The salivary glands produce saliva, a liquid compound which moistens the mouth, protects teeth from decay, and aids in food digestion. The salivary glands are located in and around the mouth. The major salivary glands are called the parotid, submandibular and sublingual glands. They all secrete saliva via ducts into the mouth. The parotid secretes saliva through Stensen’s duct near the upper back molar teeth; the submandibular gland drains via Wharton’s duct into the front portion of the floor of the mouth below the tongue; and the sublingual through multiple un-named ducts into the floor of the mouth. There are also are hundreds of tiny glands called minor salivary glands which are located in the lips, cheek and other linings of the mouth and throat. These do not drain through a duct bit rather directly into the oral cavity. Problems will occur when the salivary ducts that drain saliva into the mouth, or the glands themselves, become blocked.
Some common symptoms of salivary gland disease include:
- A lump under the tongue, in the cheek, or under the chin
- Foul-tasting discharge into the mouth
- Swelling of the face in front of the ear
- Swelling during eating
- Decreased gland moisture
- Dry mouth
- Tooth decay
Some common disease processes within the salivary glands include:
- Sialolithiasis, the formation of stones within the glands
- Sialadenitis, a bacterial infection of the glands
- Fatty infiltration due to diabetes or alcohol abuse
- Salivary gland cysts
- Obstruction of the salivary ducts by mucus or salivary calculi, or stones
- Tumors of the glands, both benign and malignant. Two thirds of parotid tumors are benign. Fifty percent of submandibular tumors are benign as well.
Infections of the parotid gland are associated with dehydration or malnutrition, and are most frequently seen in elderly debilitated patients. Medications associated with a side effect of dry mouth, other ongoing chronic illnesses, and exposure to radiation or cigarette smoke can be factors as well.
In the evaluation of salivary gland disease, an otolaryngologist at York ENT will assess the risk factors and medical history involved, will perform a thorough examination of the patient’s head, neck, and oral cavity, and, if needed, obtain further information through blood tests, CT or MRI scans, or fine needle aspiration biopsy.
A patient experiencing sialolithiasis may pass small stones without medical intervention. If the stone is too large, surgery will most likely be performed to either remove the obstruction or the gland itself.
Antibiotics are prescribed for bacterial infections, which are usually staphylococcal in origin. For a viral infection the usual treatment is rest with oral replacement of fluids until the infection clears.
Surgical removal of the gland is required for the treatment of salivary gland tumors. The identification of the facial nerve, which runs through the parotid and submandibular gland, is paramount. Radiation treatment may also be recommended after surgery for malignant tumors. This is typically administered four to six weeks after the surgical procedure to allow adequate healing.