Salivary gland disorders

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Target exams

Red flags

• A febrile child with unilateral tender parotid swelling and purulent discharge from the Stensen duct — acute suppurative parotitis, usually Staphylococcus aureus; needs prompt anti-staphylococcal antibiotics and assessment for abscess, because untreated disease can progress to septicaemia in the neonate or immunocompromised child.
• A previously well child with bilateral parotid swelling, fever and malaise who develops headache, neck stiffness, photophobia or altered consciousness — mumps meningitis or encephalitis; cerebellar and cranial nerve involvement can accompany mumps, and sensorineural hearing loss, though rare, is permanent.
• A boy past puberty with mumps parotitis who develops acute testicular pain and swelling — mumps orchitis; it can cause testicular atrophy and, though infertility is uncommon, bilateral orchitis raises that risk.
• A child with a soft bluish swelling in the floor of the mouth that is growing or interfering with feeding and speech — a ranula; a plunging ranula may present as a cervical mass crossing the mylohyoid, and recurrent lesions need surgical assessment rather than observation alone.

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and ENT: salivary gland disorders — mumps and its complications, juvenile recurrent parotitis, acute suppurative parotitis, ranula and sialolithiasis, and the red flags that demand imaging, antibiotics or surgery.
• Infectious diseases and prevention: the viral and bacterial causes of paediatric salivary swelling, MMR vaccination for mumps prevention, and antimicrobial stewardship for self-limiting viral parotitis.
• Renewed curriculum — ENT and infectious diseases: sialendoscopy for refractory juvenile recurrent parotitis, the management of ranula and plunging ranula, and the complications of mumps including orchitis, meningitis and pancreatitis.
• Public health and regional practice: mumps resurgence in under-immunised communities, the burden of salivary disease in remote and migrant populations, and oral-health and immunisation promotion.
• General Paediatrics: recognition of mumps parotitis, the distinction between viral and suppurative parotitis, and the stepwise management of juvenile recurrent parotitis and ranula.
• Public health: MMR vaccination, isolation advice for mumps, and the safety-net for complications such as meningitis, orchitis and pancreatitis.
• Long Case / Structured discussion: a child with parotid swelling — classification, the focused examination of the gland and duct, the investigation of suppurative versus recurrent disease, and the stepwise management from supportive care to antibiotics or surgery.
• Communication station: explaining to a parent why most parotid swelling is viral and self-limiting, when antibiotics are needed, and why the MMR vaccine prevents mumps.
• Level 2 / 3 — ENT, infection and immunology: the causes of paediatric salivary gland swelling by age, the mumps and bacterial parotitis patterns, and the red flags of meningitis, orchitis and abscess.
• Public health and health improvement: MMR vaccination, isolation advice for mumps, and oral-health promotion.
• Foundation of Practice (FOP): the common and dangerous causes of salivary gland swelling in infants and children, and the bedside distinction between viral, bacterial and recurrent parotitis.
• Applied Knowledge in Practice (AKP): mumps complications, anti-staphylococcal therapy for suppurative parotitis, sialendoscopy for refractory juvenile recurrent parotitis, and the surgical management of ranula.
• History-taking and management: the child with parotid swelling and fever, the focused head and neck examination, and the supportive, antimicrobial or surgical plan.
• Communication: explaining why most parotid swelling is self-limiting, when to return for complications, and the role of MMR vaccination.
• General Pediatrics Content Outline: salivary gland disorders — mumps, juvenile recurrent parotitis, acute suppurative parotitis, ranula and sialolithiasis, with the complications of mumps.
• Infectious Diseases: mumps virus and vaccination, Staphylococcus aureus as the leading cause of suppurative parotitis, and neonatal parotitis.
• Patient Care: evidence-based, supportive-first management of paediatric salivary gland disease with prompt antibiotics for suppurative parotitis and recognition of complications.
• Systems-Based Practice and Population Health: MMR vaccination promotion, isolation advice, and antimicrobial stewardship for viral parotitis.
• Medical Knowledge: the viral, bacterial and structural pathophysiology of salivary gland disease, mumps complications, and the pharmacology of anti-staphylococcal agents.
• Medical Expert: salivary gland disorders diagnosis, supportive care of mumps, anti-staphylococcal therapy for suppurative parotitis, sialendoscopy for refractory juvenile recurrent parotitis, and ranula management.
• Health Advocate and Collaborator: MMR vaccination promotion, isolation advice, and oral-health and immunisation access in remote communities.
• Communicator: explaining why most parotid swelling is benign, when complications bring the child back, and the role of vaccination.