Salivary Gland Disorders

[Saliva gland anatomy] [Salivary gland infection]

[Stones (sialolithiasis)] [Salivary Tumors and cancer]

[Surgery of the Parotid Gland (parotidectomy)]

[Surgery of the Submandibular Gland]

Where are the Saliva glands?

There are 3 pairs of major salivary glands in the body, 2 in the cheeks (parotid glands), two under the jaw (sublingual glands), and 2 under the tongue (sublingual glands). In addition, there are numerous minor salivary glands distributed through the mouth and throat.

These glands are responsible for production of saliva, which helps lubricate food as we chew and swallow it and also produces substances that protect the teeth and help with digestion.

Salivary gland infection and malfunction

Infection or malfunction of salivary glands can lead to swelling, and tenderness in the affected gland and may cause dry mouth if all glands are affected. Infections can be secondary to various causes such as diabetes, dehydration and various chronic illness or due to presence of stones within the outflow ducts of the glands that block flow of saliva and cause swelling and eventual infection. Infections are often treated with antibiotics and with intake of large amounts of fluids to help clear the saliva ducts.

Salivary Gland Stones

Salivary glands ducts may occasionally develop deposits that turn into stones (similar to kidney stones). Stones can cause blockage of the flow of saliva or

Non-infectious diseases of salivary glands may require laboratory testing or radiologic imaging for diagnosis. If stones or narrowing of the ducts are detected, the salivary ducts may need to be dilated and any stones extracted. This procedure can be performed in-office for approrpiate patients under local anesthesia, thus minimizing risks of open surgical procedures.

Sialendoscopy is a new treatment modality in which ultra thin endoscopes are inserted into salivary ducts to identify stones or other abnormalities within the ducts. Channels within the endoscopes can then be used to insert microinstruments and baskets for retrieving the stones. In select cases, laser fibers (Holmium laser) can also be inserted through endoscope channel to help break up larger stones to make them easier to retrieve.

Ultimate treatment for glands non-responsive to conservative treatments is the removal of the glands. Operations to remove the glands, however involve risks of open surgical procedures and they should only be undertaken when all other means have failed.

Salivary Gland Tumors

Tumors of salivary glands vary from benign to malignant and they vary in aggressiveness and behavior. These tumors often present as slow growing masses in the cheeks, mouth or the region under the jaw. They may cause pain or paralysis of the face if they invade the nerves of the face (facial nerve).

Initial diagnosis is via fine needle aspiration in most cases. Once the diagnosis is made the decision for treatment can be tailored to the type of tumors present. Occasionally, benign tumors can be observed but it majority of cases, treatment involves removal of part or all of the affected gland. Even benign tumors may occasionally turn malignant if left untreated over years.

Parotidectomy (surgery to remove parotid glands)

When a tumor of the parotid gland requires surgical removal, a partial (superficial) or total parotidectomy is often the procedure employed. This is a rather complex procedure that involves an incision in front of the ear lobe and separating the parotid gland from the delicate but functionally important branches of the facial nerve in order to remove the diseaes process. The surgery involves risk of complete, or partial facial paralysis which may be temporary or permanent. Use of special nerve monitoring electrodes and modern surgical techniques can help surgeons find the nerves quicker and avoid accidental injury to the nerve during surgery thus ensuring the best possible outcome for the patients.

Surgery to remove submandibular glands

This surgery is similar to parotidectomy but with less risk of nerve injury as the submandibular gland is adjacent to only the lower branch of the facial nerve. Incision for the procedure is under the jaw. Harmonic ultrasonic dissection facilitates low heat dissection of tissue with minimal injury to surrounding tissues.

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May 9th, 2017 by Sepehr Oliaei, MD