SALIVARY GLAND DISORDERS
There are several Salivary Gland disorders. Some Salivary Gland disorders may impede the Salivary Glands from functioning properly while other Salivary Gland disorders may affect one’s overall health. Most of the Salivary Gland disorders are cause by Salivary Gland Stones, infection, cysts and tumors.
SALIVARY GLAND STONES (SIALOLITHIASIS)
Deposits of calcium within the Salivary Glands can result in the formation of Salivary Gland Stones (Sialolithiasis). Salivary Gland Stones are most often found in the Submandibular Glands, but the Parotid Glands are also commonly affected. The exact cause of calcium deposition and Salivary Gland Stone formations is unknown. However, it is known that dehydration, which results in thickened saliva, increases the risk of stone formation. In addition, reduced food intake and certain medications also result in reduced saliva production, thus increasing the risk of stone formation.
- Symptoms: Salivary Gland Stones commonly occur in the Submandibular and Parotid Glands, resulting in the obstruction of the flow of saliva. Symptoms typically occur while eating. Saliva production starts to flow with eating, but cannot exit the gland, and thus leads to pain and swelling of the involved gland. Often, the swelling gradually subsides, only to swell again with the next meal. Occasionally, an infection can develop in the pool of blocked saliva, leading to more pain and swelling in the glands.
- Diagnostic Studies: A stone may be diagnosed based on the presenting symptoms and physical examination and palpation of a stone in the gland by the physician. A CT scan can be used confirm the diagnosis.
- Treatment:The goal of treatment is to remove the stone. Often, the stone can be flushed out by increasing the flow of saliva with sour candy or citrus foods (which stimulate the flow of saliva) combined with increased fluid intake and massaging the gland. If this fails, stones that are near the outer most portion of the duct can be squeezed out by a physician. In some cases, the stone may need to be surgically removed. Stones that are deep in the gland may require the entire gland to be removed.
SALIVARY GLAND INFECTION (SIALADENITIS)
Salivary Gland Infection in adults is often due to obstruction of the gland (by a stone or tumor), poor oral hygiene or dehydration. The infections in adults are usually caused by bacteria.
- Symptoms Infection results in a painful swelling of the gland involved. There is often redness of the overlying skin and it is not uncommon to have fever.
- Diagnostic Studies Salivary Gland Infections are usually diagnosed based on the presenting symptoms and physical examination. Culture of the pus from the gland’s duct can be sent to identify the type of bacteria causing the infection. In addition, a CT scan or ultrasound may be done to rule out an abscess. If the symptoms persist, imaging of the neck is usually recommended to rule out an underlying source for the infection (such as a stone or tumor).
- Treatment Bacterial infections respond well to antibiotics, warm compresses to the affected area and increasing salivary flow in order to flush out the infection. The flow of saliva can be increased with sour candy or citrus foods combined with increased fluid intake and massaging the gland. If there is an abscess, surgical drainage or aspiration is often required. The Salivary Gland may scar with recurrent infections, resulting in permanent narrowing of the gland’s drainage ducts. Patients that develop such narrowing of the gland’s drainage ducts may develop chronic or recurrent infections that may not respond to antibiotics. Surgical removal of the gland is recommended in patients with recurrent or chronic infections that fail to resolve with antibiotic therapy.
SALIVARY GLAND CYST (SIALOCELE, MUCOCELE, ORAL RANULA AND CERVICAL RANULA):
Salivary Gland Cysts occur as the result of trauma or obstruction to the Salivary Gland excretory duct and spillage of saliva into the surrounding soft tissue. The blocked duct does not allow the saliva to exit into the mouth. The saliva, therefore, gets backed up in the gland and results in the enlargement and ballooning of the gland. Salivary Gland Cysts can be classified as Sialocele, Mucocele, Oral Ranula, and Cervical Ranula.
- Sialocele Sialoceles are cysts of major Salivary Gland origin. Sialoceles are painless swellings of a major salivary gland.
- Mucocele Mucoceles are cysts of minor Salivary Gland origin. Mucoceles are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size.
- Oral Ranula Oral Ranulas are painless cysts that occur in the floor of the mouth and usually involve the major Salivary Glands. They do not extend beyond the mouth. Oral Ranulas usually present with swelling in the floor of the mouth that is painless. On occasion, they can interfere with speech or chewing.
- Cervical Ranula Cervical Ranulas (also known as Plunging Ranulas) are cysts that occur in the floor of the mouth and extend (plunge) into the neck. Cervical Ranulas usually present as a painless swelling in the neck.
Mucoceles are cysts of minor Salivary Gland origin. Mucoceles are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size.
DIAGNOSTIC STUDIES:
Simple cysts and Mucoceles are usually diagnosed with a physical examination and rarely require further diagnostic testing. Imaging of the head and neck by CT scanning or an MRI is recommended to determine the extent of a Cervical Ranula and to eliminate other disease processes prior to surgical intervention.
TREATMENT
Occasionally, Salivary Cysts spontaneously resolve, especially in infants and young children. Although aspiration of Salivary Cysts does deflate them, this is temporary and almost all cysts return after aspiration. Small and asymptomatic Salivary Cysts can be observed.
- Sialoceles Asymptomatic Sialoceles can be observed. However if Sialoceles become symptomatic (obstruct salivary flow or get infected) or become cosmetically noticeable, surgical excision is recommended. Surgical excision usually involves removal of the Salivary Gland that contains the Cyst (see below).
- Mucoceles If the Mucocele is small and superficial, it may respond to topical steroid treatment. Larger Mucoceles require surgical removal for definitive treatment.
- Oral Ranulas The preferred method of treatment of Oral Ranulas is complete excision of the Ranula and the associated sublingual gland. Drainage, marsupialization and excision of the Ranula without the excision of the associated sublingual gland results in a high rate of recurrence of the Ranula.
- Cervical Ranulas The preferred method of treatment of Cervical Ranulas is the complete surgical excision of the oral portion of the Ranula with the associated sublingual Salivary Gland and drainage of the cervical cyst. The most important factor in surgical management for Cervical Ranulas is removal of the responsible major Salivary Gland.