About Salivary Glands
As may be evident in the illustration, the salivary glands are located in and around the mouth and throat. The major salivary glands are called the parotid, submandibular and sublingual glands. In addition to these glands, there are hundreds of tiny glands called minor salivary glands located in the lips, inner cheek area (buccal mucosa) and extensively in other linings of the mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help provide protection from tooth decay. As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.
Salivary Gland Problems
There may be a number of identified causes in which salivary glands symptoms show up clinically, including:
Obstruction - In a situation when stones have formed, the flow of saliva is obstructed. This most commonly occurs in the parotid and submandibular glands. When having meals, saliva is produced but cannot exit the ductal system. This leads to swelling of the involved gland and significant pain, and an infection may also develop. 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.
Infections - There may be several reasons that salivary glands become infected and swollen. The commonly known of those are as a result of mumps in children. However, such an infection may also be caused by bacteria, especially if you are feeling run-down or one of your glands has been damaged by salivary duct stones. The lymph glands in your neck beneath the angle of your jaw at this time may also feel enlarged and tender. 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. If an infection is not treated, prolonged damage to the gland may result in loss of function. If you notice any swelling in your mouth, under your chin, or around your jaw, you should consult your physician or dentist.
Tumors -The tumors show up as painless enlargements, generally not involving more than one gland. The primary benign and malignant salivary gland tumors are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. Specialists like oral & maxillofacial, otolaryngologist (head and neck surgeon) 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 – Patients suffering from autoimmune diseases such as HIV and Sjögren's syndrome are prone to see enlargement of their salivary glands. This happens due to 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.
The Diagnosis
Your dentist/physician would need to take your history, a physical examination, and do some laboratory tests as diagnosis of salivary glands. If the reports point to any suspicion on the obstruction of the major salivary glands, your doctor 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 test to show whether the gland has been damaged). A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.
Salivary Gland Disease Treatment
Your dentist or physician will adopt either of the two modalities – medical or surgical – in the treatment of salivary glands disease. If infection of the salivary glands is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem must be treated possibly with an antibiotic if the problem seems to be caused by bacteria. 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 malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. The remaining salivary glands generally compensate for the loss. Radiation treatment is often recommended after surgery. 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 oral treatment. |
