What is normal what is abnormal?
Where are the salivary glands located?
Glands are located around mouth and pharynx. Main salivary glands are parotis (in front of ear), submandibular (under jaw) and sublingual (under tongue) glands.
All secretes saliva into the mouth. Parotis gland secretes around the molar teeth, submandibular gland secretes under the tongue beside two sides of the midpoint, sublingual gland secretes from many small orifices at the base of the tongue.
There are hundreds of very small salivary glands on buccal mucosa, inside of the mouth and pharnx. They secrete saliva that moistures the mouth, help digestion and protects teeth.
What causes abnormal glands?
Clinically abnormal salivary glands are cathegorisied as follows:
Obstruction is seen in parotis and submandibular glands because of sialolithiazis (stone in the glands). Suffering mostly occurs while eating. While eating saliva secretion is increased and gland swells because saliva secretion cannot come out due to obstruction.
If stone(s) are not obstructing totally, the gland swells while eating and then it decreases gradually. At the next eating it recurs. In accumulated saliva microbes can grow easily and infection can superimpose to the swelling. It causes pain, if not treated abscess can occur.
Main canals of the gland may be abnormal in some patients. They can interrupt the saliva flow and cause obstruction and infection.
The most common infection of salivary gland seen in parotis is called “mumps” . It is mostly seen in children but sometimes in adults also. If a swelling occurs in parotis in an adult then main cause probably obstruction or tumor rather than mumps.
Salivary glands can be secondarily infected because of neigbouring infected lymph nodes. These lymph nodes are swollen after upper respiratory infections. Some of these lymph nodes are seen inside of parotis, inside and aroud submandibular gland. Lymhp nodes cause pain and swelling when they are infected. Lymph nodes swell because of tumor also.
Primary tumors of the salivary glands are painless swellings at the beginning. Tumors rarely are more than one. These swellings should be evaluated by ent physicians.
Malign tumors of salivary glands grow quickly, they are painful and can prevent facial muscle movements on the same side. These complaints should be urgently evaluated.
Salivary glands also swell in some special diseases as well. Rheumatic diseases can accompany this. Diabetes mellitus can cause swelling in the salivary glands. In alcoholic patients both sided parotis gland swelling can be seen.
How does your doctor put diagnosis?
Diagnosis can be done by careful history, examination and laboratory tests. If stone is suspected in large salivary glands their orifices can be checked. X-ray examinations can show the place of the stone(s).
If there is a tumor found in salivary glands computerized tomographies and magnetic resonance examinations can be asked.
In many patients fine needle aspiration may help. It has 80-90% accuracy.
Treatment of salivary gland diseases
They are mainly divided into two. Drugs or operation. Treatment choice depends on the diagnosis. If problem is caused by whole body then it should be treated. Consultation with other branches may be needed. If disease is associated with obstruction and infection antibiotics are used. Sometimes we operate the canals.
If there is a tumor in the gland, it should be taken out. Most tumors of the parotid are benign. Facial nerve that innervates the fascial muscles crosses inside of the parotis therefore during the surgery it is very important to preserve the nerve. If the tumor is malignant facial nerve can be preserved mostly. After operation radiation therapy is adviced mostly in malignant tumors.
Same principles are valid for small salivary glands found in the other parts of the mouth. If they are benign only surgery is enough, if they are maligmant radiation therapy is adviced after surgery.
There are many reasons for salivary gland tumors. These diseases can be treated by both drugs and surgery.