Nasal obstruction, epistaxis, and facial swelling are typical presenting symptoms of sinonasal salivary gland cancers. Supraglottic laryngeal salivary tumors most commonly present with hoarseness, dysphagia, and odynophagia. Subglottic laryngeal salivary tumors are typically advanced at the time of diagnosis and present with stridor. The history and physical examination of the patient with a salivary gland mass provides critical information in making treatment decisions. A history of a rapidly enlarging or painful mass suggests malignancy.
Masses associated with erythema and local calor suggest an inflammatory or infectious etiology.
Suspicious skin lesions or a history of skin lesion excision may suggest metastatic spread to the parotid or submandibular lymph nodes. A thorough search of the head and neck is required to rule out other primary lesions or metastatic adenopathy. Particular attention should be given to the size of the mass, differentiation of single versus multiple masses, the presence or absence of fixation to deeper structures, and neurologic examination. The use of ancillary diagnostic procedures is guided by the history and physical examination. Plain films are occasionally useful for ruling out ductal calculi in the submandibular ducts.