Saliva is produced by both major and minor salivary glands. The major salivary glands include the parotid glands, submandibular glands, and sublingual glands. The parotid glands are the largest of these, and are located in front of the ear, extending into the upper neck behind the jaw. These glands drain through a single duct that empties into each side of the mouth next to the upper molar teeth. The submandibular glands are just under the lower border of the jaw bone. Each of these two glands drains through a single duct that empties into the front part of the floor of the mouth, under the tongue. The sublingual glands are in the floor of the mouth, under the tongue, and empty into the mouth through multiple very small ducts. Hundreds of minor salivary glands exist just beneath the lining of the mouth and many areas of the throat.
Tumors of the salivary glands
Benign and malignant tumors can occur in any of the major and minor salivary glands. The most common location for these tumors is the parotid gland. Generally, the bigger the gland in which the tumor occurs, the more likely the tumor is to be benign. Over 80% of parotid tumors, for example, are benign. In contrast, the majority of tumors that originate from the minor salivary glands are cancerous. Treatment for both benign and cancerous tumors of the salivary glands is surgery to remove the tumor. More aggressive surgery is needed for cancerous tumors than for benign tumors, and may also involve removal of certain areas of lymph nodes in the neck. Testing prior to surgery can help guide treatment, and will likely include an imaging study such as CT or MRI, as well as a biopsy of the tumor.
Salivary gland stones: Sialolithiasis
Salivary stones, or sialoliths, most commonly occur from the submandibular glands, though can also occur with the parotid glands. When large enough, these stones can block the drainage of all or part of the associated gland. This results in swelling and pain of the gland, which often worsens during eating. The poor drainage of the gland can also lead to infection of the gland, called sialadenitis. Smaller stones that are lodged in the duct of the gland can often be removed through the mouth, even under local anesthesia in many cases. Very large or multiple stones, or stones that are lodged in the gland itself, may require surgery to remove the entire gland.
Salivary gland infection: Sialadenitis
Infection of the parotid or submandibular salivary glands can occur, causing severe swelling and pain of the affected gland, as well as a fever in some cases. These infections can become severe and even life-threatening in some cases. Infections typically occur in glands that do not drain properly, such as with salivary stones, dehydration or certain medications causing thickening of the saliva, or autoimmune conditions affecting the function of the salivary glands. Infections typically respond to a combination of antibiotics, good hydration, massage of the gland, and items such as sugar-free sour candy to stimulate salivary flow. For recurring infections of the same gland, surgery to remove the gland may be needed.
Sjogren’s syndrome is an autoimmune disorder causing chronic inflammation and destruction of salivary and other glandular tissue. Typical symptoms include chronic dry mouth and dry eye. Sjogren’s syndrome can occur alone or in association with other autoimmune conditions such as lupus or rheumatoid arthritis. ENT physicians may become involved with the diagnosis of this condition by sampling some minor salivary gland tissue as a biopsy. This is a minor procedure that can be performed with minimal discomfort under local anesthesia.
The physicians of Peak ENT are experienced in the medical and surgical management of salivary gland disorders, including surgery to remove the salivary glands.