Understanding Salivary Gland Disorders
The salivary glands produce saliva, which moistens food, helps protect teeth from decay, and contains enzymes that begin the digestive process. There are three major pairs of salivary glands:
Parotid glands
Submandibular glands
Located beneath the jawbone
Sublingual glands
Located under the tongue
Additionally, there are hundreds of minor salivary glands distributed throughout the mouth and throat.
Common disorders affecting the salivary glands include:
Benign tumors
Malignant tumors
Cancerous growths, including mucoepidermoid carcinoma, adenoid cystic carcinoma, and others
Sialadenitis
Inflammation of the salivary glands, often due to infection or blockage
Sialolithiasis
Formation of stones within the salivary glands or ducts
Sjögren's syndrome
An autoimmune disorder affecting the salivary and lacrimal (tear) glands
These conditions may present with symptoms such as:
These conditions may present with symptoms such as:
- Painless swelling in the face or neck
- Pain or swelling that worsens during or after eating
- Dry mouth
- Difficulty opening the mouth
- Numbness or weakness in the face
- Drainage of pus from a salivary duct
Diagnostic Approach
Accurate diagnosis of salivary gland disorders requires a comprehensive evaluation. At Premier Head and Neck Surgery, our diagnostic approach includes:
- Detailed medical history and physical examination
- Fine needle aspiration (FNA) biopsy of suspicious masses
- Imaging studies:
- Ultrasound: Often the first imaging study, excellent for visualizing stones and masses
- CT scan: Provides detailed information about the extent of tumors and relationship to surrounding structures
- MRI: Offers superior soft tissue contrast for evaluating tumor characteristics
- Sialography: X-ray examination after injection of contrast material into the salivary ducts
- Salivary endoscopy: Direct visualization of the salivary ducts using a small camera
This multifaceted approach allows us to determine the nature of your salivary gland condition and develop a personalized treatment plan.
Surgical Approaches for Salivary Gland Disease
At Premier Head and Neck Surgery, we offer a range of surgical approaches for salivary gland disorders, tailored to the specific condition and affected gland:
Parotidectomy
- Superficial Parotidectomy: Removal of the outer portion of the parotid gland
- Preserves the facial nerve that runs through the gland
- Appropriate for most benign tumors and some early malignancies
- Minimizes risk to facial movement
- Total Parotidectomy: Removal of the entire parotid gland
- Preserves the facial nerve when possible
- Necessary for certain malignant tumors or extensive benign disease
- Higher risk of temporary or permanent facial weakness
- Radical Parotidectomy: Removal of the parotid gland along with the facial nerve
- Reserved for malignant tumors that involve the facial nerve
- Requires nerve grafting or other techniques to address facial paralysis
Submandibular Gland Excision
- Removal of the submandibular gland
- Performed through an incision in the upper neck
- Requires careful identification and preservation of surrounding nerves
- Appropriate for tumors, chronic inflammation, or recurrent stones
Minor Salivary Gland Surgery
- Excision of affected minor salivary glands
- Approach varies depending on location
- May require reconstruction for larger resections
Minimally Invasive Approaches
Sialendoscopy: Endoscopic examination and treatment of salivary ducts
- Allows removal of stones without gland excision
- Treatment of strictures with balloon dilation
- Minimal external scarring
- Preserves gland function
Extracapsular Dissection:
- Removal of small, superficial parotid tumors with a margin of normal tissue
- Less extensive than formal parotidectomy
- Reduced risk of complications
- Appropriate only for select cases
Facial Nerve Monitoring and Preservation
During parotid surgery, preservation of the facial nerve is a primary concern. At Premier Head and Neck Surgery, we employ advanced techniques to protect facial nerve function:
- Continuous intraoperative facial nerve monitoring
- Microscopic or loupe magnification for enhanced visualization
- Meticulous dissection techniques to identify and preserve nerve branches
- Nerve stimulation to confirm nerve integrity throughout the procedure
These approaches minimize the risk of facial weakness while ensuring complete removal of the disease.
Reconstruction After Salivary Gland Surgery
For some patients, particularly those undergoing extensive surgery for malignant tumors, reconstruction may be necessary to restore both function and appearance. Our reconstructive options include:
- Local tissue rearrangement for smaller defects
- Regional flaps for moderate reconstruction needs
- Free tissue transfer for complex reconstructive challenges
- Facial reanimation procedures for cases involving facial nerve sacrifice
- Fat grafting to address contour deformities after parotidectomy