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