Salivary Gland Disease
There are 3 pairs of major salivary glands:
- The Parotid gland is located in front of the ear.
- The Submandibular gland is located below the jaw line.
- The Sublingual gland is located under the tongue.
There are also hundreds of minor salivary glands throughout your oral cavity and throat that provide constant lubrication.
Swelling can occur in a gland due to blockage of the salivary duct and/or infections, and tumors growing within the glands.
A blockage due to a salivary stone is call sialolithiasis. This can result in swelling and pain in the gland that worsens when you eat. When you eat, the saliva glands produce more saliva, however if the duct is blocked by a stone, the saliva backs up and causes swelling and pain.
An infection of the saliva gland is termed sialadenitis. This can occur with or without a stone. Usually there is severe pain and swelling, warmth of the gland, and purulent drainage arising from the duct. These infections are caused by bacteria in the mouth that travel up the duct.
Salivary gland blockages and are treated by promoting salivary flow to flush out the duct system. It is important to stay well hydrated. Sucking on sour candies or lemons can help increase saliva flow and help flush out the system. Massaging the gland from back to front can help as well. If an infection is present, antibiotics are often needed to hasten recovery.
Tumors of these glands can be benign or malignant. CT scans and MRIs help to localize the specific location and to better characterize their behavior. A Fine Needle aspiration biopsy can help with the diagnosis of the lesion, however is not always accurate. Surgical excision is often recommended.
Salivary Gland Surgery
Surgery to remove parotid masses is called a parotidectomy. Removal of just the tumor is never done because there is a chance of leaving behind tumors cells. Leaving behind benign tumor cells can cause them to come back even if they are not cancerous. Removing the parotid gland involves identification of the facial nerve which comes out of the base of the skull and splits into multiple branches within the parotid gland that then go to the muscles of the face. Injury to this nerve is the main risk of this surgery. Monitoring of the facial nerve during the surgery is done with a device to detects muscle twitches in the face. This helps to facilitate identification and checking for the integrity of the nerve during surgery.
Submandibular Gland Excision
Submandibular gland excision involves making an incision in the upper neck usually 2 fingerbreadths below the jaw line. This is to avoid a branch of the facial nerve that depresses the lower lip that is located in this region. Once the gland is identified the nerve is protected and and the gland is carefully dissected free from the neck. The nerve that provides sensation to the tongue is protected and the saliva duct is sealed off.