Salivary gland surgery
The salivary glands are delicate and useful so removing them when a problem arises needs great skill to avoid complications and long-term after effects such as a dry mouth and swallowing difficulties.
About the salivary glands
We have three pairs of salivary glands as well as thousands of tiny minor glands in the mouth lining:
- The parotid glands. These are are the largest and are found in the cheeks just below and in front of the ears. They release saliva onto the inner cheek.
- The sublingual glands. These are under the tongue and release saliva to lubricate the bottom of the mouth.
- The submandibular glands. These are in the floor of the mouth and release saliva behind the front teeth.
Why salivary gland removal can be necessary
Problems can develop in any of the three pairs of glands that are most effectively treated by surgical removal:
- Blocked salivary gland ducts. If a duct closes off this can cause the glands to swell up and they can become infected. One of the most common causes of such a blockage is a tiny stone that lodges in the salivary gland duct. People who have stones in their salivary glands are said to have sialolithiasis.
- A benign or cancerous tumour in the salivary gland. Tumours can develop in the salivary glands, causing inflammation. It is important to note that salivary gland cancer is very rare and that most lumps are diagnosed as benign. There are only around 1–3 cases of salivary gland cancer per 100,000 people in the UK every year. Around 75% develop in the parotid glands.
- Diagnosis is important and Mr Cascarini works with Dr Gitta Madani, a Consultant Radiologist, who provides specialist diagnostic techniques at The Platinum Medical Centre.
What happens during surgery to remove the salivary gland?
Surgery to remove any of the salivary glands is performed under a general anaesthetic so you will need to stop eating and drinking at least six hours before. Usually you will have nothing to eat on the day of surgery, but you can drink water up to the six hour limit.
- If you need the sublingual salivary gland removed, Mr Cascarini will operate through the inside of the mouth, so you will have no external scarring. Surgery to remove a blocked gland will be less extensive than that required to remove a malignant tumour.
- To remove the submandibular gland, Mr Cascarini makes an incision just below the line of the jaw, so the scarring afterwards is minimal.
- The incision required to remove a parotid salivary gland is the most extensive, often running from the bottom of the ear and along the edge of the jaw and up in front of the ear.
- Some benign parotid tumours can be removed using a technique called extracapsular dissection (Mr Cascarini co-wrote a book chapter on this for surgeons in training).
After salivary gland surgery
You usually need to stay in hospital after surgery to remove a salivary gland as a drain needs to be put in place to allow fluid to escape. This is removed between 24 and 72 hours after surgery and, if you are otherwise feeling fit and well, you should be able to go home as soon as the drain is taken away.
Dissolving stitches are often used inside the mouth and these will disappear on their own within three weeks. The skin on your jawline and neck will be either stitched with non-dissolving stitches or clipped. These will be removed a week after the operation.
You will be sore and bruised and will probably find it a bit uncomfortable to eat and drink, particularly in the first couple of days. We will make sure you have the painkillers that you need and give you information on how to rinse your mouth and keep the wound clean until it heals.