Salivary Gland Surgery

 

Saliva, produced from saliva glands, helps your body to digest food, protect your teeth against bacteria and keep your mouth saturated.  The majority of saliva comes from your parotid, submandibular and sublingual glands.  In addition, 600 – 1,000 small salivary glands are situated in the lips, lining of the mouth and throat and the inner cheek.  When problems occur with the glands, salivary gland surgery may be required.

 

The most common problems in the salivary glands occur when the tubes become blocked and saliva cannot drain.  These blocked glands can result in painful symptoms.  The three main glands include:

 

The Sublingual Glands

These are the smallest of the salivary glands, making up just 5% of saliva that drains into the floor of the mouth.  Situated either side of your tongue in the floor of the mouth, saliva drains from them using a number of small tubes that open on the inside of the mouth, underneath the tongue.  The most frequent reason for removing a sublingual gland is blockage in these drainage tubes.

 

The Submandibular Glands

These are the second largest salivary glands making up 70% of the saliva that drains into the mouth from under the tongue and is located below the jaw.  Saliva drains from them through a tube that opens on the inside of the mouth under the tongue, immediately behind the lower front teeth.

 

The Parotid Glands

These are the largest of the salivary glands located in front of your ears and making up 25% of the saliva that drains into the mouth near the upper teeth.  Your facial nerve, which controls the muscles in your face, runs through your parotid glands.  These muscles control actions such as raising your eyebrows, closing your eyelids, and smiling.

 

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Causes and Symptoms

When there is a problem with the salivary glands, you may experience symptoms such as the salivary gland swelling, a dry mouth, pain, fever and a foul-taste in your mouth.  Many different problems can interfere with the function of the salivary glands or block the ducts so they cannot drain saliva.  Common salivary gland problems may include:

 

Salivary Gland Stones (Sialoliths)

The salivary gland stones may not cause any symptoms as they are forming, until they reach a size that can block the flow of saliva resulting in pain, swelling or discomfort.  Stones form when chemicals in the saliva gather in the duct or gland. When the salvia is unable to exit through the ducts, it backs up into the gland, causing swelling and pain. Pain is usually periodic, felt in one gland that progressively gets worse. The gland is likely to become infected if the blockage is not cleared.  Salivary stones are rarely a cause for concern, and can often be cleared with home remedies. However, some stones may require treatment.  Symptoms of salivary gland stones may include:

 

• Pain when eating
• A painful lump under the tongue

 

Salivary Gland Infection (Sialadenitis)

Bacterial infection of the salivary gland, most commonly the parotid and submandibular gland, may develop when the duct into the mouth is blocked.  Sialadenitis produces a painful lump in the gland, along with foul-tasting pus draining into the mouth.

 

Sialadenitis is more common in adults with chronic illness and older adults with salivary stones, but it can also occur in babies during the first few weeks after birth. If left untreated, salivary gland infections can result in severe pain, high fevers, and abscesses.  People can contract a salivary gland infection from having a reduced saliva flow due to medical conditions, poor oral hygiene, dehydration or a blockage in their salivary gland such as a tumour or salivary gland stone, which may result in inflammation, causing the glands to be more vulnerable to infection.  Symptoms of a salivary gland infection may include:

 

• Lump in your cheek or under your chin
• Pus that drains into your mouth
• Foul-smelling pus
• Fever

 

Cysts

Cysts can grow in the salivary glands if wounds, infections, tumours, or salivary stones block the flow of saliva. In some cases, babies may be born with cysts in the parotid gland caused by a problem with the development of the ears.  Cysts can resemble a blister and may interfere with eating and speaking.  Symptoms of a cyst in the salivary gland may include:

 

• Yellow mucus that drains when the cyst bursts
• Difficulty eating
• Difficulty speaking
• Difficulty swallowing

 

Tumours

Various types of tumours can affect the salivary glands.  They can be cancerous (malignant) or noncancerous (benign).  The tumour is usually painless and grows slowly.  Pleomorphic adenomas are benign and occur more often in women.  They are most commonly found in the parotid glands, but can also affect the submandibular and minor salivary glands.  Warthin’s tumour is more common in men than women and is benign.  It affects the parotid gland, growing on both sides of the face.  Symptoms of a tumour in the salivary gland may include:

 

• Swelling in your mouth, cheek, jaw, or neck
• Pain in your mouth, cheek, jaw, ear, or neck
• A difference between the size and shape of the left and right sides of your face or neck
• Numbness in a section of your face
• Weakness of the muscles on one side of your face
• Difficulty opening your mouth widely
• Liquid draining from an ear
• Difficulty swallowing

 

Sjögren’s Syndrome

Sjögren’s syndrome is a common autoimmune disease.  It occurs when white blood cells attack healthy cells in moisture-producing glands, such as the salivary or sweat glands, causing dry mouth and eyes.  This disease most commonly affects women with autoimmune disorders, such as lupus.  Symptoms of Sjögren’s syndrome may include:

 

• Dry mouth
• Dry eyes
• Tooth decay
• Sores in the mouth
• Joint pain or swelling
• Dry cough
• Unexplained fatigue
• Swollen salivary glands
• Frequent salivary gland infections

 

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Diagnosis

Your doctor will recommend tests based on a physical examination and your medical history.  Some cases are easy to diagnose based on your history and physical examination, therefore your doctor may be able to make a diagnosis without further diagnostic tests.

 

However, your doctor may want to see the obstruction to diagnose a salivary gland blockage.  Performing an X-ray of the affected area can help to locate the obstruction.  If your doctor needs a more in-depth insight, they may suggest additional imaging tests such as an MRI.

 

If your doctor suspects you have an autoimmune disorder that affects your salivary glands, they may suggest a biopsy where they will take a sample of tissue and send it to the lab for further testing.

 

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Treatment

Treatment for salivary gland disorders differs depending on the cause, the type and how advanced it is.

 

For stones and other blockages of the glands, treatment often starts with processes such as manual removal of stones, warm compresses, or sour sweets to increase the flow of saliva.  If simple methods are unable to relieve the problem, salivary gland surgery may be required to remove the blockage and the affected gland.

 

Salivary gland surgery is usually necessary to remove tumours.  In some cases, benign tumours are treated with radiation to prevent them from coming back.  Certain cancerous tumours require radiation and chemotherapy.  To treat large cysts, surgery may also be necessary.

 

For bacterial infections and other medical conditions such as dry mouth, antibiotics and medications are generally prescribed to help treat the condition.

 

Maintaining good oral hygiene is vital for a successful salivary gland treatment.

 

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Types of Surgery

There are various methods of salivary gland surgery and your doctor will discuss which method is most appropropriate for your condition.

 

Parotidectomy

Parotidectomy is a surgical procedure performed to remove a benign or cancerous tumour in the parotid glands.  A superficial parotidectomy is the removal of the outer part of the parotid glands where the surgeon makes an incision in the front of the ear and down the neck.

 

A total parotidectomy involves the removal of the entire parotid gland.  Your doctor will begin by making an incision in front of the ear and down the neck.  The facial nerve, as well as other tissues may be removed depending on where the tumour is located.  This could affect how your face is able to move.

 

Submandibular Gland Excision

To treat a benign or cancerous tumour in the submandibular glands, your doctor will remove the affected gland.  The submandibular glands are located just under the jaw and your doctor will make an incision under the jawline to remove the gland and some of the nearby tissue.  The amount of surgery required will depend on the size and type of tumour being treated.

 

Sublingual Gland Excision

Surgery for tumours in a sublingual gland involves removing the entire gland.  The sublingual glands sit underneath your tongue on either side of the floor of the mouth.  Your doctor will make an incision inside your mouth to remove the gland as well as some of the nearby tissue.  The surgical area is usually repaired by closing the incision with stitches or grafting the skin.  Following the surgery, your tongue may feel numb on the affected side.  This is generally temporary and can last up to a couple of months.

  

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Recovery from Salivary Gland Surgery

Following salivary gland surgery, you may experience some drowsiness following the anaesthetic.  The nurses will check on you, check your blood pressure, pulse and temperature and will assess the affected area.

 

The gland may have been removed due to an infection, a tumour, or a blocked saliva duct.  The affected area may be sore, swollen or bruised for several days following your surgery.  It will probably take 1 – 2 weeks for the incision to completely heal.

 

If your doctor used stitches to close the incision, you may need to book an appointment to have them removed, or they may dissolve on their own.  If your incision was closed with glue, it will usually peel off on its own in the weeks following your surgery.

 

When you can start eating and drinking again after the operation depends on the type of procedure you had.  You may have to wait a few days if you had surgery through your mouth as this allows the wound inside your mouth time to heal.  You will be given a drip until you can eat and drink as normal, although you can wet your mouth with small amounts of ice or water.

 

Once you can return to your normal diet, try to stick to bland, low-fat foods like plain rice, chicken, toast, and yogurt to avoid an upset stomach.  Make sure you drink plenty of fluids to avoid becoming dehydrated.

 

Putting ice or a cold pack on the affected area (taking precautions to protect your skin) for 10 – 20 minutes every 1 – 2 hours for 3 days will help reduce the swelling.

 

Your doctor will tell you when you can restart any medicines and they will give you instructions for any additional medication you have to take.  It is important you follow the instructions given to you.

 

Follow-up care is an important part of your treatment following salivary gland surgery, so be sure to attend all appointments.  It is vital you call your doctor if you are experiencing any problems following your surgery.

 

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Risks and Complications

Salivary gland surgery is considered a safe procedure and rarely results in complications; however, as with any invasive surgery, there are potential complications.  It is important that you are aware of the risks and have the opportunity to discuss them with your doctor.  Possible complications include

 

Numbness to the tongue

The lingual nerve (which supplies feeling to the side of the tongue) can become bruised because of surgery.  If this occurs, you may experience a tingling or numb sensation. This numbness may take several months to vanish and in some exceptional circumstances, may last forever. 

 

Bleeding from the wound

An uncommon complication usually occurring within the first 12 hours following surgery which is why you may be asked to stay in overnight.

 

Infection

Usually developing within 2-5 days following surgery, your doctor can prescribe you a short course of antibiotics.

 

Pain

The wound is unlikely to be overly sore; however, painkillers will be available for you during your stay and for your recovery at home. 

 

Swelling

Swelling of the upper part of the neck is not typically noticeable and is usually most painful within 2 days following the operation.  This should resolve within a few weeks.

 

Scar

Any incisions made in the skin leave a scar; however, the majority of these will become less noticeable within several months.

 

Nerve damage

Nerve damage typically occurs due to bruising the nerves during surgery.  It is usually temporary, although it can take several months to fully recover.

 

Weakness

Weakness may develop in the lower lip, resulting in a slightly uneven smile. This is rare and may occur because of damage to the lower branch of the facial nerve. 

 

Decreased movement of the tongue

This may happen due to very rare damage of the hypoglossal nerve.

 

Salivary fistula

Saliva may collect in the wound or leak out, but usually resolves itself within a few weeks following surgery.

 

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Need Help?

At One Ashford Hospital in Kent, we perform many different Ear, Nose and Throat surgeries, including Myringoplasty and Septoplasty.  At One Ashford Hospital in Kent, we can book you in to see a specialist ENT Consultant for an initial consultation, usually within 48 hours. 

 

We are ideally placed to see patients in Ashford, Maidstone, Canterbury, Folkestone, Dover and surrounding villages.

 

You can use your private medical insurance or pay for your Salivary Gland Surgery treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• 0% and low finance options**
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

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