Michigan Otolaryngology Surgery Associates

SALIVARY GLAND TUMORS

The salivary glands include the parotid glands which are situated in front of the ear, the submandibular glands located under the jaw line, and the sublingual gland which are found along the floor of the mouth under the tongue. Scattered  throughout the cheeks, lips, and palate are minor salivary glands. Fortunately the majority of salivary gland tumors are benign. The most common location for salivary gland tumors is the parotid gland. Salivary gland tumors do not vary in size with meals; salivary gland or salivary duct stone will present with swelling during meal time due obstruction of salivary flow. Salivary gland tumors tend to enlarge slowly and painlessly. Rapidly enlarging, painful tumors may be an infection or may be a cancer.  Any salivary gland swelling should be evaluated by an otolaryngologist; this may involve imaging studies (CT or ultrasound) or a biopsy (fine needle aspiration). If a tumor is identified your surgeon will recommend removal of the salivary gland (ie, parotidectomy) and if in cases of malignancy removal of lymph nodes in the area. Salivary gland stones are treated differently (see below)

SALIVARY GLAND STONES

Salivary gland stones occur most commonly in the submandibular gland and duct. The stones are like small pearls that form over many years due to deposition of calcium and phosphate in the ducts that drain saliva from the gland. When the stones become large enough, they block the flow of saliva and cause painful swelling of the salivary gland during meals. In many cases the stones may pass on their own, however in some cases the duct may be too small to allow passage of the stone(s). There are three techniques to remove stones:

• Dilation of the duct opening
  • This can often be performed in the office with local anesthesia.
• Sialoendoscopy
  • With the patient under general anesthesia, a small scope is inserted in to the duct and the stone is removed using a small retrieval basket. If the stone is not too big (less than 3-5 mm), this technique works well.
  • For patients with a history of recurrent salivary gland swelling without stones, narrowing of the ducts due to scarring is the problem. These areas of narrowing (stenosis) can be dilated with balloons using a technique similar to angioplasty for patients with heart disease. Salivary duct stenosis is often found in patients who have undergone external radiation therapy or radioactive iodine therapy following treatment of thyroid cancer. In many cases there may be no known cause for the stenosis, though it seems to be more common in women after menopause.
• Removal of the gland
  • For large stones unable to be removed using sialoendoscopy, removal of the salivary gland is the final option. Removal of the parotid gland or submandibular gland is performed under general anesthesia and requires an overnight stay in the hospital.