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WHAT IS A SALIVERY GLAND?

Salivary glands as the name implies are a series of pairs of glands located in various parts of the mouth and neck, that produce saliva. Saliva is important for various functions, such as protection of the oral cavity, maintaining integrity of teeth, taste, digestion of food, and lubricating the mouth.
 

There are three major pairs of salivary glands known as the Parotid gland, Submandibular gland and the Sublingual gland. The parotid gland is situated in the cheek region in front of the ear, whilst the submandibular glands are situated in the upper neck just underneath the ‘angle’ or corner of the jawbone (mandible). The sublingual glands lie on both sides of the floor of mouth just under the tongue. All three major salivary glands send their saliva into the mouth via channels called ducts.

PROBLEMS ASSOCIATED WITH THE SALIVERY GLANDS

 The most common problem associated with the salivary glands is a blockage of the salivary duct. This tends to occur more often in the submandibular gland, and can be caused by either obstruction of the duct due to stones or narrowing the saliva duct due to a stricture. Certain drugs and previous neck radiotherapy  can affect the production of saliva, so a full past medical and drug history will be taken.

Tumours of the saliva glands can occur, especially in the parotid gland. Parotid gland tumours are mostly benign, compared to submandibular or sublingual gland tumours that have a higher risk of cancer. However, because you cannot be certain on the exact nature of a tumour in your salivary glands (i.e. benign versus cancerous) if you notice a lump in your salivary glands, you should see your doctor (GP) on a urgent basis who will make an assessment and decide whether you need to be referred urgently to a head and neck surgeon.

 

SYMPTOMS OF A BLOCKED SALIVARY DUCT

  • Dry mouth (Xerostomia) as a result of reduced saliva production

  • Painful, intermittent swelling of the gland, especially around mealtimes, can result in difficulty eating,

  • Tooth decay

  • Severe blockage can cause the gland to become inflamed and chronically swollen.

  • Presence of a lump (often benign, but may or could become cancerous)

 

DIAGNOSIS

Various diagnostic methods can be employed to determine how best to manage salivary gland disease. Examples include:

  • An X-ray or CT scan- to determine if stones are present inside the gland or duct.

  • Sialogram- A contrast liquid is injected into the salivary ducts, then an x-ray is taken to determine the narrowing of the duct or presence of stones.

  • Ultrasound- sound waves are used to detect the presence of lumps inside the gland. This is the initial investigation of choice because it is readily available and does not involve radiation exposure.

  • Biopsy using a fine needle, is used to determine the nature of the lump by extracting cells for laboratory analysis.

  • Sialoendoscopy- a very fine camera is passed into the saliva duct to visualise the nature of any obstruction.

MANAGEMENT

Salivary gland disease is managed according to the cause.

  1. Salivary gland stones:
    Non-surgical:
    (a) use analgesia, increased fluid consumption, massages to the glands, a warm compress and encourage eating foods that increase saliva production.
    (b) removal of small (less than 5mm) saliva duct stones with a wire basket under x-ray guidance

    Surgical:
    (a) removal of the obstructing saliva duct stone or
    (b) removal of the entire submandibular gland for inflammatory conditions or tumour
    (c) removal of part or all of the parotid gland (most commonly for tumours)

 

Mr Ofo is a very experienced salivary gland surgeon and also uses incisions such as the modified facelift (rhytidectomy) approach which hides the facial and neck scar for parotid gland surgery producing a more favourable cosmetic result compared to traditional techniques.

COMPLICATIONS OF SURGERY

As with any operation, complications can arise and include pain, infection and bleeding at the site of the surgery.

Other recognised complications include;

 

  • Formation of blood clots, abscess or haematoma

  • Facial weakness: temporary or permanent weakness to the lower lip may occur if a nerve close to the submandibular gland is damaged through surgery. Likewise, temporary or permanent weakness to parts of or the entire face may occur if the facial nerve is damaged during parotid gland surgery. Permanent facial weakness is very uncommon, occurring in less than 1% of patients. (Rare if the surgery is performed by a high volume head and neck surgeon).

  • Numbness of the face, ear and/or tongue- may occur following surgery, however this usually improves over time, but facial and ear numbness may be permanent for a small proportion of patients.

  • Frey’s syndrome: excessive facial sweating during eating occurring several months after parotid surgery.

 

AFTER THE PROCEDURE

 

Patients are usually discharged a day after surgery. You may have a small wound drain (plastic tube) in the neck that is removed prior to discharge from hospital. You will be advised to stay off work for a period of two weeks to minimise bleeding or catching an infection. Medication to relieve symptoms of pain will be advised.