Salivary Gland Surgery
he salivary glands are exocrine glands that secrete saliva through ducts. Humans have three paired major salivary glands and hundreds of minor salivary glands (lining the mucous membranes). The major salivary glands are the sublingual (below the front of the tongue), the submandibular (underneath the mandible) and the parotid glands (behind the mandible and under the ear). Saliva lubricates your mouth and throat, protects your teeth against bacteria and aids in digestion of food.
There are different diseases that may occur in salivary glands
* Sialoliths (ductal stones)- blocks salivary ducts. Causes a painful, swollen gland.
* Sialadenitis (infection of gland)- viral infections like mumps or bacterial infections.
* Cysts- develop due to trauma, infections, tumors or congenital.
* Tumors that may be benign (noncancerous) or malignant (cancerous).
* Sjogren’s disease- an autoimmune disease that destroys salivary glands.
* Drooling- not a primary salivary gland disease, but treatment targeted at glands.
Stones that form in ducts (especially the submandibular) obstruct the flow of saliva, with a buildup and swelling of the gland. Swelling is usually on and off and in a single gland. If left it will become infected. The main treatment is removing the stone (blockage) or if this is not possible, surgical removal of the whole gland.
Viral infections of the glands (like in mumps) cause swelling of the major glands (especially the parotids). This gives the typical “chipmunk” appearance.
Bacterial infections of the glands (commonly the parotid) causes swelling, redness, pain and fever. Pus may drain from the opening of the duct. Appears commonly with stones.
Blockage of the opening of minor or major salivary glands, with the buildup of saliva and formation of a cysts. These cysts may be congenital or due to secondary causes like trauma, infections, stones or tumors.
Tumors may be benign or malignant. They can originate in both major as well as minor salivary glands. Most tumors develop in the parotid gland (65%). Most tumors in the parotid are benign (75%). Most tumors (80%) in the minor salivary glands are malignant. Pleomorphic adenomas are the most common benign tumors. Tumors are usually treated surgically, although radiotherapy may be added after surgery.
In certain patients, their own immune system gets “confused” and attacks part of their own bodies. This is called an autoimmune disease. The salivary and other secretory glands can get damaged from this chronic inflammation, causing dry eyes, nose, mouth and throat. Treatment consists of rheumatological and supportive management.
In patients with decreased tongue and oral function (cerebral palsy), saliva leaks through the mouth. Treatment consists of Botox injections into the submandibular glands or surgical repositioning of the submandibular ducts, to drain into the back of the throat. The Botox works in 50% of patients and needs to be given every few months. The surgical option is once off.