sialendoscopy with steroid lavage, symptoms returned in 27.49% of patients, a repeat procedure was required in 10.64%, and serious complications in 0.77%.
- Narrowing of the duct
- In a meta-analysis of 91 studies (8,218 patients), the overall success rate of sialendoscopy was 80.9%, but with narrowing of the duct, it was 56.3%. Most studies had a moderate or high risk of error.
- Sjögren and radioiodine
- In Sjögren's syndrome, based on a review of 6 studies (125 patients), at least a temporary improvement can be expected in 90–99% of cases. After radioiodine, a review of 8 studies (122 patients) reported an improvement of at least 75%, and a large meta-analysis reported a success rate of 45.8%.
- Children
- In a review of studies of juvenile parotitis after sialendoscopy, exacerbations recurred in 25.8% of 336 children. However, in two controlled studies, children without the procedure improved just as much, and the disease itself often resolves without treatment.
03
If nothing else helped
- Botulinum toxin
- Injections of botulinum toxin into the parotid gland are tried when even sialendoscopy did not help. In the series described, improvement was noted in 34 of 35 patients, but these are small series without comparison, so the evidence is low.
- Parotid gland removal
- In a series of 37 patients (46 operations), treatment was successful after 87% of operations. There was no permanent paralysis of the facial nerve, temporary weakness of facial expressions — after 26.1% of operations, Frey's syndrome (sweating and redness of the cheek while eating) — in 20 cases (43.5%).
- Removal of the submandibular gland
- It is done for chronic inflammation that does not respond to other treatment. In a series of 29 operations, complications occurred more often after operations for inflammation; weakness of the lower branch of the facial nerve — in 2 cases (6.8%).
04
Sialosis and general diseases
- They treat the cause
- The main thing with sialosis is to find and better control the general disease: diabetes, the effects of alcohol, an eating disorder. This is the task of an endocrinologist, therapist, or psychotherapist, and there is nothing to be ashamed of when contacting them.
- Sjögren and IgG4
- Sjögren's syndrome is managed by a rheumatologist: it cannot be cured yet, but the symptoms help control. IgG4-associated disease mostly responds quickly to glucocorticoids — hormonal drugs.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Chronic sialoadenitis and sialosis at Dr. Valikhnovskyi's Institute of Surgery are considered in the "New face" direction. Treatment of the common cause — Sjogren's syndrome, diabetes, IgG4-associated disease — is conducted by a specialized doctor: rheumatologist, endocrinologist; the surgeon is responsible for his part.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation and assessment — the surgeon finds out how often the gland is aggravated, what examinations have already been done and what they show.
- Personal plan — a sequence of steps — from treatment without surgery to intervention, if it is really necessary.
- CT — if necessary — to assess the gland and surrounding tissues before intervention.
- Rehabilitation of facial expressions — if facial expressions have weakened after surgery on the parotid gland, physical therapy and facial exercises are prescribed.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Statements onlineSend the results of the ultrasound, CT scan or MRI and the discharges, if any - the doctor will pre-evaluate the situation.
- ConsultationAn examination of the glands and ducts, a discussion of exacerbations, medicines and general diseases.
- PlanWhat to do without surgery, which of the specialized doctors to involve, whether intervention on the gland is necessary.
- Restoration of mimicryIf facial expressions have weakened after parotid gland surgery, physical therapy and facial exercises are recommended.
- Follow-upControl examinations to notice a new exacerbation in time and change the plan.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How does sialosis differ from sialoadenitis?
Sialoadenitis is an inflammation, so the gland hurts and swells with exacerbations. Sialosis is an increase in glands without inflammation, usually on both sides, which is often painless; about half of the cases are related to general illness.
Is it possible to do without surgery?
Often yes. According to the 2024 review, most salivary gland disorders are treated without surgery: drinking, chewing sugar-free gum, massage, heat, oral hygiene, reviewing medications, treating the cause.
What is sialendoscopy?
This is an examination and washing of the duct with a thin endoscope through its opening in the mouth. The method preserves the gland; the result depends on the cause of exacerbations.
Will the gland have to be removed?
Not necessarily. In a meta-analysis of 91 studies of sialendoscopy, the gland was subsequently removed in 0–14% of patients, depending on the study. Removal is discussed if other methods have not helped.
Are enlarged glands related to diabetes or alcohol?
Maybe Type 2 diabetes, long-term alcohol consumption, and bulimia are among the causes of sialosis. A specialized doctor helps to treat such a cause, and there is nothing to be ashamed of.
The child's cheek near the ear was swollen several times. Is it a mumps?
If the child has received both doses of the measles, mumps and rubella vaccine or has already had mumps, mumps is very unlikely. Repeated swelling occurs in juvenile recurrent parotitis, which often resolves on its own. The child should be shown to the doctor.
And if it is a tumor?
Salivary gland tumors are rare and mostly benign. But a firm swelling that grows or does not go away for more than 2 weeks should be shown to the doctor and examined.
Sources
21 sources · reviews, meta-analyses, research and NHSshowCollapse
- Salivary Gland Disorders: Rapid Evidence ReviewAmerican Family Physician, 2024pubmed.ncbi.nlm.nih.gov/38905553 ↗
- Diagnostic work-up in obstructive and inflammatory salivary gland disordersActa Otorhinolaryngologica Italica, 2017doi:10.14639/0392-100X-1597 ↗
- Efficacy of Sialendoscopy with Steroid Irrigation for Non-Lithiasic Chronic Sialadenitis: A Systematic Review and Proportional Meta-AnalysisJournal of Clinical Medicine, 2025doi:10.3390/jcm14155202 ↗
- Success rate of sialendoscopy. A systematic review and meta-analysisOral Diseases, 2024doi:10.1111/odi.14662 ↗
- Juvenile recurrent parotitis: A systematic review of treatment studiesInternational Journal of Pediatric Otorhinolaryngology, 2018doi:10.1016/j.ijporl.2018.07.002 ↗
- Sialendoscopy in the Management of Radioiodine Induced Sialadenitis: A Systematic ReviewAnnals of Otology, Rhinology & Laryngology, 2017doi:10.1177/0003489417732795 ↗
- Sialendoscopy and Sjogren’s Disease: A Systematic ReviewLaryngoscope, 2021doi:10.1002/lary.29233 ↗
- Botulinum toxin for chronic parotid sialadenitis: A case series and systematic reviewLaryngoscope Investigative Otolaryngology, 2021doi:10.1002/lio2.558 ↗
- Management Options for SialadenosisOtolaryngologic Clinics of North America, 2021doi:10.1016/j.otc.2021.02.005 ↗
- Parotid gland swelling in primary Sjögren’s syndrome: activity and other sialadenosis causesRheumatology (Oxford), 2022doi:10.1093/rheumatology/keab816 ↗
- Surgical Treatment of Chronic ParotitisInternational Archives of Otorhinolaryngology, 2019doi:10.1055/s-0038-1667006 ↗
- Surgical complications of submandibular gland excisionActa Otorrinolaringológica Española, 2012pubmed.ncbi.nlm.nih.gov/22014641 ↗
- IgG4-Related Disease and the Salivary Glands: A Review of Pathophysiology, Diagnosis, and ManagementOtolaryngologic Clinics of North America, 2021doi:10.1016/j.otc.2021.02.002 ↗
- Parotid sialosis: morphometrical analysis of the glandular parenchyme and stroma among diabetic and alcoholic patientsJournal of Oral Pathology & Medicine, 2010doi:10.1111/j.1600-0714.2009.00806.x ↗
- The impact of bulimia nervosa on oral health: A review of the literatureBritish Dental Journal, 2017doi:10.1038/sj.bdj.2017.837 ↗
- Salivary gland stonesNHS, 2023nhs.uk/conditions/salivary-gland-stones ↗
- Dental abscessNHS, 2026nhs.uk/conditions/dental-abscess ↗
- Swollen glandsNHS, 2023nhs.uk/symptoms/swollen-glands ↗
- Sjögren’s syndromeNHS, 2024nhs.uk/conditions/sjogrens-syndrome ↗
- MumpsNHS, 2025nhs.uk/conditions/mumps ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
The figures on the page are from these sources.
Gland again
swollen?
Send the discharges, ultrasound or CT scan if available. The doctor will tell you where to start and whether an intervention is needed.