Palpate the parotid (Figure 19) and submandibular (Figure 20) salivary glands using a bilateral technique. Normally these glands should not be palpable. Induration and pain could be signs of infection, blockage, immune system disorder or a neoplastic process. In addition, non-tender parotid enlargement may occur with alcoholism, diabetes, Sjögren’s syndrome, eating disorders, HIV infection and various malignant/non-malignant states involving the salivary glands.
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