The Salivary Glands produce saliva which moistens food to facilitate chewing and swallowing. Saliva contains enzymes which initiate the digestion process by breaking down food before it reaches the stomach. In addition, saliva cleanses the mouth by washing away bacteria and food particles, and thus, helps prevent tooth decay.
The Salivary Glands empty saliva into the mouth, through ducts that open at various locations in the mouth. There are three pairs of major (large) Salivary Glands. In addition, there are many 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.
The major Salivary Glands are:
There are several Salivary Gland disorders. Some Salivary Gland disorders may impede the Salivary Glands from functioning properly while other Salivary Gland disorders may affect one's overall health. Most of the Salivary Gland disorders are cause by Salivary Gland Stones, infection, cysts and tumors.
Deposits of calcium within the Salivary Glands can result in the formation of Salivary Gland Stones (Sialolithiasis). Salivary Gland Stones are most often found in the Submandibular Glands, but the Parotid Glands are also commonly affected. The exact cause of calcium deposition and Salivary Gland Stone formations is unknown. However, it is known that dehydration, which results in thickened saliva, increases the risk of stone formation. In addition, reduced food intake and certain medications also result in reduced saliva production, thus increasing the risk of stone formation.
Salivary Gland Stones commonly occur in the Submandibular and Parotid Glands, resulting in the obstruction of the flow of saliva. Symptoms typically occur while eating. Saliva production starts to flow with eating, but cannot exit the gland, and thus leads to pain and swelling of the involved gland. Often, the swelling gradually subsides, only to swell again with the next meal. Occasionally, an infection can develop in the pool of blocked saliva, leading to more pain and swelling in the glands.
A stone may be diagnosed based on the presenting symptoms and physical examination and palpation of a stone in the gland by the physician. A CT scan can be used confirm the diagnosis.
The goal of treatment is to remove the stone. Often, the stone can be flushed out by increasing the flow of saliva with sour candy or citrus foods (which stimulate the flow of saliva) combined with increased fluid intake and massaging the gland. If this fails, stones that are near the outer most portion of the duct can be squeezed out by a physician. In some cases, the stone may need to be surgically removed. Stones that are deep in the gland may require the entire gland to be removed.
Salivary Gland Infection in adults is often due to obstruction of the gland (by a stone or tumor), poor oral hygiene or dehydration. The infections in adults are usually caused by bacteria.
Infection results in a painful swelling of the gland involved. There is often redness of the overlying skin and it is not uncommon to have fever.
Salivary Gland Infections are usually diagnosed based on the presenting symptoms and physical examination. Culture of the pus from the gland's duct can be sent to identify the type of bacteria causing the infection. In addition, a CT scan or ultrasound may be done to rule out an abscess. If the symptoms persist, imaging of the neck is usually recommended to rule out an underlying source for the infection (such as a stone or tumor).
Bacterial infections respond well to antibiotics, warm compresses to the affected area and increasing salivary flow in order to flush out the infection. The flow of saliva can be increased with sour candy or citrus foods combined with increased fluid intake and massaging the gland. If there is an abscess, surgical drainage or aspiration is often required.
The Salivary Gland may scar with recurrent infections, resulting in permanent narrowing of the gland's drainage ducts. Patients that develop such narrowing of the gland's drainage ducts may develop chronic or recurrent infections that may not respond to antibiotics. Surgical removal of the gland is recommended in patients with recurrent or chronic infections that fail to resolve with antibiotic therapy.
Salivary Gland Cysts occur as the result of trauma or obstruction to the Salivary Gland excretory duct and spillage of saliva into the surrounding soft tissue. The blocked duct does not allow the saliva to exit into the mouth. The saliva, therefore, gets backed up in the gland and results in the enlargement and ballooning of the gland. Salivary Gland Cysts can be classified as Sialocele, Mucocele, Oral Ranula, and Cervical Ranula.
Simple cysts and Mucoceles are usually diagnosed with a physical examination and rarely require further diagnostic testing. Imaging of the head and neck by CT scanning or an MRI is recommended to determine the extent of a Cervical Ranula and to eliminate other disease processes prior to surgical intervention.
Occasionally, Salivary Cysts spontaneously resolve, especially in infants and young children. Although aspiration of Salivary Cysts does deflate them, this is temporary and almost all cysts return after aspiration. Small and asymptomatic Salivary Cysts can be observed.
Salivary Gland Tumors are growths in the Salivary Glands. There are many different types of tumors which can develop in these glands, some non-cancerous (benign) and others cancerous. All Salivary Glands can develop tumors; however some are more prone than others. For example the majority of tumors are seen in the Parotid Gland. In addition, some glands tend to develop benign tumors while others are more likely to develop a cancerous tumor. For example, 80% of Parotid Gland Tumors are benign, while 50% of Submandibular Tumors and only 35% of Sublingual Gland Tumors are benign.
Although the causes of Salivary Gland Cancer are not clear, certain risk factors have been associated with increased chance of developing Salivary Gland Cancer. These risk factors include:
The majority of Salivary Gland Tumors are non-cancerous (benign). These growths do not spread to other parts of the body and are rarely life-threatening. There are several types of benign Salivary Gland Tumors and they include Pleomorphic Adenoma, Warthin tumors and Oncocytomas.
There are many types of Salivary Gland Cancers. Salivary Glands are made up of many different kinds of cells and Salivary Gland Cancer can arise from any of these cell types. The rate that the cancer grows and spreads depends on the type of cancer. These cancers include Mucoepidermoid, Acinic Cell, Carcinoma Ex-Pleomorphic, Adenoid Cystic and Squamous Cell cancer.
The most common symptom is a painless mass. Often, Salivary Gland Tumors may not cause any symptoms. They are frequently found during a physical examination or incidentally noted on an imaging study done for another reason. Symptoms that may present include:
Imaging of the neck with an MRI or CT scan helps identify the extent of growth and involvement of surrounding structures.
Fine needle aspiration biopsy is often used to determine whether the salivary growth is cancerous. The biopsy samples the cells in the area of concern which are then sent to a pathologist for analysis. During the procedure, a thin needle is inserted through the skin into the salivary mass to collect a sample of cells. Multiple samples are usually taken to ensure an accurate analysis. Ultrasound technology can be used to visualize masses which are difficult to find and to guide the placement of the needle. Fine needle aspiration biopsy is carried out in the office by Dr. Zadeh. The samples of cells are then sent to a pathologist for evaluation.
The type of treatment varies based on the patient, location of the tumor and type of tumor. Treatment options include observation, surgical removal, radiation therapy and chemotherapy.
Surgical excision of the tumor with the involved Salivary Gland is a common treatment for Salivary Gland Tumors (see below). Because the glands are numerous, removal of one of the salivary glands does not typically cause any noticeable decrease in saliva production. The nerves that control the motion of the facial muscles lie in close proximity or are within the salivary glands. Dr. Zadeh uses facial nerve monitoring equipment and delicate and meticulous dissection techniques to minimize the risk of any trauma to these important nerves during the procedure. Dr. Zadeh also uses cosmetic surgery principles to disguise the incision scar.
Laryngeal nerve monitor
Submandibular Gland Surgery involves removal of the entire Submandibular Gland. This surgery is commonly performed to treat Submandibular Gland tumors and stones. In addition, a chronic infection of the Submandibular Glands that fails to respond to medications is often treated with surgical removal. A small incision is made below the jaw line in the neck. The gland is then removed through this small incision, while preserving surrounding tissues, nerves and vessels.
Dr. Zadeh uses facial nerve monitoring equipment and delicate and meticulous dissection techniques to minimize the risk of any trauma to these important structures during the procedure. Dr. Zadeh also uses cosmetic surgery principles to disguise the incision scar. Submandibular Gland Surgery is an outpatient procedure and most patients are able to go home a few hours after surgery.
The surgery to remove the Parotid Gland is called a Parotidectomy. This surgery involves removing either part or all of the Parotid Gland. This surgery is commonly performed to treat Parotid Gland Tumors and stones. In addition, a chronic infection of the Parotid Gland that fails to respond to medications is often treated with surgical removal. A skin incision is made, which runs from the front of the ear, curving towards the back of the ear, to the level of the hair line. This incision is very similar to that used in face-lift surgery and has excellent cosmetic results. An important part of the surgery is identification and preservation of the facial nerve which runs through the Parotid Gland and controls movement of the face.
Dr. Zadeh uses facial nerve monitoring equipment and delicate and meticulous dissection techniques to minimize the risk of any trauma to this important nerve during the procedure. Dr. Zadeh also uses cosmetic surgery principles to disguise the incision scar. Parotid Gland Surgery is an outpatient procedure and most patients are able to go home a few hours after surgery.