Salivary glands are found in and around your mouth and throat.
The major salivary glands are the parotid, submandibular, and sublingual glands.
Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat.
Function of Salivary Glands
Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.
They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth.
Salivary Gland Problems
Salivary gland problems that cause clinical symptoms include:
Obstruction: Obstruction of saliva flow usually occurs in the parotid and submandibular glands as a result of stone formation. Symptoms typically occur when eating. Saliva is produced, but is unable to exit the ductal system. Blockage of the ductal system, leads to swelling of the involved gland, pain, and potential infection. Infection often will develop in the pool of blocked saliva, causing pain and swelling in the glands. If untreated, the glands may become abscessed.
Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. On the other hand, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor.
Due to the high level of bacteria present in the mouth, infection is often results from either ductal obstruction or a sluggish flow of saliva.
If nearby lymph nodes become infected, a secondary infection in the salivary glands can transpire that usually presents as redness, swelling, and pain. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat and can be located within or near the parotid or submandibular glands. Lymph nodes also enlarge due to tumors and inflammation.
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. An otolaryngologist-head and neck surgeon should check these enlargements.
Malignant tumors of the major salivary glands can grow quickly, may be 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 Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjogren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Patients with Diabetes can cause salivary gland enlargement, especially in the parotid glands. People who consume a high volume of alcohol often present with salivary gland swelling on both sides.
Diagnosis of Salivary Gland Disease
Salivary gland disease can often be diagnosed following a detailed patient history consideration, physical exam, and laboratory tests.
If a salivary gland is likely obstructed, it may be necessary to probe/dilate the opening of the salivary duct to help any stones to pass.
Through CT scans or MRI (magnetic resonance imaging), the presence and location of salivary stones can often be determined. Sometimes, a fine needle aspiration biopsy in the doctor’s office is helpful. Sometimes dye is injected through the parotid duct before an x-ray of the gland for better visualization, known as a sialogram.
Minor salivary glands may be biopsied to identify or rule out certain autoimmune diseases.
Treatment for Salivary Gland Disease
Salivary diseases treatment can fall into two categories: medical and surgical. Selection of treatment depends on the nature of the problem.
If the disease process relates to salivary gland obstruction and subsequent infection, your doctor will recommend increased fluid intake and may prescribe antibiotics.
If a mass has formed within the salivary gland, excision of the mass may be encouraged. Most masses in the parotid gland are noncancerous. When surgery is necessary, great care must be taken to avoid damage to the facial nerve within this gland that moves the muscles face including the mouth and eye. When malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended 4 to 6 weeks following surgery.
The same general principles apply to masses in the submandibular area or in the minor salivary glands within the mouth and upper throat. Benign diseases can usually be treated by either non-invasive measures or in office surgery. Malignant diseases may call for more in-depth surgery and postoperative irradiation. If the lump in the vicinity of a salivary gland is a lymph node that has become enlarged due to cancer from another site, then obviously a different treatment plan will be needed. An otolaryngologist-head and neck surgeon can effectively direct treatment.
Removal of a salivary gland does not usually lead to a dry mouth (Xerostomia). However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances.