So I don't have a definitive answer here, although I think I know what might be happening. This patient described intermittent swelling on the left side of her face that is accompanied by discomfort when it occurs.

The discomfort is diffuse and can't be isolated to a muscle; rather it feels "deep" and more "inside than outside" to the patient. There is nothing of odontogenic origin clinically or radiographically, including a cone beam CT that could be related to the swelling. There are no lesions or unusual tissue abnormalities.

While I do not see the "swelling," the photograph is during one of the "slightly swollen" times. She reports that she cannot pinpoint specific behavior or situation that is associated with the swelling. When I palpated the area and milked the gland to check for salivary flow, she had active serious flow from the duct on the L side. I found nothing out of the ordinary in the exam.

The next day she called me and said that about 30 minutes after, she left the swelling was gone and it felt better.

So, my question to the dental community is: What's going on?


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Comments

Commenter's Profile Image Richard Sigismondi
December 6th, 2013
More info would help. How often does it occur? Any particular time of day? What brings it on? Describe the scenario that occurs when the swelling occurs? How long does the swelling usually last? Does anything relieve her discomfort? Based on what you said, it could be salivary gland related. You could either refer her for a scan of her gland and ducts now or wait until she is swollen again and milk the gland again to see if she has relief 30 minutes later.
Commenter's Profile Image Michael Weisbrod
December 6th, 2013
Blocked parotid gland? When the swelling occurs, does it get worse when she eats or drinks anything?
Commenter's Profile Image Steve Ratcliff
December 6th, 2013
could be, she doesn't give a reliable history of anything that makes it better or worse. When I asked that question she said she wasn't sure and on subsequent visits she was still non-committal.
Commenter's Profile Image Denise Beaudet
December 8th, 2013
Need more specific info. Could be related to dry mouth cycles from BP meds or other mouth drying meds. Could have a neuritis related condition like Bell's palsy, trigeminal neuralgia, or the start of shingles. We've seen irritation to salivary glands from strong mint gum; it's too astringent. She doesn't have a Sjogrens appearance at all, but needs to be ruled out as well. Had a patient last year with the same symptoms in the submandibular gland area, and it turned out to be a viral infection in the gland.
Commenter's Profile Image Steven Roth
December 10th, 2013
I have seen a similar case shown where no one can figure out the problem and the patient ended up having a Parotid Malignancy. The patient had seen dentist, oral surgeon, tmj specialist etc. By the time someone suggested an MRI it was too late for the patient. SO..............I would suggest a "Rule Out Visit" to the head and neck doctor.
Commenter's Profile Image Steve Ratcliff
December 10th, 2013
Steve and others. I still am not sure what is happening with her swelling. It comes and goes and she states it has occurred for years. When I milk the gland the salivary flow is normal, she denies that eating or drinking seems to make it occur or when present get worse. She complains of slight pain when it is swollen. She has an appointment this week with an OMFS who also does head and neck surgery. I'll let you all know the outcome.
Commenter's Profile Image Parotid Gland Swelling
January 8th, 2014
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