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Salivary gland disorders
The salivary glands — parotid, submandibular and sublingual — can be affected by several conditions:
- Salivary stones : a stone blocks the gland’s duct and causes painful swelling, often at mealtimes.
- Infection (sialadenitis) : the gland becomes painful, swollen and red.
- Tumours : most salivary gland tumours are benign, but any persistent lump should be assessed.
- Sjögren’s syndrome and other causes of dry mouth.
Swelling under the jaw or in front of the ear that lasts more than two weeks deserves an assessment.
Three pairs of glands
Saliva is produced by three main pairs of glands: the parotids, in front of and below the ears; the submandibular glands, under the jaw; and the sublingual glands, under the tongue. Hundreds of smaller accessory glands also line the mouth and throat. Any of them can become obstructed, infected, or develop a tumour.
What we assess
Swelling that appears at mealtimes and subsides afterwards suggests a salivary stone blocking the duct. A painful, warm, swollen gland, sometimes with pus, corresponds to sialadenitis — an infection that tends to occur when saliva flows poorly. A firm, persistent mass in front of the ear or under the jaw should always be assessed: most of these tumours are benign, but only assessment can confirm it. Chronic dry mouth, often related to medication, radiotherapy or an autoimmune condition, also falls within this field.
The assessment
It rests on examination of the mouth and neck, with bimanual palpation of the gland. Ultrasound is the first-line investigation; a CT scan or MRI completes it when needed. For a mass, fine-needle aspiration clarifies the nature of the cells before any surgical decision.
Treatment
A small stone may pass with good hydration, massage of the gland and agents that stimulate salivation. When it remains lodged, it has to be removed. Infection is treated with antibiotics and local measures. For a tumour, surgical removal of the gland — parotidectomy or excision of the submandibular gland — is the rule; in the case of the parotid, protection of the facial nerve, which runs through the gland, is central to the operation and is discussed in detail beforehand.
The signal not to ignore
Any swelling or lump of the face or neck lasting more than two weeks should be examined by a physician.
Other ENT topics
Sinus disease, endoscopic and nasal surgery · Snoring and sleep apnea · Thyroid and parathyroid · Voice and larynx disorders
See also Common ENT conditions. Consultations are by physician referral: Book an appointment.