(BQ) Part 2 book "Das manual of clinical surgery" has contents: Examination of the salivary glands, examination of the thyroid gland, examination of a rectal case, examination of a urinary case, examination of male external genitalia, examination of an abdominal lump,. and other contents. | EXAMINATION OF THE SALIVARY GLANDS THE PAROTID GLAND HISTORY.— 1. Swelling.— Careful history must be taken as 'How did the swelling start?' 'Where exactly was the swelling first noticed?' 'How long is the swelling present?' 'Has the swelling enlarged uniformly throughout the period?' or 'Has it suddenly enlarged very recently?' So the onset of the swelling, exact site of the swelling, duration of the swelling and growth of the swelling are noted. In dehydrated patient with poor oral hygiene if he complains of sudden increase in size of both the parotid glands with considerable pain, the case is probably one of acute parotitis. If there is brawny oedematous swelling of the parotid region with pain, this is probably a case of parotid abscess. When there is generalized enlargement of all major salivary glands including lacrimal glands, it is called Mikulicz's syndrome. If this is associated with dry eyes and generalized arthritis the condition is called Sjogren's syndrome. A slow growing tumour having duration for years or months of the parotid gland is the pleomorphic adenoma. When such a tumour suddenly starts growing rapidly and becomes painful, it is highly suggestive of malignant transformation of this adenoma (mixed parotid tumour). Site is important as adenolymphoma, which is also a slow-growing painless tumour, arises in the lower part of the parotid gland at the level of the lower border of the mandible slightly lower than the usual site of pleomorphic adenoma. 'Does the swelling increase in size, becomes tense and painful during meals?' This is characteristic of obstruction of the parotid duct with stone. 2. Pain.— Acute parotitis is a painful condition. It must be remembered that mumps is the commonest cause of bilateral parotitis (See Fig. ). Throbbing pain is the characteristic feature of parotid abscess. Excruciating pain, slight swelling and redness in the region of the parotid gland are characteristic features of parotid abscess. In case .
