Salivary
Glands
Where
Are Your Salivary Glands?
The glands are found in and around your mouth and throat. We call
the major salivary glands the parotid, submandibular, and sublingual
glands.
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.
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. Salivary glands produce
the saliva used to moisten your mouth, initiate digestion, and help
protect your teeth from decay.
As
a good health measure, it is important to drink lots of liquids
daily. Dehydration is a risk factor for salivary gland disease.
What
Causes Gland Problems?
Salivary gland problems that cause clinical symptoms include:
Obstruction:
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 and significant pain, sometimes with an 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 untreated for a long time, the glands may become abscessed.
It
is possible for the duct system of the major salivary glands that
connects the glands to the mouth to be abnormal. These ducts can
develop small constrictions, which decrease salivary flow, leading
to infection and obstructive symptoms.
Infection:
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 occur in adults. However, 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.
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. In fact, many of
these lymph nodes are actually located on, within, and deep in 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 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 Sjögren'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.
Diabetes may cause enlargement of the salivary glands, especially
the parotid glands. Alcoholics may have salivary gland swelling,
usually on both sides.
How
Does Your Doctor Make the Diagnosis?
Diagnosis
of salivary gland disease depends on the careful taking of your
history, a physical examination, and laboratory tests.
If
your doctor suspects an obstruction of the major salivary glands,
it may be necessary to anesthetize the opening of the salivary ducts
in the mouth, and probe and dilate the duct to 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 a MRI (magnetic resonance imaging). Sometimes, a fine
needle aspiration biopsy in the doctor's office is helpful. Rarely,
dye will be injected through the parotid duct before an x-ray of
the gland is taken (a sialogram).
A
lip biopsy of minor salivary glands may be needed to identify certain
autoimmune diseases.
How
Is Salivary Gland Disease Treated?
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 doctor will recommend increased fluid
intake and may prescribe antibiotics. Sometimes an instrument will
be used to open blocked ducts.
If
a mass has developed within the salivary gland, removal of the mass
may be recommended. Most masses in the parotid gland area are benign
(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 after surgery. This 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
or in the minor salivary glands within the mouth and upper throat.
Benign diseases are best treated by conservative measures or 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 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 produce a dry mouth, called 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.
Salivary
gland diseases are due to many different causes. These diseases
are treated both medically and surgically. Treatment is readily
managed by an otolaryngologist-head and neck surgeon with experience
in this area.
©2002
American Academy of Otolaryngology-Head and Neck Surgery One Prince
St., Alexandria, VA 22314-3357, 1-703-836-4444
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