Saliva is produced by three paired “major” salivary glands in the head and neck – Parotid, Submandibular, and Sublingual as well as ~400 “minor” salivary glands throughout your oral cavity and oropharynx. Saliva is usually plentiful (your mouth makes between one pint and one liter per day) and is important in the enzymatic digestion of food, providing an immunologic barrier for dental protection, and to foster ideal oral mucosal health. Salivary glands may be affected by several different disorders that disrupt their important normal function:
Identification and appropriate referral for management of Salivary Gland pathology is important, as treatment is dependent on timely and accurate diagnosis. Imaging studies in the form of ultrasound versus contrasted CT scanning provide information about potential neoplastic versus inflammatory processes. Rapid referral to Otolaryngologists with a special interest in head and neck pathology is imperative for appropriate management.
Inflammation or Infection
Symptomatic management in association with antibiotic therapy (Augmentin vs Clindamycin) is important for management of sialadenitis. In general, the mainstays of therapy relate to appropriate hydration, warm compresses, sialogogues (sour candies to promote salivary flow), and NSAIDs.
Gland Enlargement or Mass
Enlargement of salivary glands in the absence of signs/symptoms of inflammation is concerning for neoplasm or autoimmune disease. Laboratory testing for autoimmunity is often performed in tandem with definitive imaging and/or Fine Needle Aspiration (FNA). Performing FNA may precipitate secondary inflammatory response within the salivary glands, so the benefit of this procedure is weighed against the potential for creating a temporary worsening of symptoms. Alternatives to FNA for a primary salivary gland neoplasm include surgical gland removal. This is a safe, effective, and rapid (< one hour) outpatient procedure to definitively remove the affected gland.
If salivary gland or duct stones are identified on imaging or physical exam findings, intraoral extraction of the stone may be attempted if the stone is palpable, or endoscopic removal (sialoendoscopy) may be performed – akin to removal of kidney stones.
Removal of salivary glands is performed for suspected neoplasm, and is undertaken with careful preservation of surrounding structures, which are vital for normal facial function, speech, and swallow.
Salivary gland neoplasms are characterized as either benign or malignant, and there are multiple pathologies within each class. Overall, the management includes wide local excision of the mass, with preservation of the surrounding nerves, vessels, and muscles, as allowable to obtain negative margins. If there is malignant pathology, adjuvant therapy in the form of cervical lymphadenectomy (neck dissection) with or without postoperative chemoradiation may be required. Otolaryngologists will use the pathology obtained from surgery and present the patient to a multidisciplinary cancer conference (tumor board) for comprehensive management.
Christopher Clark, MD is Board Certified in Otolaryngology – Head and Neck Surgery and is Fellowship Trained in Rhinology and Allergy. He practices with ENT Associates of Alabama.
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