Chapter 88 - Part A: Saliva Is Not the Enemy: When Swellings Aren’t Glands at All

In this BoardsCast episode, we begin Tobias Chapter 88 – Salivary Glands, and tackle one of the most common diagnostic traps in head and neck surgery:
not every swelling near the mandible, cheek, or throat is a salivary gland problem.

Many oral, dental, lymphatic, traumatic, and neoplastic conditions mimic salivary disease. Misdiagnosis leads to wrong surgeries, unnecessary gland removals, and missed pathologies.

This episode teaches you how to think systematically when you see a “salivary swelling” — and how to avoid the trap.

You’ll learn:

• When a swelling looks like salivary disease… but isn’t
• The difference between true salivary pathology vs mimics
• How to identify mucoceles, sialoceles, abscesses, cysts & pseudocysts
• Why mandibular vs sublingual anatomy matters in diagnosis
• When imaging changes everything
• Classic board patterns involving “lumps under the jaw”
• The biggest mistakes surgeons make before committing to gland excision

This episode reframes salivary disease not as a simple surgical problem — but as a diagnostic challenge requiring anatomical thinking.

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Listen On: Spotify | Apple Podcasts | Amazon Music

Chapters

• 0:00 Introduction: The "Three-Week Recurrence" Nightmare
• 1:00 The Misdiagnosis Trap: Bad Luck vs. Bad Mechanics
• 2:30 Plumbing vs. Oncology: Reframing the Salivary Gland Issue
• 4:15 The Pseudocyst: Why the "Sack" is Not the Problem
• 6:50 Anatomical Deception: Why Swellings Often "Lie" About Their Origin
• 9:44 The Diagnostic Puzzle: Aspiration and Fluid Identification
• 11:00 Mechanical Logic: Identifying the Leaking Source
• 13:00 Decision Driven Surgery: Mechanics First
• 14:00 Summary: Saliva is Not the Enemy, Mislabeling Is