# Sialoadenitis > Sialoadenitis in FMGE Surgery: mumps and suppurative parotitis, submandibular calculi, sialography, sialendoscopy and gland excision decisions. - Canonical URL: https://prepelephant.com/topics/fmge/surgery/sialoadenitis-fmge - Exam / course: FMGE · Subject: Surgery - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Sialoadenitis", PrepElephant, https://prepelephant.com/topics/fmge/surgery/sialoadenitis-fmge ## Direct answer Painful swelling of a salivary gland that surges at mealtime announces obstructive sialoadenitis, usually a calculus in the submandibular (Wharton's) duct, while a feverish, tender parotid oozing pus from Stensen's papilla in a dehydrated or post-operative patient characterises acute suppurative parotitis, classically staphylococcal. Viral sialoadenitis — mumps, a paramyxovirus — produces bilateral tender parotid swelling without pus and remains the commonest cause worldwide where immunisation lags. Chronic and recurrent cases in adults often follow duct stenosis or radioiodine therapy for thyroid cancer. Management ascends a clear ladder: hydration, sialogogues, massage and antibiotics; image the stone with ultrasound and plain occlusal films (most submandibular calculi are radio-opaque); extract intraoral stones, use sialendoscopy or lithotripsy for deeper ones, and reserve gland excision for the permanently damaged gland. ## What you must remember - **Site rules:** calculi favour the submandibular gland in roughly 80-90% of cases because its secretions are mucinous and its duct runs uphill; parotitis, in contrast, is usually non-calculous. - **Radio-opacity:** most submandibular stones are radio-opaque on an occlusal film; most parotid stones are radiolucent, so ultrasound or sialography finds them. - **Suppurative parotitis:** Staphylococcus aureus is the classical organism in the dehydrated, elderly or post-operative patient; pus expressed from Stensen's papilla confirms it. - **Mumps:** bilateral painful parotid swelling with fever and orchitis risk in post-pubertal males; supportive care, and it is prevented by MMR vaccine under India's Universal Immunisation Programme. - **Acute obstructive attack:** meal-related swelling and colicky pain, tenderness along the duct, sometimes a palpable stone in the floor of the mouth. - **Conservative triad:** rehydration, sialogogues (lemon, citrus) and gland massage with antibiotics (amoxicillin-clavulanate or flucloxacillin) for bacterial infection. - **Stone extraction logic:** stones in the anterior duct, especially near the papilla, come out transorally; hilar or intraglandular stones need sialendoscopy, lithotripsy, or submandibular sialadenectomy if the gland is chronically destroyed. - **Radioiodine sialoadenitis:** a recognised aftermath of I-131 therapy for differentiated thyroid cancer — an Indian exam favourite given the volume of thyroid cancer treatment. ## How to work through a painful submandibular swelling A 34-year-old man describes left submandibular swelling and pain appearing within minutes of every meal and subsiding over an hour; the gland is tender and bimanual palpation of the floor of the mouth reveals a hard pea-sized nodule. The clinical diagnosis is obstructive sialoadenitis from a Wharton's duct calculus, and an occlusal radiograph plus ultrasound localises a 6 mm radio-opaque stone 2 cm from the papilla. Because it lies in the anterior duct, a transoral duct incision and stone extraction under local anaesthesia relieves him, with duct marsupialisation to prevent restricture; antibiotics settle the surrounding infection. Had the stone sat at the hilum, sialendoscopy with basket retrieval would be first choice, and a gland that has suffered years of recurrent infections, now fibrotic and non-functioning on sialography, earns a submandibular gland excision — protecting the marginal mandibular and hypoglossal nerves and the lingual nerve during dissection. ## Viva angles examiners favour Panels test the parotid versus submandibular inversion: calculous disease is submandibular, suppurative (non-calculous) sialoadenitis is parotid — mixing them loses easy marks. The second angle is the differential of bilateral parotid swelling: mumps in the unimmunised, Sjogren syndrome, sarcoid, bulimia or alcoholic sialosis, and HIV-associated lymphoepithelial lesions. Third, chronic single-gland swelling in an older adult is never "chronic sialoadenitis" until a neoplasm — including benign lymphoepithelial lesions and pleomorphic adenoma — is excluded by imaging and, when indicated, fine-needle aspiration. ## Frequently asked questions ### Why do most salivary calculi form in the submandibular gland? Its mucoid, alkaline, calcium-rich saliva, the long upward-draining duct and the papillary narrowing together favour stone formation in roughly 80-90% of cases. ### How is acute suppurative parotitis managed? Rehydration plus antibiotics active against Staphylococcus aureus (flucloxacillin or amoxicillin-clavulanate), sialogogues and massage, with surgical drainage if the gland fluctuates. ### Which imaging best demonstrates salivary stones? Ultrasound with an occlusal plain film for submandibular calculi; sialography, sialendoscopy or CT for radiolucent parotid stones and duct strictures. ### When is submandibular gland excision indicated? For a chronically infected, fibrotic gland with recurrent attacks, a hilar stone not amenable to endoscopy, or suspicion of neoplasia. ### What causes sialoadenitis after thyroid cancer treatment? Radioiodine (I-131) is concentrated by salivary ducts, producing painful parotid and submandibular inflammation that is usually managed conservatively.