SALIVARY GLAND SURGERY SINGAPORE

Salivary Glands

What are major salivary glands?

These are paired glands that are responsible for producing saliva which drain into the mouth through small tubes called ducts.

  • Parotid glands
  • Submandibular glands
  • Sublingual glands

Minor salivary glands are found in the lips, within the inner lining of the cheeks and throughout the mouth and throat.

Types of salivary gland problems

  • Salivary stones or sialoliths
  • Salivary gland infection or sialadenitis
  • Viral infection (mumps)
  • Tumors (benign or cancerous)

Salivary stones usually affect the submandibular gland more than the other glands because of the more viscous saliva that is produced as well as the drainage of the duct. It usually presents with intermittent painful swelling of the gland under the jaw especially during meal times. Occasionally, a stone may be seen or felt under the tongue as shown in the photo.

Salivary stones or sialoliths
Stone in the submandibular gland duct orifice

Salivary gland bacterial infection usually present as a persistent swelling and pain affecting the gland. There is usually localized redness over the swelling and associated with fever. Occasionally the patient may experience difficulty in opening the mouth widely. Intravenous antibiotics and surgery are urgently needed to treat the infection, relieve the swelling and prevent further complications.

Submandibular gland abscess
Submandibular gland abscess

Viral infections usually affects the glands on both sides of the neck or face and is associated with fever. Mumps is a common example while other infections include Epstein-Barr virus (EBV), cytomegalovirus (CMV), Coxsackievirus and Human Immunodeficiency virus (HIV)

Salivary gland tumours may be divided into non-cancerous (benign) and cancerous. The majority of parotid gland tumours are benign such as Warthin’s tumour and pleomorphic adenoma while tumours of the submandibular and sublingual glands tend to be cancerous. Many different types of salivary gland cancers exist. Knowing the type of cancer helps your doctor in determining which treatment options are best.

Submandibular gland mass
Submandibular gland mass
Parotid gland mass
Parotid gland mass

Symptoms of salivary gland problems

  • A mass or swelling behind or under the jaw
  • Painful swelling when eating
  • Difficulty swallowing
  • Difficulty opening the mouth widely

Risk factors for salivary gland problems

  • Chronic smoking
  • Inadequate fluid intake (chronic state of dehydration)
  • Poor oral health
  • Older age

Diagnosis

Your head and neck surgeon will examine the mass and any associated masses in the oral cavity and neck region. A bedside ultrasound is most helpful in evaluating the salivary gland mass and other associated masses for the size and features that may suggest a cancerous growth. At the same time, a fine needle biopsy can be performed to determine what kinds of cells are involved and whether they are cancerous.

Additional imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT) are generally necessary for a more accurate evaluation of the size and location of the mass as well as the surrounding tissues and organs.

Salivary gland surgery

Salivary gland conditions generally require surgical treatment. For acute bacterial infections, surgical drainage is needed expediently. For all other masses and growth, a comprehensive evaluation to determine the type of growth is necessary followed by surgery to remove it. Surgery may include:

  • Removing the stone(s) from the salivary gland duct
  • Removing a portion of the affected salivary gland: this is usually adequate surgery for benign tumors
  • Removing the entire salivary gland: if the tumour is large or cancerous. If the tumour is extending into nearby structures such as facial nerve, muscles, bone or skin, these will be need to be removed together.
  • Removing lymph nodes in the neck: if the tumour is cancerous and there is a risk that the cancer has spread to the lymph nodes
  • Reconstructive surgery: if bone, skin or nerves are removed during your surgery, these may need to be repaired or replaced with reconstructive surgery.

Salivary gland surgery can be difficult because several important nerves are located in and around the glands. For example, a nerve in the face that controls facial movement runs through the parotid gland. Removing tumors that involve important nerves may require stretching or cutting the nerves. This can cause partial or complete paralysis of your face (facial droop) that can be temporary or, in some situations, permanent. Surgeons take care to preserve these nerves whenever possible. Sometimes severed nerves can be repaired with nerves taken from other areas of your body or with processed nerve grafts from donors.

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