The salivary glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular and sublingual glands, they 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. Besides these glands, there are tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa) and in the linings of your mouth and throat. Salivary glands produce saliva which is used to moisten your mouth, initiate digestion and help protect your teeth from decay.
Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland, the blockage causes significant pain and sometimes infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If left untreated, the glands may become abscessed.
It is possible for the duct system of the salivary glands that connects the glands to the mouth to become abnormal due to developing small constrictions which decrease the salivary flow which leads to infection and other obstructive symptoms. Dehydration is a risk factor for salivary gland disease.
The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can also occur in adults. However, if an adult has swelling in the area of only one side of the parotid gland, it is more likely due to an obstruction or a tumor.
Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria. You may have a secondary infection of salivary glands from nearby lymph nodes. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat. Some lymph nodes are located within the substance of the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. Lymph nodes also enlarge due to tumors.
Primary benign and malignant salivary gland tumors usually begin as painless enlargements of the glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, or on the palate floor of mouth, cheeks or lips. 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 by the physicians at Oklahoma Otolaryngology Associates, they are trained extensively on how to examine these enlargements and determine the cause.
Salivary gland enlargement occurs in autoimmune diseases such as HIV and Sjögren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Diagnosis of salivary gland disease depends on the accurate record of your history, a physical examination and laboratory tests by the physicians at Oklahoma Otolaryngology Associates. If your physician suspects an obstruction of the major salivary glands, it may be necessary to anesthetize the opening of the salivary ducts in the mouth, probe and dilate the duct which will help an obstructive stone pass. Before these procedures, dental x-rays may show where the calcified stones are located.
If a mass is found in the salivary gland, it is helpful to obtain a CT scan or an MRI (magnetic resonance imaging). Sometimes, a fine needle aspiration biopsy is helpful. A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.
The treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on 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 must be treated. This may require consulting with other specialists. If the disease process relates to salivary gland obstruction and subsequent infection, your physician at Oklahoma Otolaryngology Associates will make recommendations which may include increasing fluid intake and prescription of antibiotics and sometimes an instrument is used to open blocked ducts.
If a mass has developed within the salivary gland, removal of the mass may be recommended. If surgery is necessary, great care is 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 is possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended after surgery and is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation.
The same general principles apply to masses in the submandibular area, the minor salivary glands within the mouth and upper throat. Benign diseases are best treated by performing surgery, whereas malignant diseases may require 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 a different treatment plan will be needed, which the physicians at Oklahoma Otolaryngology Associates can help coordinate.
Removal of a salivary gland does not produce a dry mouth, called xerostomia. However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your physician can prescribe medication or other conservative treatments that may reduce the dryness in these instances. Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically.