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What and where are salivary glands?
Salivary glands make the saliva in your mouth, which is very
important for the health of your mouth and teeth (eg it stops
your mouth drying out) - and also for the first stages of digestion
of food (it contains some enzymes and salts).
There are three major salivary glands around the mouth (1) sublingual
- under the tongue, 2) parotid - overlying the cheek, and 3) submandibular
gland- close to the jawline).
There are also many small (minor) salivary glands, which are
scattered throughout the mouth (eg you can feel them as little
bumps in your cheeks and lips).
Both the major and minor glands have ducts, which are the channels
down which the saliva travels on its way to the mouth.
What can go wrong with salivary glands?
The most common problem with salivary glands that people notice
is a swelling and/or infection of glands. This is usually because
of a sudden blockage (obstruction) of the salivary ducts.
This can be caused by either a 'stone' or thicker saliva in the
ducts of the major salivary glands or because of injury to the
minor salivary glands and ducts (eg you might have bitten your
cheek or lips accidentally).
Does a swelling in my glands mean I might have cancer?
It is very common for people to notice lumps and swellings of
their salivary glands. Some of these get better on their own and
your dentist (or doctor) will be able to work out the cause.
It is possible to get cancer of the salivary glands but
this is very rare.
As for all changes in your body that you might notice, it is
better to have things 'checked out' by your dentist, doctor or
an oral and maxillofacial surgeon than worry about them - especially
if they haven't got better on their own after about two or three
weeks.
How to prevent oral disease
Where are the parotid glands and what can go wrong with them?
You have two parotid glands, which are situated on either side
of your face between the back part of the lower jaw and the ear.
The ducts of each gland open inside the mouth in the upper cheek
on both sides (you can feel this as a small lump and can even
see saliva dribble out of it if you are patient).
One of the most common problems of the parotid glands is mumps,
which is an acute virus infection that gives pain and swelling
usually on both sides.
The ducts of parotid glands can also get blocked, leading to
swelling, infection and pain.
Where are the submandibular glands and what can go wrong with
them?
You have two submandibular glands, which are situated under
the lower jaw at the corner on both sides.
The ducts open close to each other behind the lower front teeth
under the tongue (you can see these as raised bumps).
These ducts often develop stones, which can block them causing
swelling, infection and pain. You might be able to see or feel
the stone under the tongue.
What are the sublingual glands and what can go wrong with them?
You have two sublingual glands, which are situated in the front
of the mouth under the tongue. They share ducts with the submandibular
glands (see above).
They can develop the same type of stones as the other major glands,
with similar consequences.
What are salivary stones and what do you do to treat them?
The saliva stone is full of calcium and other minerals and sometimes,
when the salivary flow is sluggish and thick, stone formation
is enhanced.
What is a mucocoele ('mew-co-seal')?
The minor salivary glands are scattered throughout the mouth,
including on the inner aspect of the lips and cheek.
The most common problem with minor salivary glands is called
a mucocoele.
A mucocoele is a swelling of a minor salivary gland, and is often
on the inner aspect of the lower lip or cheek. It happens when
the duct is blocked and therefore the saliva collects in the gland.
Sometimes these are small and will 'pop' on their own without
the need for treatment.
Sometime they can get quite large or recur frequently. If this
is the case, your oral and maxillofacial surgeon will probably
recommend having them removed, which can be done under local anaesthetic
with dissolving stitches to close the small wound.
When are salivary glands active?
When you are at rest, up to 75% of your saliva comes from your
submandibular and sublingual glands. When the glands are stimulated
by the smell or sight of food, up to 95% of your saliva is from
your parotid glands.
When might I need to have an operation on my salivary glands?
The following problems with salivary glands can need attention
from an oral surgeon:
-
When the ducts are blocked, for example by a stone (or calculus).
-
When a cyst has formed in the gland, which is sometimes because
of a previous infection. See also dental
cysts
-
When repeated infections of your salivary gland have caused
scarring, inflammation and continuous discomfort.
-
If you have an uncoordination between your nerves to the
glands and the muscles of your mouth (neuromuscular uncoordination),
which can lead to an excess of saliva, which can't be easily
swallowed or wiped away (leading to drooling/dribbling).
Your oral and maxillofacial surgeon might advise removal of
the selected salivary gland or redirection of salivary duct(s).
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When a tumour has formed in the gland. This is quite rare
but your oral and maxillofacial surgeon will want to send
some or all of it for microscopic analysis to make sure that
it is benign and not a cancer.
What sort of things do you do during surgery of the salivary
glands?
There are several main approaches to surgery of the salivary
glands, which include
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Removal of the object that is obstructing the duct.
The oral and maxillofacial surgeon will try to repair the
duct so that the gland will resume its previous function.
-
Removal of part or all of a salivary gland.
If it is a major gland, the ducts might need to be re-routed.
What will I feel like after surgery for salivary gland problems?
How you will feel after salivary gland surgery will depend on
what you have done, on the cause of the problem and also on how
you react to surgery in general.
Your oral and maxillofacial surgeon will be able to advise you
on what will be done, under what kind of anaesthetic and how long
it is likely to take you to recover. In general:
-
For minor surgery under local anaesthetic, you will probably
just feel a bit sore for a day or two and wait for the dissolvable
sutures to fall out.
-
For more major surgery, especially after a general anaesthetic,
you will feel tired after the anaesthetic, take longer to
recover and might have some swelling for a week or so.
-
For some surgery, we can approach the area safely through
the mouth so any scars will be inside the mouth.
For other surgery, it will be necessary to approach the area
through the skin of the face/neck, which will leave some small
scars on the skin.
These will fade with time and are designed to lie in skin
creases so they are less noticeable. We use fine sutures for
these, which are removed after five to seven days.
-
Sometimes you will need to have some wound drains put in,
which are just small tubes. They are left in for a day or
two to keep the wound dry.
I am having an operation on my parotid gland, what might I
experience after the surgery?
The parotid gland is situated outside the mouth between the
ear and the jaw. Its duct, however, discharges its saliva into
the mouth via an opening in the cheek.
Surgery to the gland is complicated by the presence of the facial
nerve that happens to run through it. This nerve provides sensation
to some areas of the face (including the ear lobe) but also includes
the nerves that control movement of that side of the face (including
the lower eyelid).
During surgery, we take great care to protect the facial nerve
from direct damage. However, after surgery the following might
affect you:
-
Numbness of the earlobe and skin associated with the scar.
This can be temporary or permanent and is caused by damage
to small sensory nerve fibres.
-
Temporary weakness of the facial nerve.
This is caused by the surgeon moving and touching it (manipulation).
Usually full movement recovers with time.
-
Permanent weakness of the facial nerve.
This is very rare but can be distressing. It will only affect
the same side of the face that has been operated on.
-
Sweating of the skin of the face at meal times.
This is called Frey's syndrome. This occurs because after
surgery the nerves to the parotid gland that control the production
of saliva sometimes link with the nerves that control sweating
in the skin.
Your oral and maxillofacial surgeon will advise you about
the appropriate treatment.
-
Saliva can leak through the skin (called a salivary fistula)
or collect under the sin (called a sialocele). This is very
rare.
I am having surgery to my submandibular gland, what might I
experience after surgery?
Surgery to the submandibular glands is fairly common and usually
straightforward. This surgery requires an incision (cut) under
your lower jaw on a skin crease line. Sometimes, however, you
might experience:
-
Weakness of movement of the lower lip. This is because there
has been some disturbance to a lower branch of the facial
nerve. The weakness is usually temporary and rarely permanent.
-
Rarely, numbness of the tongue. This is because the lingual
nerve (which supplies the tongue) has been bruised during
or after surgery. This numbness is usually temporary and rarely
permanent.
-
Extremely rare: weakness of movement of the tongue, which
is caused by bruising of the hypoglossal nerve, which supplies
the tongue.
I am having surgery to my sublingual gland, what might I experience
after surgery?
Surgery to the sublingual glands is fairly common and usually
straightforward. Surgeons gain access via the mouth so you won't
have any scarring of the face or neck. Sometimes, however, you
might experience:
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Some swelling inside the mouth due to surgery near to the
tongue and in the floor of the mouth;
-
Some temporary discomfort when swallowing when tongue muscles
are affected;
-
Numbness of the tongue, which is caused by bruising of the
lingual nerve during surgery. The numbness is usually temporary
and rarely permanent.
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