Salivary Gland Diseases

Salivary gland diseases encompass a broad range of issues such as stones that obstruct salivary flow, infections, inflammation (sialadenitis), cysts, autoimmune problems (e.g., Sjögren’s), and benign or malignant tumors. These problems may manifest with symptoms like dry mouth, facial swelling, pain, difficulty chewing or swallowing, or a bad taste in the mouth. Quality of life can be significantly improved with early evaluation, accurate diagnosis, and appropriate treatment options; clear and patient-friendly diagnosis and treatment plans can be created for international patients when necessary.

What are salivary gland diseases?

Salivary Gland Stones (Sialolithiasis)

In some cases, thin, calcium-rich stones form inside the salivary glands. The exact cause of these stone formations is unknown. Some stones may form due to the following reasons:

• Dehydration (causes saliva to thicken),
• Reduced food intake (decreases saliva production),
• Certain antihistamines, blood pressure medications, and psychiatric drugs (reduce saliva production),

• Some stones form inside the gland without any symptoms. In other cases, the stone partially or completely blocks the excretory duct. In this situation, the salivary gland swells and becomes painful. Furthermore, the flow of saliva is partially or completely obstructed. This problem can be followed by a salivary gland infection, which is another salivary gland disease.

Salivary Gland Infection (Sialadenitis)

A salivary gland infection is a painful infection usually caused by bacteria. This disease is more common among older adults who have salivary gland stones. Salivary gland infection can also occur in infants within the first few weeks after birth. If an appropriate treatment course is not followed, the condition can turn into a serious infection, especially in the elderly and frail individuals.

Viral Infections

Systemic (occurring throughout the body) viral infections sometimes localize in the salivary glands. This condition causes facial swelling, pain, and difficulty eating. These symptoms are most commonly seen in mumps.

Cysts

Babies are sometimes born with a cyst in the parotid gland, resulting from problems related to ear development. Later, there is a possibility of cyst formation in the salivary glands due to traumatic injuries, infections, salivary gland stones, or tumors.

Benign Tumors (Non-Cancerous Tumors)

Most of these tumors are benign, mostly occur in the parotid gland, and the most common type of discomfort usually appears as a slow-growing, painless swelling just below the earlobe. Radiation exposure and possibly smoking are considered the most important causes of these tumors.

Malignant Tumors (Cancerous Tumors)

Salivary gland cancers are rare. Known risk factors for salivary gland cancer are Sjögren’s Syndrome and radiation exposure. Smoking may also play a role in the development of these types of tumors.

Sjögren’s Syndrome

Sjögren’s Syndrome is a chronic, autoimmune disease. The cause of the disease is the body’s immune system attacking the salivary and tear glands (and in some cases, sweat and oil glands). This disease is mostly seen in middle-aged women.

Nonspecific Salivary Gland Enlargement (Sialadenosis)

In some cases, the salivary glands show enlargement without a known cause and without signs of infection, inflammation, or tumor. This condition most often affects the parotid gland.

What are the symptoms of salivary gland diseases?

Symptoms vary depending on the ailment affecting the salivary glands. Symptoms according to diseases include:

• Painful swelling under the cheek or jaw
• Foul discharge coming from the duct into the mouth
• Fever, chills, and general malaise seen in severe cases
• Fever
• Headache
• Muscle aches
• Joint pain
• Loss of appetite
• Malaise

These symptoms are usually followed by swelling in the parotid glands on both sides of the face. In this case, fully opening the mouth becomes difficult. Cysts cause a painless swelling. This swelling can sometimes be large enough to impede eating. Slow-growing swellings that can sometimes be painful are the most common symptoms of both benign and malignant salivary gland tumors. These swellings; can be found on the tongue or roof of the mouth, under the jaw, and on the cheeks.

The main symptoms of Sjögren’s Syndrome are swelling of the salivary glands and dryness in the mouth and eyes.

Symptoms of non-specific salivary gland enlargement typically manifest as a painless swelling of the parotid glands on both sides of the face.

When should one consult a doctor?

• If there is a persistent lump or swelling anywhere on the neck, jaw, cheek, tongue, or hard palate,
• If the gland is tender, red, and painful,
• If fever and chills are present,
• If there is difficulty opening the mouth, speaking, chewing, and swallowing, a doctor should be consulted.

How are salivary gland diseases diagnosed?

For the diagnosis of these diseases, your doctor will first inquire about your medical history, medications, and eating habits. Your doctor will also ask the following questions:

• Have you previously received radiation for neck cancer treatment?
• Have you had the mumps or been vaccinated against it?
• Have you recently had surgery? (Food intake after surgery can pose a risk of stones and infection)
• Have you recently been in contact with people who have the flu or another viral illness?
• Do you have an autoimmune disorder such as rheumatoid arthritis?

Next, your doctor will examine the head and neck area, including inside the mouth. If you feel pain due to touching during this examination, inform your doctor.

Depending on the symptoms, your doctor may also request the following tests:

• Blood test
• X-ray
• MRI
• Computed Tomography
• Fine Needle Aspiratıon Biopsy
• Sialography
• Salivary gland biopsy
• Salivary function test
• Eye tests

How are salivary gland diseases treated?

Treatment varies depending on the condition:

Treatment for Salivary Gland Stones

If the stone is located at the end of the duct, your doctor may gently press to expel the stone. Stones located deeper can be removed surgically.

Treatment for Salivary Gland Infection

A salivary gland infection can be treated by:

• Taking fluids, either orally or intravenously,
• With antibiotics,
• With a warm compress applied to the infected gland,
• By eating sour, sugar-free candies or drinking orange juice to increase saliva flow.

If the infection cannot be treated by these methods, intervention may be necessary to drain the inflammation.

Treatment for Viral Infections

These infections generally resolve on their own. In this case, the treatment focuses more on eliminating the symptoms. These treatments include:

• Rest
• Plenty of fluid intake
• Taking painkillers and fever reducers

Treatment for Cysts

Small cysts may disappear on their own. Larger cysts can be removed with conventional surgery or laser surgery.

Treatment for Benign Tumors

Non-cancerous tumors are generally removed surgically. In some cases, radiation therapy may be applied to prevent the tumor from recurring.

Treatment for Malignant Tumors

Smaller, early-stage, and low-grade tumors can usually be treated with surgery alone. However, larger, high-grade tumors generally require radiation therapy after surgery. Radiotherapy or chemotherapy is also applied to tumors that cannot be surgically intervened.

Treatment for Sjögren’s Syndrome

Medications that stimulate saliva secretion are given to relieve dry mouth, the typical symptom of the disease. Sugar-free gum may also be recommended to stimulate saliva production. Reducing smoking consumption will also help relieve dryness. Since people with Sjögren’s Syndrome have low saliva secretion, problems frequently occur in the mouth and gums. Therefore, people with this problem should pay attention to oral hygiene.

Treatment for Nonspecific Salivary Gland Enlargement

Treatment aims to address the underlying health problem.

How can salivary gland diseases be prevented?

Mumps and flu vaccines should be administered to protect the salivary glands against viral infections. There is no specific way to prevent other salivary gland diseases. However, the following precautions can help protect against these diseases:

• Avoid smoking.
• Eat a healthy diet.
• Drink 6 to 8 glasses of water a day to prevent dehydration.
• Ensure oral hygiene by brushing your teeth and flossing regularly.