Salivary gland disease

Salivary glands produce all the saliva that keeps our mouths moist. We have three pairs of salivary glands as well as thousands of tiny minor glands in the mouth lining. Each of these pairs connects to the mouth by a thin tube, or duct.

Some terms explained
Sialadenitis = salivary gland infection

Sialolithiasis = recurrent salivary gland stones

Sialadenosis = painless salivary gland swelling with no discernible cause

About the salivary glands

Around 70% of all our saliva comes from the submandibular glands, the parotid glands produce 25% and the rest is secreted by the sublingual glands, which lie right under the tongue.

• The parotid glands are the largest salivary glands and are found in the cheeks just below and in front of the ears, near the top teeth. They release saliva onto the inner cheek.
• The sublingual glands lie right under the tongue and release saliva to lubricate the bottom of the mouth.
• The submandibular glands, which are just under the tongue at the front of the bottom of the mouth and release saliva behind the front teeth.

Blocked salivary gland duct

A common cause of salivary gland disease is a blocked salivary gland duct. One of the most common causes of such a blockage is a tiny stone that lodges in the salivary gland duct. These tiny but solid calcium deposits are termed sialoliths. If one of them breaks free from the main gland and passes into the salivary gland duct, it can get half way and then get stuck. A blocked duct means that no saliva can escape and the gland can become swollen and painful and they can become infected.

If bacteria builds up and start growing in the blocked off gland, this can escalate into a serious infection that can spread into the blood.

People who have stones in their salivary glands are said to have sialolithiasis.

Other causes of swollen salivary glands include:

• Viral infections – these often cause salivary glands to swell. This can happen if you get ‘flu, mumps or cytomegalovirus infections.
• Salivary gland cysts – these are benign growths inside the gland that can have various causes.
• Salivary gland tumours – benign tumours and cancers can form in the salivary gland itself or in the duct.
• Sjögren’s syndrome – an autoimmune disease that is common in patients with lupus, rheumatoid arthritis or scleroderma.

Sometimes one of the salivary glands can enlarge but no reason can be found and the gland is not painful.

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, but when they are diagnosed they are usually in people in their 50s and above. Around 75% develop in the parotid glands.

Diagnosis is important and Mr Luke Cascarini works with leading consultant radiologists who provide specialist diagnostic techniques.

Benign tumours may need treatment as they cause swelling in the gland. The three recognised non-cancerous tumours that occur in the salivary glands are:

• Warthin’s tumour – this affects the parotid gland and is usually seen in older men.
• Pleomorphic adenoma – also affects the parotid gland, is slow growing and more common in women. It presents as a lump, just below the earlobe, and is usually painless.
• Benign pleomorphic adenoma – this usually affects the submandibular gland or any one of the 1000 tiny minor glands.

Treating salivary gland disease

Although some salivary gland stones can be treated using ultrasound to break them up and infections are treated with antibiotics, many other salivary gland problems need surgery. Mr Luke Cascarini performs salivary gland surgery to remove stones, cysts, benign tumours and salivary gland cancers.

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.

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, Luke 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, Luke makes an incision just below the line of the jaw, so the scarring afterwards is minimal. Read more about submandibular gland surgery.

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. Read more about parotid gland surgery.

Some benign parotid tumours can be removed using a technique called extracapsular dissection (Luke 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.