Head and Neck Surgery

About Salivary Gland Disorders

The salivary glands consists the following:

  • Parotid gland (paired)
  • Submandibular gland (paired)
  • Sublingual gland (paired)
  • Minor salivary glands of the oral cavity and pharynx

A variety of conditions may affect the salivary gland including:

  • Stones of the salivary ducts (sialolithiasis)
  • Infection of the salivary glands (sialoadenitis)
  • Benign salivary gland tumours
  • Salivary gland cancers
  • Inflammatory disorders of the salivary glands

Symptoms and signs

  • Salivary gland swelling: This may happen suddenly e.g. from salivary duct obstruction due to stones or may develop gradually e.g benign tumours
  • Pain: Pain is usually associated with infection or sudden onset swelling as when the duct becomes obstructed with stones

Assessment

X ray – large salivary stones can be identified on simple X ray

  • CT, MRI and ultrasound of the salivary glands may be required to obtain more detailed information e.g. about tumours in the salivary gland, small stones that cannot be seen on X ray
  • Fine needle aspiration cytology  (FNAC) – sampling and microscopic examination of the cells from the tumour to differentiate benign tumours from cancers and may allow the pathologist to distinguish between the different types of benign tumours or cancers.

Treatment and Management

  • Antibiotics for infections
  • Removal of stones from the duct. This can be performed directly if the stone is close to the exit of the duct. For stones that are deeper, very narrow endoscopes can be inserted through the duct opening to visuallse and remove them (sialendoscopy). Stones that lie within the salivary gland and continue to cause pain, swelling or infection may require complete removal of the affected gland.
  • Salivary gland tumours require surgery to remove the tumour and part or all of the salivary gland tissue in which it is located. This is done to ensure that all of the tumour is removed and to allow the excised tissue to be examined microscopically so that a confirmed diagnosis of the tumour can be made by a pathologist.
  • The treatment of salivary gland cancers will require further investigations to determine the stage of disease. Additional treatment, including further surgery, radiotherapy, and even chemotherapy, may be recommended depending on the type of tumour and the stage.