Salivary glands are glands located in and around the oral cavity which secrete saliva into the mouth to facilitate lubrication of the mouth during chewing and also partially digest the food. There are three pairs of major glands, the parotid, submandibular and the sublingual glands. They all secrete saliva of slightly different consistency into the oral cavity through narrow tubes called ducts. It is these ducts and their potential problems separate from the gland and our understanding which has revolutionised the treatment of glands and brought about the technique of Sialendoscopy.
There are three major salivary gland groups present on either side. These are the parotid, submandibular and the sublingual glands. The parotid glands are located in front of and below the ear. The submandibular glands are present just below the jaw bone on either side midway between the chin and angle of the jaw. The sublingual glands are small glands present completely in the oral cavity below the loose tissue under the tongue.
If you have a sharp pain and swelling in one or more glands then you probably have an infected gland which is called sialadenitis. This is usually thought to occur secondary to any obstruction in the ductal outflow of the affected gland. Primary treatment consists of antibiotics to resolve the infection, painkillers for the pain and hydration for good orodental hygiene. Any nearby tooth infection must also be shown to your nearest dentist. Once the attack has subsided we recommend all to visit your ENT doctor specialising in salivary gland disorders to rule out any mechanical cause of ductal obstruction which then is addressed to prevent any future attacks.
The cause of infection of the glands or sialadenitis is thought to be either ductal, glandular, systemic or due to infection spread from nearby sites.
The various ductal causes can be stones, narrowing of ducts, kinks of the duct, polyps or generalised swelling of the duct leading to outflow obstruction.
The glandular causes could be viral or bacterial in origin.
There are various systemic conditions which can also cause swelling of one or more salivary glands. Some of them are dehydration, radiation therapy, syndromes which decrease the saliva production like Sjögren’s syndrome or xerostomia.
Dental infection can also preclude to salivary gland infection, particularly the submandibular glands.
Tips to prevent gland infection include: Adequate hydration Good orodental hygiene Avoid excessive dehydrating beverages like tea, coffee or soft drinks Gland massage in case of chronic sluggish glands.
Stones are thought to form in salivary gland ducts usually due to stasis of secretions which over time organise to form small debris. This debris is allowed to remain in the duct for long, lead to progressive calcium deposition which over time lead to stone formation.
Sialendoscopy or salivary gland duct endoscopy is a novel way to tackle non-cancer conditions of the parotid and submandibular gland. It is based on the premise that gland infections are usually due to ductal outflow obstruction and on the removal of the duct obstruction the gland reverts back to normal. Sialendoscopes are miniature endoscopes or varying diameters ranging from below a millimetre in diameter r to 4 mm in diameter to address all ductal sizes. Miniature instruments like forceps, baskets and dilatory have also been devised to not just diagnose the ductal conditions but also treat it in the same sitting.