Salivary Gland Pathologies

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Types of salivary glands

The salivary glands produces saliva that helps in hydrating the soft tissues of our mouth, protects teeth from cavities or decay and to digest food. The three major salivary glands are the submandibular gland, parotid gland, and sublingual glands. Saliva exits and drains into the oral cavity through small tubes called salivary ducts.

The most common problems in the salivary gland occurs when these salivary ducts gets blocked by physical or reactionary products and saliva cannot drain.

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Problems with the ducts

Sialolith also called as salivary stones is a condition in which tiny salivary stones are formed in the glands or its ducts. The stones are made of calcium. They do not cause any symptoms, but some block the ducts and does not drain ant saliva that leads to severe pain and dry mouth. The saliva flow is either stopped completely or partially. The gland might enlarge and an infection will develop.

Sialadenitis is a infection of a salivary gland caused by Staphylo or Streptococcus, Haemophilus influenzae or anaerobic bacteria which is painful. This is commonly seen in elderly people who have salivary gland stones, but children can develop during the first few weeks of life. It can turn into severe infection if not treated properly on time.
Viral infections such as mumps, flu, Coxsackie viruses, cytomegalo virus and echovirus can enlarge the salivary glands.
Cysts can develop in the salivary glands after injuries, infections, stones or tumors or due to unknown reasons.
A mucocele, is a cyst that is formed on inside of the lower lip, that contains yellow mucous. They can hinder eating, speaking or swallowing.
Tumors – Most salivary tumors are noncancerous. The Most common salivary tumors grow and affect the parotid glands.
Pleomorphic adenomas are the most common parotid tumor seen majority in women. It is benign and grows slowly. It begins as a painless swelling at the back of the jaw, right below the earlobe. They also affect the submandibular gland and minor salivary glands.
Warthin’s tumor ,  is another benign condition of the parotid gland that ranks second to pleomorphic. More common in older men.
Malignant tumors are rare in the salivary glands and usually occur above elder ages. They grow either fast or slow-growing.
Sjögren’s syndrome is chronic disease. White blood cells attack the liquid glands such as the salivary glands, the tear-producing glands, and sometimes the sweat and oil glands. Middle-aged women are most affected. Frequently seen in people who have rheumatoid arthritis, lupus, polymyositis.
Sialadenosis is a painless growth of the salivary gland without any known cause or reason. The parotid is usually the most commonly affected gland.

Causes & Risks ?

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

Investigations :

  • An X-ray, CT scan or MRI to look for stones or tumors
  • A fine needle biopsy (FNAC) 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. It can be removed by finger pressure by your doctor by pressing on it if the stone is close to the opening of a duct.
  • Ultrasound waves – to shatter large stones into small pieces.
  • Deep or large stones are more difficult – requires the entire salivary gland may need to be removed.
  • Bacterial infections require antibiotics and mouth washes. Warm compresses are placed on the gland. Chewing sour candies will help in good flow of saliva.
  • Viral infections require antiviral drug therapy, Bed rest, increased fluids, and paracetamol for fever are the best ways to help the body cure itself.
  • Cysts : Small cysts may drain without treatment. Large cysts might need surgery.
  • Prescribed medications help during conditions like dry mouth or its syndrome.
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  1. Parotidectomy

Parotidectomy involves the removal of the some or entire part of the parotid gland, the largest salivary gland. It is removed for reasons such as tumor, a chronic infection or a blocked saliva gland. Not all tumors are cancerous.

Facial nerve, the helps in movements of the eye, lip chin, lips and forehead lies near the gland. There are high chances that this nerve gets affected temporarily or permanently during the course of surgery. Facial nerve physiotherapy is followed after surgery to help in recovery of the nerve function

The gland has 2 separate lobes : a superficial lobe and a deep lobe. The facial nerve separates the two lobes. We are equipped with a facial nerve stimulator, that allows the surgeons to monitor the nerve during the operation.

Decision of removal of the entire lobe or only a part of it is based on the benign or cancerous condition of the gland which is confirmed on the basis of biopsy report.

Post surgery:

  • Numbness of the entire operated region, earlobe and incision site from the scar
  • Weak and improper or no movements of face muscles
  • Nerves that helps to produce 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 during chewing or eating (Frey’s syndrome).
  • Salivary fistula or sialocele, may develop and cause saliva to leak through the incision sssite on the skin.
  1. Submandibular Sialadenectomy

A submandibular sialadenectomy is used for chronic infections, stones and tumors. Submandibular gland tumors are mostly malignant, in which the entire gland will be removed.

In this procedure the gland is approached from outside of the skin through the skin creases and the entire gland along with lymph nodes are removed.

  1. Sublingual gland surgery

The subingual gland is approached from inside the mouth as it is a small gland. Mostly in cases of mucocele or retention cyst or salivary stones, this gland is completely removed, even done under local anaesthesia.



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