Examination of Salivary Gland

History:
 Pain: duration, present continuously or paroxysmally, variation in intensity during the
day
 General underlying conditions and medical history: DM, metabolic, immune, or
neurological disorders, arteriosclerosis, hormonal imbalances
 Previous surgery or radiotherapy
 Antihypertensive drugs
Physical examination
Inspection
 Xerostomia and sialorrhea
 Tongue
 Dental status
 Salivary gland orifices
Palpation
 Size
 Consistency
 Tenderness

Sjogren’s syndrome
 Eye: dryness (sandy or gritty feeling), itching, fatigue, increased sensitivity to light
o Tear flow: Schimmer test
 Positive when filter paper wetting is <5mm in five minutes
o Tear composition: tear break-up time or tear lysozyme content
 Xerostomia
o Salivary flow measurement
o Parotid sialography
o Salivary scintigraphy
Sarcoidosis
 Respiratory symptoms such as dry cough, shortness of breath, and chest pain (40–
50%): Most common presenting chief complaint
o Chest radiograph appearance
 Type 0: normal
 Type I: enlargement of hilar, mediastinal, and occasionally
paratracheal lymph nodes
 Type II: adenopathy seen in type I as well as pulmonary infiltrates
 Type III: infiltrates without the adenopathy
 Constitutional symptoms such as fever, weight loss, and malaise (25%)
 Extrathoracic inflammation such as peripheral lymphadenopathy (25%)
 Rheumatic symptoms such as arthritis (5–10%)
o 2 types of arthritic symptoms
 Early form: begins in the ankles and may spread to involve the knees
and other joints, axial skeleton is typically spared
 Lofgren syndrome involves a triad of hilar lymphadenopathy,
erythema nodosum, and arthritis
 Late form: occurs at least six months after the onset of sarcoidosis, and
is generally less dramatic than the early form. The knees are the most
common joints to be involved, followed by the ankles. Monarthritis
can occur in the late form of arthritis, and erythema nodosum is not
commonly noted.