What is it?
Lumps that grow in the salivary glands may be benign or malignant. That distinction cannot be made by feeling with the hand, and often not by imaging on its own either; examination at tissue level is needed. The purpose of this page is not to say which possibility is more likely, but to explain how a lump that has been noticed is dealt with.
Lumps are most often seen in the parotid gland in front of the ear. The gland under the jaw and the small salivary glands spread through the mouth can also be the site; a firm swelling on the palate or inside the lip may come up in this way. The description often given is of a painless lump that grows slowly over months and does not move with the skin.
What sets this picture apart from the other swellings in the area is its course. With a salivary stone the swelling comes on with a meal and then settles; with an infected gland it swells quickly, reddens and hurts. With a lump the swelling does not come and go, has no link to meals, and often causes no pain. The absence of pain should not be counted as a reassuring sign.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The cause often cannot be identified
For the great majority of salivary gland lumps no single cause can be pointed to. That is why the question "why did this happen to me" often has no answer; what matters is that the lump is examined once it has been noticed.
- 02
Radiotherapy given to the area
Salivary gland lumps have been reported more often in people who have had radiotherapy to the head and neck in the past. If you have a history of this, be sure to mention it at the examination.
- 03
Smoking and alcohol
These habits are known to be linked with some of the lumps in the head and neck region. How strong the link is varies with the type of lump, and a lump can also appear in people with no such habits.
- 04
Frequency rising with age
These lumps can be seen at any age, but they become more common as age rises. Rather than accepting a swelling as something that comes with age, it needs to be examined; age on its own is not an explanation.
How does it progress?
- Noticing it
A quiet, painless swelling
The lump is often found by chance with the hand; while shaving, while washing the face, or at a dental examination. Because it causes no pain, it may not be dwelt on.
- Growth
Increasing in size over months
The swelling grows slowly and the difference between the two sides of the face may become visible from outside. There may still be no pain at this stage.
- Change
The nature of the lump changing
Hardening, becoming fixed to the tissue so that it no longer moves, the skin over it being pulled in, or pain starting are the changes to watch for.
- Nerve sign
Weakness in the facial muscles
With a lump in the parotid gland, involvement of the facial nerve may show as the corner of the mouth drooping or the eyelid not closing fully. This sign should not be put off.
How is it treated?
This condition is not treated in a dental clinic. When a growing lump is noticed in front of the ear or under the jaw, the department to go to is ear, nose and throat, or head and neck surgery; for swellings that arise from the small glands inside the mouth, oral and maxillofacial surgery also takes part in the assessment. The dentist's role is to notice the lump at the examination, to record where it is and how large it is, and to direct you to that door.
The steps to expect from the doctor you see are these: examination of the lump and of the facial nerve, imaging that begins with an ultrasound scan, an MRI scan if needed, and a sample taken with a needle. The nature of the lump can only be discussed once these examinations are complete. Before that stage no distinction between benign and malignant can be made; do not settle for an opinion given by eye.
The treatment decision is made in the relevant surgical department, according to where the lump is and the results of the examinations. Because the facial nerve runs through the parotid gland, protecting the nerve is the main heading in planning any procedure in this area. Keeping a lump under observation is a doctor's decision too; do not decide on your own to watch it or to wait.
- Muscle weakness on one side of the face, or the corner of the mouth drooping
- The lump growing quickly, hardening and no longer moving when you press it
- The skin over the lump being pulled in, changing colour, or breaking open
- Numbness that has just started in the area, or difficulty opening your mouth
How is it prevented?
- There is no known way of preventing these lumps from forming; the realistic step in your hands is noticing them early.
- Once a month, compare the two sides of your face in the mirror and feel under your jaw with your hand.
- At a routine dental examination the area under the jaw and the neck are felt by hand; do not skip these check-ups.
- Stopping smoking and limiting alcohol lowers the general risk in the head and neck region.
Frequently asked questions
- If there is no pain, can it be left for a while?
- It should not be. Most salivary gland lumps start out painless; the absence of pain does not show that the lump is unimportant. The measure is not pain but the swelling failing to go and growing instead. For a swelling that lasts longer than two weeks and does not get smaller, an assessment is requested.
- Is this swelling a lymph node or a salivary gland?
- Telling them apart by hand is not reliable. A lymph node swollen because of an infection from a tooth usually settles within a few weeks, whereas a lump arising from a salivary gland is expected not to go, or to grow. The definite distinction is made by examination and imaging, and by taking a sample where that is needed.
- Will the dentist remove this lump?
- No. The dentist's role in this picture is to notice the lump, to record where it is and how large it is, and to refer you to ear, nose and throat or head and neck surgery. For lumps that arise from the small glands inside the mouth, the assessment is carried out together with oral and maxillofacial surgery.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.