Soft tissue conditions of the face and oral cavity

Emergency referrals

Advise patient to present to the Royal Brisbane and Women's Hospital Department of Emergency Medicine.

For emergency referrals the on-call Oral and Maxillofacial Registrar must be contacted through Royal Brisbane and Women's Hospital switch (07) 3646 8111 to obtain appropriate prioritisation and treatment advice. Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Oral and Maxillofacial Clinic Fax: (07) 3646 3545

Lumps and suspected neoplasms
Salivary gland lumps
Salivary gland infection (Sialoadenitis/ Sialolithiasis)

Triage and management guideline

Priority

Category 1

Examples

Lump and suspected neoplasms

Evaluation

Refer all suspected malignancies

Referral to include:

CT scan head and neck
FNA of lymph nodes
Biopsy result (if available)

Priority

Category 2

Examples

Salivary gland lumps

Salivary gland infection

Sialoadenitis/ Sialolithiasis

Evaluation

Referral to include:

CT scan head and neck
FNA of lump
Facial nerve evaluation

Consider:

Culture of purulent discharge (mouth)
Hydration
Anti staphylococcal antibiotics: Augmentin
Occlusal view of floor of mouth for calculi

Refer immediately in the presence of:

Limited eye opening
Facial swelling
Increasing pain
Tinnitus
Dysphagia

Referral indicated if:

Calculi suspected on exam – depending on circumstances
Poor antibiotic response within one week of diagnosis – depending on severity
Abscess formation
Hard mass present – consider neoplasm

Referral to include:

Occlusal view x-ray of floor of mouth for calculi
USS or sialogram (sialogram in the absence of infection or when cleared up with antibiotics)

Referral requirements

A referral may be rejected without the following information.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use