Salivary Gland Disorders
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The exact cause of these stones is unknown. Some stones may be related to:. Medications that decrease saliva production, including certain antihistamines, blood pressure drugs and psychiatric medications. Some stones sit inside the gland without causing any symptoms. In other cases, a stone blocks the gland's duct, either partially or completely. When this happens, the gland typically is painful and swollen, and saliva flow is partially or completely blocked.
This can be followed by an infection called sialadenitis. Sialadenitis infection of a salivary gland. Sialadenitis is a painful infection that usually is caused by bacteria. It is more common among elderly adults with salivary gland stones. Sialadenitis also can occur in infants during the first few weeks of life. Without proper treatment, sialadenitis can develop into a severe infection, especially in people who are debilitated or elderly. Viral infections.
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Systemic whole-body viral infections sometimes settle in the salivary glands. This causes facial swelling, pain and difficulty eating. The most common example is mumps. Cysts tiny fluid-filled sacs. Babies sometimes are born with cysts in the parotid gland because of problems related to ear development before birth. Later in life, other types of cysts can form in the major or minor salivary glands. They may result from traumatic injuries, infections, or salivary gland stones or tumors. Benign tumors noncancerous tumors.
Salivary Gland Disease and Tumors
Most salivary gland tumors occur in the parotid gland. The majority are benign. The most common type of benign parotid tumor usually appears as a slow-growing, painless lump at the back of the jaw, just below the earlobe. Risk factors include radiation exposure and possibly smoking. Malignant tumors cancerous tumors. Salivary gland cancers are rare. They can be more or less aggressive.
The only known risk factors for salivary gland cancers are Sjogren's syndrome and exposure to radiation. Smoking also may play some role. Sjogren's syndrome. Sjogren's syndrome is a chronic autoimmune disorder. The body's immune defenses attack different parts of the body, including the salivary glands, the lacrimal glands glands that produce tears , and occasionally the skin's sweat and oil glands. Most people with this disease are women who first develop symptoms during middle age.
In about half of cases, the illness occurs together with rheumatoid arthritis, systemic lupus erythematosus lupus , scleroderma or polymyositis. Sialadenosis nonspecific salivary gland enlargement. Sometimes, the salivary glands become enlarged without evidence of infection, inflammation or tumor.
This nonspecific enlargement is called sialadenosis. It most often affects the parotid gland, and its cause remains unknown. The most common symptom is a painful lump in the affected gland. Pain may worsen during eating. These symptoms are followed by swelling in the parotid glands, usually on both sides of the face.
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It may difficult to fully open the mouth. Cysts — A cyst causes a painless lump. It sometimes grows large enough to interfere with eating. Tumors — A slow-growing lump is the most common symptom of both cancerous and noncancerous salivary gland tumors. The lump is sometimes painful. This lump may be found in the cheek, under the chin, on the tongue or on the roof of the mouth. Sjogren's syndrome — The main features of Sjogren's syndrome are swelling of the salivary glands, dry eyes and a dry mouth. Sialadenosis — This condition typically causes painless swelling of the parotid glands on both sides of the face.
Have recently been hospitalized for surgery. Decreased intake of food and liquids after surgery can increase the risk of salivary gland stones and infections. Next, your doctor will examine your head and neck, including the area inside your mouth. The doctor will press gently on areas of your cheeks to feel for swelling of the parotid gland.
He or she also will feel under your jaw for enlarged salivary glands. Tell your doctor if there is any tenderness during the exam.
Depending on your symptoms, history and physical findings, the doctor may order one or more of the following tests:. Blood tests. To look for a high white blood count that would suggest a bacterial infection. Other blood tests might include testing for Sjogren's syndrome, nutritional deficiencies and viral infections.
These tests can detect tumors and stones that are not visible on X-rays. Fine-needle aspiration. This test uses a thin needle to remove cells from the salivary gland to determine whether a tumor is cancerous. Dye is injected into the gland's duct so that the pathways of saliva flow can be seen. Salivary gland biopsy. Patients with sialolithiasis typically present with postprandial salivary pain and swelling. They may have a history of recurrent acute suppurative sialadenitis.
On examination, bimanual palpation along the course of the duct may reveal the stone. Ultrasonography and non—contrast-enhanced computed tomography are accurate in detecting the stone Figure 4. Non—contrast-enhanced computed tomography of the neck showing a salivary stone in the left parotid duct arrow with postobstructive ductal dilatation.
Initial management consists of treating any acute infection, followed by surgical removal of the stone Figure 5. The surgical approach depends on the location of the stone. Submandibular stones that can be palpated and are located in the anterior floor of mouth can be excised intraorally, usually under local anesthesia.
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Submandibular stones near the hilum of the gland may require gland excision. Stones in the parotid duct are more difficult to manage and may require parotidectomy. An alternative to open surgery is sialendoscopy, 18 , 19 wherein a small 0. Several studies have demonstrated its superiority over open surgery in stone clearance, symptom resolution, gland preservation, and safety.
The parotitis is characterized by local pain and edema, as well as otalgia and trismus. Most cases are bilateral, though it commonly begins on one side. Diagnosis is confirmed through viral serology. Treatment involves supportive measures, including hydration, oral hygiene, and pain control. Edema typically resolves over several weeks. Human immunodeficiency virus—associated salivary gland disease involves diffuse cystic enlargement of the major glands.
It presents with a gradual, nontender enlargement of one or more of the major salivary glands, with the parotid being the most commonly affected. Imaging generally demonstrates multiple low-attenuation cysts and diffuse lymphadenopathy. Management involves antiretroviral therapy, oral hygiene, and sialagogues. Benign neoplasms of the salivary glands typically present as painless, asymptomatic, slow-growing neck or parotid masses Figure 6. The most common salivary gland neoplasms in children are hemangiomas, lymphatic malformations, and pleomorphic adenomas.
In adults, pleomorphic adenoma is the most common salivary gland neoplasm. With some tumors, particularly pleomorphic adenomas, there is a risk of malignant transformation over time; thus, these radioresistant tumors are typically surgically resected. Contrast-enhanced computed tomography of the neck showing expansion of the left submandibular gland by a benign-appearing tumor arrow. Surgical excision confirmed a pleomorphic adenoma. Both types typically present as a painless mass in the gland.
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Patients who present with nonacute facial weakness should have the parotid gland evaluated with examination and imaging. If a mass is identified, prompt referral to an otolaryngologist is indicated. Pleomorphic adenoma. Most common tumor; usually found in parotid gland; may undergo malignant transformation, so excision is advised.
More common in older men; associated with smoking; may be multifocal or bilateral. Mucoepidermoid carcinoma. Tends to invade nerves; higher incidence of facial weakness; may recur years after treatment. Information from references 28 and Malignant parotid gland tumor with fixation and inflammation of the overlying skin. The most common histologic types of malignant salivary gland tumors are mucoepidermoid and adenoid cystic carcinomas.
Most salivary gland malignancies are treated surgically, so prompt referral is recommended when one is suspected Table 4. Data Sources : A PubMed search was completed in Clinical Queries using the key terms salivary gland tumors, sialadenitis, and sialolithiasis. The search included systematic reviews, meta-analyses, reviews of clinical trials and other primary sources, and evidence-based guidelines.
Search dates: May 18, , and January 14, Already a member or subscriber? Log in. Address correspondence to Kevin F. Medical Dr. Reprints are not available from the authors. Epker BN. Obstructive and inflammatory diseases of the major salivary glands. Stenner M, Klussmann JP. Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved.
Eur Arch Otorhinolaryngol. Inflammatory disorders of the salivary glands. Cummings Otolaryngology Head and Neck Surgery. Philadelphia, Pa. McQuone SJ. Acute viral and bacterial infections of the salivary glands.
Salivary Gland Disorders - Ear, Nose, and Throat Disorders - MSD Manual Consumer Version
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What to know about salivary gland infections
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