What are the salivary glands?
The salivary glands make saliva and release it into the mouth. A continuous flow of saliva is important for keeping the oral cavity moist, facilitating speech and swallowing, initiating digestion, and protecting the teeth against bacteria and decay.
While there are 600 to 1,000 minor glands scattered throughout the mouth and throat, there are three pairs of larger major salivary glands:
- Parotid glands — located in the upper part of the cheek, near the ear. The duct of each parotid gland empties onto the inside of the cheek, near the upper molars.
- Submandibular glands — located under the jaw. They have ducts that empty behind the lower front teeth.
- Sublingual glands — located beneath the tongue. They have ducts that empty onto the floor of the mouth.
What sort of problems can occur in the salivary glands?
In general, there are three major disorders of the salivary glands: obstruction, infection and tumours.
Obstruction
A salivary duct obstruction can be caused by any blockage of the salivary ducts, but most commonly by salivary stones (sialolithiasis, or salivary gland stones). Salivary stone blockages usually develop in your submandibular salivary gland. Sometimes, an obstruction can be caused by narrowing of the salivary duct (stenosis).
Symptoms
Common symptoms include pain — especially before meals when saliva production increases — swelling in your neck and face, and difficulty swallowing.
Who is susceptible?
Anyone can develop an obstruction; however, the condition predominantly affects adults aged 30 to 60. Men are slightly more at risk than women.
Other factors that may increase susceptibility include dehydration, certain medications (including diuretics, antihistamines and anticholinergic drugs), underlying medical conditions (gout, autoimmune diseases, chronic illnesses, and poor oral health), smoking and radiation therapy.
Diagnosis
A salivary duct obstruction is diagnosed through a combination of your clinical symptoms, a physical examination of your jaw and mouth, and medical imaging (CT, x-rays, ultrasound or sialography).
Treatment
Treatment depends on the cause of your obstruction. Your doctor may suggest you try various home-care treatments first — such as gland massage and the use of saliva-promoting agents known as ‘sialagogues’ (lemon juice is a common example). Antibiotics are sometimes required to cover an infection.
Sometimes, surgery is required. This may involve a sialendoscopy (a long, thin camera inserted into the opening of the gland), which can help visualise the duct, the obstructing stone, and aid in washing out the gland and potentially removing the stone. This technique, however, is suitable for very small stones. Alternatively, your surgeon may surgically remove your salivary gland — this can be required for very large stones, multiple stones, or pathology such as tumours.
When to get help
Contact your GP if your swelling worsens after eating, or if symptoms persist for more than a week. Seek immediate medical attention or visit an emergency room if you develop severe signs of infection, such as pus in your mouth, a high fever, or difficulty breathing or swallowing.
Infection (sialadenitis)
Your salivary glands may become infected by either viruses or bacteria. Your major salivary glands are susceptible to common viral infections such as mumps, flu and Epstein-Barr virus. These typically resolve on their own and can be managed with simple treatments.
When bacteria cause salivary gland infections, they can be more severe. There may be severe pain, swelling, redness, fevers and difficulty eating. Sometimes, an abscess may form.
Salivary gland infections typically affect your parotid and submandibular glands. They are usually not serious. However, treatment is recommended — without treatment, the infection can spread to the deep tissues of your neck and affect your breathing.
Who is susceptible?
Although infections can affect anyone — including infants — the most at-risk groups for salivary gland infections are the elderly and chronically ill people.
Diagnosis
A salivary gland infection (sialadenitis) is diagnosed using a combination of your medical history, physical examination and specialised imaging tests (ultrasound, CT scan or sialography).
Treatment
Treatments vary depending on the cause of your infection. They may include:
- Antibiotics (for a bacterial infection)
- IV fluids — to help with dehydration
- Sialendoscopy — a non-invasive procedure to remove salivary gland stones or open a narrow duct
- Surgery — commonly for impacted stones with recurrent infections
When to get help
Contact your GP if your symptoms worsen or persist for more than a week, or if you develop a fever or pus drainage.
An infection that spreads to your neck tissues can block your airways and is a medical emergency. If you find it hard to breathe, call 000 or go to the nearest hospital emergency centre immediately.
Tumours
Tumours are uncommon abnormal growths that can be benign or malignant. In the salivary glands, they are mostly benign.
Most tumours are in the parotid glands and are benign. They are less commonly in the submandibular glands and rarely in the sublingual glands.
Symptoms
Signs and symptoms of a salivary gland tumour may include:
- Swelling or a lump on or near the jaw, or in the neck or floor of the mouth under your tongue
- Muscle weakness on one side of the face
- Numbness in one part of the face
- Ongoing pain near the salivary gland
- Trouble swallowing
- Trouble opening the mouth widely
Who is susceptible?
Though salivary gland tumours can happen at any age, they most often happen in older adults. Radiation exposure, tobacco smoking, workplace exposure to certain substances (rubber manufacturing, nickel) and viral infections (Epstein-Barr virus, HIV, human papillomavirus) may increase the risk of salivary gland tumours.
Diagnosis
A salivary gland tumour diagnosis typically begins with a physical examination of the area by your doctor. Imaging tests (ultrasound, CT, MRI) and a biopsy may be used to locate the tumour and determine the type of cells involved.
Treatment
Treatment for salivary gland tumours is usually surgical removal. Individuals with salivary gland cancers may need additional treatments, such as chemotherapy, radiation therapy, targeted therapy or immunotherapy.
When to get help
Contact your GP immediately if you notice a new, painless lump in your jaw, cheek or neck — especially if it persists for more than two weeks or grows. Seek urgent medical attention if you experience numbness, facial weakness or difficulty swallowing.
Summary
Salivary gland disorders include stones (sialolithiasis), infections, cysts and tumours. Head and neck assessments also cover thyroid nodules and unexplained neck lumps.
Thorough examination and targeted imaging guide diagnosis and management.
