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Salivary Gland Disorders: Rapid Evidence Review

Michael J. Kim, MD
Anna Milliren, DO
Dennis J. Gerold, Jr., MD

American Family Physician. 2024;109(6):550-559.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

The major salivary glands are the paired parotid, submandibular, and sublingual glands. Salivary gland disorders can affect the glandular tissue or its excretory system. The parotid glands are the largest and produce aqueous serous secretions that are less immunogenic. They are more susceptible to infections and neoplasms. The submandibular glands produce mucinous secretions that are high in calcium and phosphate salts through a long submandibular duct that flows against gravity. The submandibular glands are responsible for more than 80% of salivary stones. Sialadenitis can be acute or chronic and caused by bacterial, viral, and obstructive etiologies; the most common bacteria is Staphylococcus aureus. The most common viral etiologies in children are mumps (globally) and juvenile recurrent parotitis (in vaccinated populations). Sialadenosis is a chronic asymptomatic enlargement of the salivary glands due to systemic disease. Sialolithiasis causes up to 50% of salivary gland disorders. It is associated with salivary stasis and inflammation caused by dehydration, malnutrition, medications, or chronic illness. Obstruction is also caused by trauma, stenosis, and mucoceles. Neoplasms are rare and typically benign, but they warrant referral and imaging with ultrasonography, computed tomography, or magnetic resonance sialography. Most disorders are managed with conservative measures by treating the underlying etiology, optimizing predisposing factors, controlling pain, and increasing salivary flow with sialagogues, hydration, massage, warm compresses, oral hygiene, and medication adjustment. Sialendoscopy is a gland-sparing technique that can treat obstructive and nonobstructive disorders. (Am Fam Physician. 2024;109(6):550-559. Copyright © 2024 American Academy of Family Physicians.)

MICHAEL J. KIM, MD, FAAFP, is an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md., and associate program director of the Travis Air Force Base (Calif.) Family Medicine Residency, David Grant Medical Center, Travis Air Force Base.

ANNA MILLIREN, DO, is an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences and core faculty at the Travis Air Force Base Family Medicine Residency, David Grant Medical Center.

DENNIS J. GEROLD Jr., MD, is core faculty at the Travis Air Force Base Family Medicine Residency, David Grant Medical Center.

Address correspondence to Michael J. Kim, MD, 101 Bodin Cir., 60 HCOS/SGGF, Travis Air Force Base, CA 94535 (drmichaeljkim@gmail.com). Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

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