Salivary gland disorders: Treatment, symptoms, advice and help

Normal Salivary Gland Anatomy

Two parotid glands are located in front of the ear over the jaw joints on each side. Two submandibular glands are located in the upper neck just below the jaw. Two sublingual glands are located in the floor of the mouth. Many minor salivary glands are found throughout the upper aerodigestive tract.

The Parotid gland consists of a superficial (outer) and a deep (inner) part which are separated by the tree like terminal branches of the facial nerve which are responsible for facial movement. Lymph nodes are present within the gland.

Saliva leaves the gland through Stensen's duct which pierces the facial muscles and enters the mouth through the cheek opposite the second upper molar tooth.

Saliva flow is stimulated by chewing and the presence of food in the mouth, particularly sour substances. The stimulus is mediated via parasympathetic nerve fibres carried on the auriculotemporal nerve to the parotid gland.

The submandibular gland consists of inner and outer parts separated by the myelohyoid muscle. The duct leaves the deep part of the gland and enters the floor of the mouth in the midline to meet its opposite partner. The deep part of the gland is intimately related to the hypoglossal nerve which moves the tongue, and the lingual nerve which provides sensation to the front half of the tongue.

Saliva flow from the submandibular gland is stimulated via parasympathetic (chorda tympani) nerve fibres carried along the lingual nerve.

Classification of Salivary Gland Enlargement

Infectious/Inflammatory

• Acute: mumps, acute suppurative sialoadenitis and abscesses
• Chronic: Granulomatous diseases (sarcoid, cat scratch, tuberculosis, actinomycosis), chronic/recurrent sialoadenitis, Sjogrens syndrome.

Stones (Calculi)

• Sialolithiasis

Benign tumours

• Pleomorphic adenoma
• Warthins tumour
• Oncocytoma
• Vascular tumours and cysts

Malignant tumours

• Adenoid cystic tumours
• Mucoepidermoid tumours
• Carcinoma in pleomorphic adenoma
• Squamous cell carcinoma
• Acinic cell tumour
• Lymphoma