What are your salivary glands?
There are multiple salivary glands found in and around your mouth and throat. These are divided into two groups: major salivary glands and minor salivary glands. The major salivary glands include the parotid glands (in your cheeks), the submandibular glands (below your jaw), and the sublingual glands (under your tongue). There are hundreds of minor salivary glands in your lips, cheeks and throughout the lining of your mouth and throat. All salivary glands secrete saliva into your mouth to moisten your mouth, initiate digestion, and help protect your teeth from decay. The duct system of the major salivary glands connect the glands to the mouth. The parotid ducts empty into your cheek adjacent to your molars. The submandibular ducts empty just below your teeth.
What causes salivary gland problems?
There are many different problems that can arise from the salivary glands. These include:
Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands. This can be due to infection, inflammation or salivary stones. Symptoms typically occur when eating. Eating triggers saliva production, but the saliva cannot exit the drainage system. Typically the glands will swell during a meal and then gradually subside only to swell again at the next meal. Infection can develop if the gland is block for a long period of time. This can lead to more severe pain and swelling in the glands. If persistent gland swelling is left untreated the glands may become abscessed.
It is possible for the duct system of the major salivary glands to develop small areas of narrowing which decrease salivary flow, leading to infection and obstructive symptoms. Autoimmune diseases such as Sjogren’s syndrome attack the salivary glands and narrow the ducts. Other disorders such as HIV, diabetes, and prior radioactive iodine treatment can also cause narrowing of the ducts or enlargement of the glands.
Sialadenitis usually affects the parotid or submandibular glands. It is most common in adults but can occur in children. Sialadenitis can be caused by viruses (such as mumps) or bacteria. Mumps is most common in children who have not been immunized but can occur in adults and in those who have been immunized. Bacterial infections can happen when the flow of saliva is blocked or the flow of saliva is reduced. Reduction in saliva flow is most commonly see with dehydration but can the result of medications such as anti-histamines, beta-blockers, or diuretics. The symptoms of sialadenitis can include:
- Swelling in the cheek and neck region, especially after eating
- Mouth or facial pain
- Dry mouth
- Foul taste or gritty feeling in the mouth
- Redness over the side of the face or upper neck
- Pus in the mouth
Salivary gland tumors usually show up as painless lumps in these glands. Tumors rarely involve more than one gland. There are both benign (noncancerous) and malignant (cancerous) tumors that can affect the salivary glands. Rarely these tumors can cause loss of movement of part or all of the affected side of the face.
How does your doctor make the diagnosis?
Diagnosis of salivary gland disease depends on the careful taking of your history, a physical examination, and possibly laboratory tests.
Imaging such as Ultrasounds, CT scans or MRIs can be used to evaluate the gland for stones, masses, or abscesses. Sometimes, a fine needle aspiration (FNA) biopsy is helpful in the setting of a mass in the gland.
A lip biopsy of minor salivary glands may be needed to identify Sjogren’s disease.
How is salivary gland disease treated?
Selection of treatment depends on the nature of the problem.
Treatment for sialadenitis includes good oral hygiene, increasing fluid intake, massaging over the affected gland, applying a warm compress, and using candies or foods which increase saliva (such as lemon drops). In cases that are due to bacteria, antibiotics may be prescribed. Antibiotics are not useful for viral infections. Most salivary gland infections resolve or are cured with conservative treatment.
For chronic obstruction or smaller stones sialendoscopy can be utilized. Sialendoscopy uses a very small lighted camera called an endoscope that is passed through the natural opening of the duct in the mouth into the salivary duct to retrieve the stone, dilate a narrowing or flush out the gland. This procedure is performed as an outpatient procedure, is minimally invasive, has few side effects and is well tolerated by patients.
If a mass has developed within the salivary gland, removal of the mass may be recommended. When surgery is necessary in the parotid gland, great care must be taken to avoid damage to the facial nerve (the nerve that moves the muscles of the face, eye and mouth) that runs through this gland. When malignant (cancerous) masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment may be recommended after surgery for cancers of either the parotid or submandibular gland. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation.
If the salivary gland disease is due to diseases or disorders sites outside of the salivary gland (such as HIV, diabetes, autoimmune diseases), then the underlying problem must be treated. This may require consulting with other specialists