Initial Encounter
New patients with complaints of swelling and/or pain in the area of
major salivary glands should be interviewed and visually examined during
the initial telemedicine encounter. To compensate for the limitations of
the visual exam, patients should be instructed to palpate the area of
the affected salivary gland to determine the presence of a palpable
mass. Although this maneuver might not to be trivial or reliable,
self-palpation should be attempted as a screening method since a large
portion of head and neck masses can be detected on self-exam.
Patients should be asked about the major causes of inflammatory salivary
gland disease such as history of salivary gland stones, auto-immune
conditions, history of receiving iodine contrast, radioactive iodine or
radiation to the head and neck area.3 History of skin
malignancies of the head and neck and history of other cancers should be
taken into account as a potential cause for metastatic lesions within
the salivary glands (Table 1).
A thorough description of presenting symptoms must be determined since
inflammatory and neoplastic salivary gland disease have different
presentations. Special emphasis should be placed on chronicity of
symptoms and any red flag symptoms such as a palpable mass, facial
muscle weakness, and reports of paresthesia (Table 1). If the onset of
salivary gland swelling and pain is gradual and progressive, and the
patient reports palpating a mass in the area of salivary gland, workup
should be initiated to provide additional information and rule out
salivary gland neoplasm.4,5
If the symptoms are consistent with inflammatory or infectious
sialadenitis without a palpable mass, medical management should be
initiated and a follow-up telemedicine visit should be scheduled to
ensure symptom resolution. If the symptoms persist or relapse after
appropriate medical management, imaging should be considered, since
obstructive salivary gland disease such as sialadenitis could be caused
by the salivary gland neoplasm or coexist with salivary gland neoplasm
and metastatic lesions within the salivary gland (Figure
1).6