Salivary Glands

About your salivary glands

About your salivary glands - Salivary Glands

You have three paired major salivary glands: the parotid glands located on the cheeks, and the submandibular and sublingual glands located under the jaw. You also have thousands of very small minor salivary glands located throughout the mouth and throat. The major and minor salivary glands are responsible for the production of saliva, which aids in the start of food breakdown, in the moisturization of your mouth and throat, and in antimicrobial protection of the mouth and throat.

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What problems happen with the salivary glands?

There are several kinds of salivary gland disease that mostly affect the major salivary glands in people of all ages. The most common types of salivary gland disease include:

  • Sialadenitis, which is inflammation or infection of the salivary gland. This results from a viral or bacterial infection involving the salivary gland. Bacterial infections occur most commonly in elderly patients when they become dehydrated, classically after undergoing surgery. Sialadenitis may also be precipitated by certain medications that cause dry mouth or following treatment with radioactive iodine for thyroid cancer or hyperthyroidism.
  • Sjögren's disease, which is an autoimmune disease that destroys normal salivary gland tissue rendering it nonfunctional.
  • Sialolithiasis, or salivary gland stones, similar to kidney stones, which can form within the ducts of the major salivary glands, and can cause recurrent, painful swelling of the inflicted gland. This is the most common cause of obstructive sialadenitis.
  • A ranula, which results from trauma to the duct of the salivary gland, typically the sublingual gland. The trauma results in obstruction of the duct, which then causes leakage of saliva into the soft tissues of the neck. A fluid-filled, soft, painless mass results under the tongue and it can fluctuate in size.
  • Benign tumors, which can form from the salivary gland tissue. Most of these are detected when a lump is felt in the check or under the jaw.
  • Cancers, which are less commonly found in the salivary glands than benign tumors, but they do occur.

Contact Ashford Clinic for an appointment if you have recurrent, painful swelling or any mass of the cheek or area under the jaw.

What is sialadenitis?

Sialadenitis is inflammation or infection of the salivary gland. Parotitis refers to sialadenitis of the parotid gland, which is located in the cheek. Sialadenitis is most commonly caused by a bacterial infection, but prior to widely used vaccinations, the mumps virus was a common cause. Classically, sialadenitis results from a bacterial infection in the setting of dehydration or following general anesthesia for any kind of surgery. Obstructive sialadenitis results most commonly from salivary gland stones or from strictures of the salivary gland duct. Other less common causes of sialadenitis include systemic diseases such as sarcoidosis or Sjögren's disease.

What symptoms occur with sialadenitis?

Symptoms of acute sialadenitis include recurrent, painful episodes of swelling in the cheek or under the jaw. The skin overlying the affected gland may become red and warm to touch and you may even experience fever and generalized malaise. Additionally, you may experience a very foul taste in the mouth from pus draining from the affected gland.

Sometimes, recurrent, swelling of a salivary gland occurs without infection, such that patients notice swelling of the gland every time they eat and this may or may not be accompanied by tenderness of the gland when swollen. This happens because the normal saliva produced during eating does not drain properly, causing the salivary gland to swell, but it may then gradually decrease in size between meals.

Recurrent episodes of acute sialadenitis result in chronic changes to the salivary gland, which may then precipitate further episodes. In certain situations, such as extreme malnutrition, diabetes, and in alcoholics, sialadenosis results, which is the non-neoplastic, non-inflammatory enlargement of a salivary gland. Sialadenosis is difficult to distinguish from a tumor of the salivary gland, but can be differentiated from this based on a biopsy of the gland.

How is acute sialadenitis treated?

Episodes of infection are treated with antibiotics, warm compresses and massage to the area, good hydration techniques, avoidance of mouth drying medications, and the use foods that cause saliva production, such as lemons or sour candies.

How is recurrent sialadenitis treated?

If you experience recurrent episodes of sialadenitis, then surgery is indicated. Surgery is typically accomplished when the gland is not acutely infected. Conservative, minimally invasive surgery may be recommended in order to spare complete removal of your salivary gland. Less commonly, complete removal of the problematic salivary gland is indicated. Prior to surgery, most physicians obtain imaging to thoroughly evaluate the gland in question. Imaging may include a diagnostic ultrasound of the area or a CT scan. Most often, salivary gland surgery can be accomplished as an outpatient without hospital admission even when the entire salivary gland has to be removed.

What is sialolithiasis?

Sialolithiasis is the term used when stones form within the salivary gland or within the duct of the salivary gland. Similar to kidney stones, stones may form that cause a back-up of normal salivary drainage within the gland. The impaired salivary flow causes sialadenitis with recurrent bouts of swelling of the gland, which can then lead to recurrent episodes of acute infection. Recurrent infections are treated in the same way as sialadenitis without stones: antibiotics by mouth, warm compresses and massage to the area, good hydration techniques, and foods that cause saliva production, such as lemons or sour candies.

How are salivary stones diagnosed?

Recurrent episodes of salivary gland swelling and/or salivary gland infections are first evaluated by physical exam, which includes palpation of the mouth and gland in search of a mass or stone, both of which can often be felt by your physician. Following the examination, an imaging study is typically obtained. An ultrasound or CT scan of the problematic gland is very useful in ruling out a mass and in identifying a salivary gland stone. The duct draining the salivary gland will often appear dilated on the imaging secondary to the saliva backed-up behind where the salivary stone is located. Most stones are also visible on imaging, depending on the type of imaging obtained.

How are salivary gland stones treated?

In the setting of a salivary gland stone causing recurrent episodes of sialadenitis, surgery is indicated. However, in this particular setting, surgery to remove the entire gland can often be avoided. Minimally invasive salivary gland surgery can be performed to remove the stone and preserve the salivary gland. This is accomplished through the mouth by the use of extremely small cameras and tools introduced through the duct draining the salivary gland, which is a technique known as sialendoscopy.

What is sialendoscopy?

Sialendoscopy is the endoscopic evaluation of the salivary gland ducts similar to a colonoscopy, but on a MUCH smaller scale. It is indicated for non-neoplastic salivary gland disorders such as salivary gland swelling of unclear origin, obstructive sialadenitis (i.e. from a stone, stricture, mucous plugging, or foreign body), for the evaluation of a mass within the duct, for radioactive iodine induced sialadenitis, for recurrent parotitis of childhood, and for autoimmune recurrent parotitis. It is performed in order to spare complete removal of the salivary gland, which is reserved as the last resort if conservative measures fail to cure the salivary gland disease.

Sialendoscopy is not indicated during an acute infection of the gland and is unable to be performed in patients who cannot open their mouths widely; otherwise, it is a very safe and very effective surgery. In the setting of salivary gland stones, the stones must be small enough to be removed through the duct. Occasionally, medium-sized stones are removed with the use of a laser or shock wave therapy, which is utilized to break the stone into much smaller pieces for retrieval. In the case of larger stones, a combined technique is used to retrieve the stone and save the salivary gland. In the combined approach, the salivary stone is localized with sialendoscopy and the light of the endoscope is used to illuminate the location of the stone externally, either in the mouth in the case of a submandibular stone, or on the cheek in the case of a parotid gland stone.

In the setting of a submandibular stone, a very small incision is then created inside the mouth to retrieve the stone under direct visualization. The new opening into the duct is usually preserved in order to prevent scar tissue from narrowing or completely obliterating the duct after surgery. In the setting of a parotid gland stone, a conservative face lift incision is used to facilitate removal of the stone without compromising the facial nerve, which innervates the muscles of facial expression and travels through the parotid gland. The parotid duct is then repaired and stented open for a sufficient amount of time to allow proper healing of the duct.

Do tumors grow in the salivary glands?

Just like everywhere else in the body, tumors can form in the salivary glands. They are usually noticed as a lump or mass at the site of the salivary gland. Any lump in the neck should be evaluated by a physician to rule out a tumor, called a neoplasm. Most commonly, tumors of the salivary glands are benign, meaning noncancerous, but they can be cancer too. That is why it’s so important to have any mass evaluated by your ENT doctor.

If a tumor of the salivary gland is suspected, imaging and a biopsy will be performed. Imaging typically includes a CT scan or an ultrasound, both of which can evaluate the salivary gland as well as the surrounding lymph nodes to see if anything looks worrisome. A fine needle aspiration (FNA) biopsy will be performed to look at the cells within the tumor. By evaluating the cells, your physician is able to get more information about the type of tumor growing in your salivary gland. Most benign tumors and essentially all cancerous tumors require surgery. In the case of cancer, the surrounding lymph nodes will also likely be removed to evaluate for spread of the cancer.

Once the entire tumor is removed, it is thoroughly evaluated by a pathologist in order to get any further details about the type and behavior of the tumor. Once the entire tumor has been evaluated, your physician will know if any further treatment is needed, such as in the case of a salivary gland cancer.

What is Sjögren's syndrome?

Sjögren's syndrome is a chronic inflammatory disorder characterized primarily by decreased saliva production by the salivary glands in the mouth and throat. It also affects tear production by the lacrimal glands of the eyes. The main symptoms include dry mouth and dry eyes. Sjögren's syndrome may present with a gradual swelling of the parotid or submandibular glands on both sides. Sjögren's syndrome is an autoimmune sialadenitis that eventually causes destruction of the gland.

How is Sjögren's syndrome treated?

Sjögren’s syndrome is treated conservatively and with symptomatic relief. Mouth lubrication is always recommended and includes artificial saliva and products to aid in maintaining moisturization of the mouth and throat. Maintaining good hydration also facilitates relief of the constant dry mouth. For dry eyes, lubricating drops are recommended.

How is salivary gland disease treated?

Treatment in the acute, infected setting includes antibiotics by mouth, warm compresses and massage to the area, good hydration techniques, and foods that cause saliva production, such as lemons or sour candies.

Curative treatment for chronic salivary gland disease depends on what kind of problems you have. In many cases of non-neoplastic (without tumors) salivary gland disease, treatment entails sialendoscopy with preservation of the salivary gland. Sialendoscopy is a minimally invasive salivary gland surgery that is highly effective and has a quick recovery time. It utilizes extremely small cameras and tools, which are introduced through the duct draining the affected salivary gland. In this way, stones can be removed, the ducts can be cleaned out, and any narrow areas within the ducts can be identified and treated. Minimally invasive salivary gland surgery spares the patient a more invasive surgery in which the entire salivary gland is removed.

Sometimes though, complete removal of the salivary gland is required. In these cases, your ENT doctor will remove the entire problematic salivary gland in order to cure your salivary problems. In this case, surgery is typically done as an outpatient with a slightly longer, although still gentle, recovery. Complete removal of a salivary gland does require an incision on the face or neck, but these are carefully disguised in a very cosmetic fashion. Be sure to ask your doctor about the type of scar to expect prior to surgery.

What is minimally invasive salivary gland surgery?

Minimally invasive salivary gland surgery, or sialendoscopy, can be performed to spare complete removal of a salivary gland. This is accomplished through the mouth by the use of extremely small cameras and tools introduced through the duct draining the affected salivary gland. Sialendoscopy is the endoscopic evaluation of the salivary gland ducts and it is similar to a colonoscopy, but on a MUCH smaller scale.

Sialendoscopy is indicated for non-neoplastic (without tumors) salivary gland disorders such as salivary gland swelling of unclear origin, obstructive sialadenitis (ie from a stone, stricture, mucous plugging, or foreign body), a mass within the duct, radioactive iodine induced sialadenitis, recurrent parotitis of childhood, and autoimmune recurrent parotitis. It is performed in order to spare complete removal of the salivary gland, which is reserved as the last resort if conservative measures fail to cure the salivary gland disease.

Sialendoscopy is not indicated during an acute infection of the gland and is unable to be performed in patients who cannot open their mouths widely; otherwise, it is a very safe and effective surgery that is used in both children and adults. In the setting of salivary gland stones, the stones must be small enough to be removed through the duct, although larger stones can be removed with the use of a laser or extracorporeal lithotripsy (shock wave therapy), which is utilized to break the stone into much smaller pieces for retrieval.

In the setting of strictures (narrow areas) or stenoses of the salivary gland duct, dilations or other methods of repair can be performed during sialendoscopy. Sialendoscopy also allows the ducts and the salivary glands to be therapeutically rinsed with steroids and antibiotics as well. Sialendoscopy is a proven method for the treatment of salivary gland disease and it is beneficial because it is less invasive with a quick recovery time and it spares complete removal of the salivary gland.