SALIVARY GLAND PATHOLOGIES

SALIVARY GLAND PATHOLOGIES

The salivary glands produce saliva to moisten the mouth, to help protect teeth from decay and to digest food. The three major salivary glands are the parotid gland, submandibular gland and sublingual glands. Saliva drains into the mouth through small tubes called ducts.

The most common problems in the salivary gland occur when the ducts become blocked and saliva cannot drain.

Problems with the ducts

Sialolithiasis is a condition in which tiny salivary stones form in the glands. The stones are made of calcium. Some stones do not cause any symptoms, but some block the ducts. The saliva flow is partially or completely stopped. The gland might enlarge, and an infection can develop.

Sialadenitis is a painful infection of a salivary gland caused by Staphylococcus, streptococcus, Haemophilus influenzae or anaerobic bacteria. The condition is common with elderly people who have salivary gland stones, but infants can develop during the first few weeks of life. It can become a severe infection if not treated properly.

Viral infections such as mumps, flu, Coxsackie viruses, echovirus and cytomegalovirus can make the salivary glands enlarge.

Cysts can develop in the salivary glands after injuries, infections, stones or tumors. Sometimes babies are born with cysts in the parotid gland because of a problem with early development of the ears.

A mucocele, a common cyst on the inside of the lower lip, can burst and drain yellow mucous. Other cysts can hinder eating, speaking or swallowing.

Tumors – Most salivary tumors are benign (noncancerous), but they can also be cancerous. Most salivary tumors grow in the parotid gland.

Pleomorphic adenomas are the most common parotid tumor. It grows slowly and is benign. It begins as a painless lump at the back of the jaw, just below the earlobe. These are more common in women. Benign pleomorphic adenomas can also grow in the submandibular gland and minor salivary glands, but less often than in the parotid.

Warthin’s tumor is the second most common benign tumor of the parotid gland. It is more common in older men.

Cancerous (malignant) tumors are rare in the salivary glands and usually occur above ages. They grow either fast or slow-growing.

Sjögren’s syndrome is chronic disease. White blood cells attack the moisture-producing glands such as the salivary glands, the tear-producing glands, and sometimes the sweat and oil glands. Middle-aged women are most affected. Sjögren’s syndrome is frequently seen in people who have rheumatoid arthritis, lupus, scleroderma and polymyositis.

Sialadenosis is a painless enlargement of the salivary gland without a known cause. The parotid is usually the affected gland.

Causes & Risks ?

• Dehydration, malnutrition, eating disorders
• Recent surgery, chronic illness, cancer, prematurity
• Antihistamines, diuretics, psychiatric medications, blood pressure medications, barbiturates
• History of Sjögren’s syndrome
• Air blowing occupations 
• Radiation exposure
• Smoking
• Obese
• Pregnant or breastfeeding
• Malnourished or have eating disorders
• Alcoholics with liver cirrhosis
• Having kidney failure or thyroid problems

Investigations :

• An X-ray, CT scan or MRI to look for stones or tumors
• A fine needle biopsy to determine if a tumor is cancerous
• Salivary function tests, eye tests and blood tests to diagnose Sjögren’s syndrome
• A sialogram X-ray that uses dye to look for problems in the salivary ducts

Various non surgical treatment modalities :

• Small stones might pass out of the duct without treatment. A doctor might be able to remove a stone by pressing on it if the stone is close to the opening of a duct.

• Ultrasound waves can be used to shatter large stones into small pieces.
• Deep or large stones are more difficult. If they cannot be removed and symptoms of pain or infection persist, the entire salivary gland may need to be removed.
• Bacterial infections require taking antibiotics and extra fluid either by mouth or intravenously. Warm compresses are placed on the infected gland. Chewing sour candies encourages the flow of saliva. Surgery may be needed to drain the gland.
• Antibiotics do not help cure a viral infection. The body must use its own defense system to clear itself of a virus. Bed rest, increased fluids, and acetaminophen for fever are the best ways to help the body cure itself.
• Small cysts may drain without treatment. Large cysts might need surgery.
• Benign tumors usually require surgical removal. Some are treated with radiation to keep them from coming back.
• Malignant tumors require surgery if possible. Some tumors need surgery only; others require radiation and chemotherapy in addition to surgery. Radiation and chemotherapy are also used for tumors that are inoperable.
• Prescribed medications help decrease dry mouth.

Surgical Treatment :

Parotidectomy

Parotidectomy is the removal of the parotid gland, the largest salivary gland. The paratoid is usually removed because of a tumor, a chronic infection or a blocked saliva gland. Most parotid gland tumors are not cancerous.

The nerve that closes the eyes, wrinkles the nose and moves the lips grows through the middle of the parotid gland. Small branches of the nerve might need to be trimmed if the gland is large and the surgeon cannot remove it. Decreased motion of facial muscles might occur while the nerve recovers from surgery. If facial movement does not completely return, rehabilitation can help restore facial movements.

Surgeons think of the gland as two separate lobes: a superficial lobe and a deep lobe. The facial nerve separates the two lobes. The parotid gland can usually be removed without permanent damage to the facial nerve. A facial nerve monitoring machine, called a facial nerve stimulator, allows the surgeons to monitor the nerve during the operation.

Benign tumors usually need only the superficial lobe removed. But if a benign tumor is deep in the gland, the deep lobe might need to be partially or completely removed.

In most cases, the entire gland is removed if the tumor is cancerous. If the tumor is small and low-grade (does not spread and does not grow quickly), the surgeon might be able to remove only the superficial lobe.

General anesthesia is required for a parotidectomy.

During the operation, the surgeon will determine the amount of tissue that should be removed. After the gland or section is taken, it is sent to a pathologist.

Post surgery: 

• Numbness of the earlobe and incision site from the scar
• Weak face muscles
• Nerves that link to the saliva-producing areas in the parotid gland sometimes link with the nerves that control sweating in the skin. This might cause sweating of the skin at meal time (Frey’s syndrome).
• A rare condition, called a salivary fistula or sialocele, can develop and cause saliva to leak through the skin.

Submandibular Sialadenectomy

A submandibular sialadenectomy is used for chronic infections, stones and tumors. Submandibular gland tumors are often malignant, in which case entire gland needs to be removed.

Sublingual gland surgery

The incision for sublingual gland surgery is through the mouth. No incision is made in the face or neck.

OUR TREATMENT PLAN FOR SALIVARY GLAND SWELLING

OUR TREATMENT PLAN FOR SALIVARY TUMOURS