Tiny Salivary Glands Big Problems How We Treat These Painful Disorders

Most of the time, people don’t notice their salivary glands. They are located in the mouth and throat, and they produce saliva. We start to notice these glands if a stone or tumor develops and blocks the flow of saliva. When that happens, they can become swollen and painful and can interfere with hydration, digestion and dental hygiene.

Salivary stones and tumors can range in size from smaller than a marble to larger than a golf ball! While the vast majority of salivary gland tumors are not cancerous, some continue to enlarge and can develop into cancer if left untreated. We treat a range of salivary gland conditions, including:

• Chronic inflammation or infection, called sialadenitis
• Parotid gland and submandibular gland tumors, either cancerous or benign
• Salivary gland stones, called sialolithiasis
• Salivary tumors

Let’s take a look at the risk factors and symptoms of salivary gland diseases and how we treat them.

LISTEN: Dr. Pierce discusses salivary gland diseases in the Medical Intel podcast.

Risk factors and behavior of salivary gland disorders

We don’t know why some people develop salivary stones or tumors. However, we know some behaviors are associated with them:

• Not drinking enough fluid
• High calcium levels
• Smoking
• Previous radiation or radioactive iodine treatment for thyroid cancer

Salivary gland tumors can occur in young people, but they are found most commonly in patients in their 40s and older. Often, the condition is discovered when the patient is getting imaging such as an X-ray for an unrelated reason. If the tumors are not treated early, they can continue to enlarge over time and can potentially lead to cancer.

Salivary gland conditions behave differently from patient to patient. A stone or tumor:

• May appear and get better—even go away—then come back
• May cause no noticeable symptoms
• May be quite painful

Because we don't know exactly why stones develop in salivary glands, our best recommendation to prevent them is to stay well-hydrated. We can provide mouthwashes and medications to patients who have dry mouth to help improve saliva production before or after treatment for a salivary gland disease.

Treatment for salivary gland diseases

Patients used to undergo invasive surgeries to remove salivary stones, or even the glands themselves. Today, we have a minimally invasive procedure called sialendoscopy, in which we use scopes with miniaturized instruments that can fit into the larger salivary glands. We use these tools to look for narrowing (stricture) of the ducts, as well as stones and other abnormalities. Then we use the tools to remove small stones from inside the salivary glands.

Sialendoscopy is a relatively straightforward and low-risk procedure, typically done with the patient asleep for comfort but sometimes can be done with the patient awake. Patients who have the procedure for a stricture or stone usually can go home the same day, whereas a hospital stay is usually required if the gland is removed for a tumor or other reason via an open procedure. However, sometimes a patient may be able to go home sooner than expected. For example, I had a patient who had a tumor of his parotid gland, and he elected to undergo surgery to remove the gland. He was able to go home the first day after surgery, and he is extremely happy with his result.

While we use minimally invasive techniques whenever possible, removal of some larger salivary gland stones usually is performed with open surgery under general anesthesia, which requires a small, discrete incision in the neck or right in front of the ear. Patients who have salivary gland cancers sometimes require further treatments in addition to surgery, including radiation and/or chemotherapy.

Salivary gland disease treatment has come a long way. Advanced treatments allow us to care for a wide range of patients with more minimally invasive options than ever before. The key, as in many conditions, is early diagnosis and treatment. The earlier we can intervene, the faster a patient can experience a better quality of life.