The salivary glands are found in and around the mouth, throat and face. The largest or major salivary glands are the parotid, submandibular, and sublingual glands. The salivary glands secrete saliva into the mouth, through tubes that drain the saliva, called salivary ducts.
The parotid ducts drain near the upper teeth, the submandibular ducts under the tongue, and the sublingual glands through many ducts in the floor of the mouth. Besides the major salivary glands, there are many tiny glands called minor salivary glands located in the lips, inner cheek area (buccal mucosa), and in the linings of the mouth and throat.
Salivary gland function
- Salivary glands produce the saliva which moistens the mouth, initiates digestion, and help protect 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 may include
Obstruction – blocked salivary gland
Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because a salivary gland stone has formed. Symptoms of a blocked salivary gland 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 a salivary gland stone totally obstructs 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.
Salivary gland 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. Salivary gland infection commonly occurs secondary to blockage by a salivary gland stone.
The salivary glands may also become swollen due to a secondary infection 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. Occasionally salivary gland swelling is due to a tumour.
Salivary gland tumours
Benign and malignant salivary gland tumours usually show up as painless enlargements of these glands. Tumours rarely involve more than one gland and are detected as a lump in the face, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head and neck surgeon should check these enlargements. Malignant tumours 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 salivary gland disorders
Ranula
- A ranula is a type of mucocoele found on the floor of the mouth
- Ranulas present as a swelling consisting of collected mucin from a ruptured salivary gland duct
Generalised salivary gland enlargement
Salivary gland enlargement may also occur in autoimmune diseases such as 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.
Treatment of salivary gland diseases
- Treatment of salivary gland diseases falls into two categories: medical and surgical
- Selection of treatment depends on the nature of the problem
Medical treatment
When salivary gland problems are 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.
Surgical treatment for parotid lumps
If a mass has developed within the salivary gland, removal will usually be recommended – most masses in the parotid gland area are benign (noncancerous). When surgery is necessary, great care is taken to avoid damage to the facial nerve within this gland – the facial nerve moves the muscles face including the mouth and eye. For parotid gland cancer, it may be possible to surgically remove the parotid gland and preserve most of the facial nerve – radiation treatment is then often recommended starting 4 to 6 weeks later.
Surgical treatment for submandibular and minor salivary gland lumps
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 radiation treatment. An ENT – head and neck surgeon can effectively direct treatment.
Surgery to remove a submandibular salivary gland
The submandibular salivary glands are located under the angle of the jaw on each side of the neck. They produce saliva which passes into the mouth through a narrow tube (duct). The duct may be block by stones which leads to pain and swelling in the neck and mouth.
A lump in the submandibular gland may also be due to a benign or malignant tumour. 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 a different treatment plan will be needed.
Parotid gland surgery
The parotid salivary gland is situated in the face, in front of and below the ear. Swelling in the parotid gland is often due to infection or a benign or malignant tumour. The facial nerve which supplies the facial muscles runs through the parotid gland.
The facial muscles control movement of the face, including mouth and eye. If a lump has developed within the parotid gland, removal is usually recommended. Most lumps in the parotid gland area are benign (noncancerous). When surgery is necessary, great care is taken to avoid damage to the facial nerve within this gland.
Does removal of a salivary gland produce a dry mouth
- No, removal of one 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 treatment
- Salivary gland diseases are due to many different causes
- These diseases are treated both medically and surgically
- Treatment is routinely managed by an ENT – head and neck surgeon with experience in this area
