Salivary Glands

The salivary glands produce saliva and secrete it through ducts into your mouth.  There are three major paired glands:  the parotid glands are the largest and are found in front of and just beneath your ears and drain behind into inner cheeks next to your upper premolar teeth; the submandibular glands are located just below your jaw bone, closer to the angle of the jaw than the chin and drain into the floor of your mouth just behind your lower front teeth; the sublingual glands are located in the floor of the mouth deep to the surface and drain into the middle of the floor of your mouth.  Additionally, there are millions of minor salivary glands located throughout your mouth and throat.  Saliva is important in lubrication of the mouth, has antibacterial properties that are especially important in the prevention of tooth decay, and aid in the initial stages of the digestion of starches.

Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed or the ductal system is malfunctioning. 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.

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, lips, and other rare locations associated with minor glands.  ENT physicians are specialists when it comes to problems involving the salivary glands.

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. Dental cavities can develop quickly in the presence of dry mouth.  Radiation to the head and neck can lead to significant functional deterioration of the salivary glands.  Every patient who has had radiation in the field of their salivary glands must submit to regular dental evaluation.  Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.

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.  Massage, heat, fluids, and sialagogues to promote secretion of saliva are the backbone of treating salivary gland inflammation and swelling.

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 if the mass is cancerous. 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.