Salivary glands are located around the oral cavity. They secrete saliva which moistens food to facilitate its swallowing. Saliva contains also enzymes which begin the digestion process and helps cleaning oral cavity by flushing out the bacteria and food leftovers
There are major and minor salivary glands. The group of major salivary glands includes three pairs of salivary glands: parotid, submandibular and sublingual. Parotid salivary glands are the largest ones and are located at both sides of the mandible to the front from the earlobes. Submandibular glands are located at the back of the oral cavity, medially in relation to the angles of mandible. Sublingual salivary glands are located in the front part of the oral cavity floor. Apart from large salivary glands, also thousands of small salivary glands scattered throughout the oral mucosa, throat and nasal cavities are responsible for secretion of saliva.
Salivary gland tumours are rare. Most are found in the parotid glands (80%) and are benign, although some of them may be malignant (cancer). There is some relationship between the size of a salivary gland and the nature of the tumour: the larger the salivary gland, the greater likelihood that this is a benign tumour
- A hard, usually painless tumour in one of the salivary glands (in front of the ear, under the chin or at the bottom of the oral cavity); tumour usually grows slowly.
- Impaired mobility of the half of the face (facial nerve paralysis)
- In a diagnostic process, it is essential to thoroughly gather medical history and perform accurate palpation examination.
- Fine needle aspiration biopsy (FNAB) controlled by ultrasonography (USG) is performed to determine the nature of the tumour (benign or malignant)
- In certain cases (e.g. vague on of the tumour, suspected malignant tumour), basic medical examination is accompanied by imaging studies: computed tomography (CT) or magnetic resonance imaging (MRI).
Salivary gland tumours are treated surgically by removing a part or the entire salivary gland. Malignant tumours usually require concomitant treatment: surgical (removal of salivary gland together with neck lymph nodes) and postoperative radiotherapy
Surgery of submandibular gland is performed under local anaesthesia. Skin incisions are made in the natural furrow in the neck skin approximately 3 cm below the mandible. Salivary gland is always entirely removed together with a part of its duct. Potential complications of the submandibular salivary glands include:
In the postoperative period, antibiotics are used for 5-7 days; it is recommended to protect the wound against moisture for 1 week and to conduct energy limiting life-style for approx. 2 weeks. Stitches are removed after 7 days.
Surgery of parotid gland (parotidectomy) is performed under general anaesthesia. Skin incision starts in front of the earlobe and afterwards behind the mandible angle and is made in a short fragment downwards to the neck. The tumour is usually removed together with part of the saliva gland. Removal of the entire saliva gland is reformed only in certain cases. Potential complications of parotidectomy include:
These complications occur sporadically and in most cases are transient. In the postoperative period, antibiotics are used for 5-7 days; it is recommended to protect the wound against moisture for 1 week and to conduct energy limiting life-style for approx. 2 weeks. Stitches are removed after 7 days.
Sublingual salivary gland surgery is most often performed through the oral cavity, however in certain cases additional incision on the neck may be necessary.
Removal of submandibular salivary gland
- abnormalities of the lower lip motion (damage to the marginal mandibular branch of the facial nerve);
- numbness of the bottom of the oral cavity and of side of the tongue (damage to lingual nerve);
- tongue motion abnormalities (damage to hypoglossal nerve);
- abnormal sensation of the skin at the operated area (sensory nerve damage);
- bleeding in the postoperative cavity;
- infection of the post-operative cavity.
- Removal of the parotid gland (partial or total)
- sensory disturbances our the earlobe (damage of the great auricular nerve);
- bleeding in the postoperative cavity;
- retention or leakage of saliva from the postoperative cavity;
- excessive sweating and redness on the skin near the ears during meals (Frey’s syndrome).
- Removal of sublingual salivary gland
- Endoscopic procedures in the area of the salivary glands’ ducts
Sialoendoscopy is a new and minimally invasive technique that gives direct view of the inside of the large salivary glands’ ducts (i.e. submandibular and parotid gland). Due to small size of those ducts (from 1.2 to 1.5 mm), creation of miniature optical systems for their study became possible only recently thanks to the use of state-of-art materials and technology. Pathologies from the ducts of the salivary glands can be removed during sialoendoscopy.
Indications for the procedure
Main indications to conduct sialoendoscopy include recurring painful and painless swelling of large salivary glands, which are a symptom of impaired patency of the ducts releasing saliva from the gland. The most common causes of obstruction include salivary stones and rarely narrowing of the duct. Other pathologies which hinder the outflow of saliva from the salivary glands include: mucous plugs, mucosal polyps, foreign bodies, bending of the duct.
Preparation and course of the procedure
Sialoendoscopy is always preceded with a consult with an otolaryngologist or a maxillofacial surgeon and ultrasound examination of the salivary glands. Blood group determination, tests of morphology and coagulation system should also be performed. In adults, the procedure is usually performed under local anaesthesia and does not require any special preparations from the patient. If the case of children and if the duration of the procedure may exceed 2 hours, general anaesthesia is recommended and the patient must be fasting for 6 hours prior to surgery.
Sialoendoscope is entered to the lumen of the salivary glands through its natural opening in the oral cavity (opening of the submandibular gland is located under the tongue on the bottom of the oral cavity and near the frenulum of the tongue, whereas the opening of parotid duct is located in the buccal mucosa at the height of the second upper molar). At first, the opening of the duct becomes extended with a set of probes of increasing diameter. If the pathological lesions are observed in the duct, there is a possibility to remove them during the same procedure. This is performed with a microsurgical instruments (forceps, drills, baskets, etc.) entered through the working channel of the endoscope. Possible narrowing of the ducts are extended by low-pressure balloons or with use of a set of tubes with increasing diameter. In some cases, stent preventing scarring is entered to the duct and remains there for approx. 7-10 days.
After the procedure, patients are routinely administered an antibiotic, analgesic, anti-inflammatory and antispasmodic medicines. Furthermore, massage of the salivary gland treated is indicated.