Salivary Glands

 

There are three major pairs of salivary glands in the mouth. The largest pair of salivary glands, called the parotid glands, lies just behind the angle of the jaw, below and in front of the ears. Two smaller pairs, the sublingual glands and the submandibular glands, lie deep in the floor of the mouth and under the jaw. In addition to these major glands, many tiny salivary glands are distributed throughout the mouth. All of the glands produce saliva, which aids in breaking down food as part of the digestive process.

There are 5 basic things that can cause your glands to swell:

• OBSTRUCTION: The flow of saliva most commonly occurs in the parotid and submandibular glands, usually due to stone formation. Symptoms typically occur when eating. Saliva production is initiated, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection.
  
• INFLAMMATION: In some individuals the duct system of the major salivary glands may be abnormal (possibly from repeatedly passing stones) . These ducts can develop small constrictions which decrease salivary flow, leading to infection and obstructive symptoms.
  
• INFECTION: The most common salivary gland infection is mumps, which involves the parotid glands. While this is most common in children, it can occur in adults. However if an adult has swelling in the area of the parotid gland on one side, it is more likely due to an obstruction or a tumor.
  
• TUMORS: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. These enlargements should be checked by an otolaryngologist-head and neck surgeon.
  
  Malignant tumors of the major salivary glands can grow quickly, are painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated..



• OTHER: Salivary gland enlargement is also seen in auto-immune diseases, which cause significant inflammation. Patients often have a dry mouth or dry eyes. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Salivary gland swelling (usually on both sides) is also seen in alcoholics.

Evaluation for swelling of the salivary glands:

The diagnosis of salivary gland disease depends upon a careful history, a physical examination, and laboratory tests. If an obstruction of the major salivary glands is suspected, it may be necessary to anesthetize the opening of the salivary ducts in the mouth, and to probe, and dilate the duct to help an obstructive stone pass. Prior to such instrumentation, dental x-rays may show the location of calcified stones.

If a mass is found in the salivary gland, it is helpful to obtain an x-ray called a CT scan. CT scans will show whether the mass is an actual part of a salivary gland, or an associated lymph node.

Treatment for swelling of the salivary glands:

Treatment of salivary diseases is broadly classified into two categories: medical and surgical. Selection of treatment depends upon the nature of the problem. If it is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem or process must be treated. This may require consultation with other specialists. If the disease process relates to salivary gland obstruction and subsequent infection, antibiotics are used. Sometimes dilation of the ducts will be needed.

If a mass has developed within the salivary gland, removal of the mass may be required. Most masses in the parotid gland area are benign. When surgery is necessary, great care must be taken to avoid damage to the facial nerve which lies within this gland. When malignant masses are present in the parotid gland, it may be possible to surgically remove these masses and preserve most of the facial nerve.

In summary, salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. Such treatment is readily managed by an otolaryngologist-head and neck surgeon with experience in this area.