Salivary Gland Disorders

The salivary glands

The facial nerve, which moves the muscles of the face, runs through the parotid gland. This matters for parotid tumors and surgery.

Common salivary gland disorders

Salivary stones (sialolithiasis)

Salivary stones are calcium deposits that block a duct. About 80 percent occur in the submandibular gland, because its saliva is thicker and its duct runs uphill. Classic symptom: swelling and pain under the jaw that starts as you eat (mealtime syndrome) and settles over an hour or two. Small stones may pass with hydration, massage and sour sweets. Larger ones are removed through the mouth or with a tiny camera (sialendoscopy).

Bacterial infection (sialadenitis)

Sialoadenitis is usually caused by Staphylococcus aureus when saliva flow slows: dehydration, after surgery, older age, medicines that dry the mouth, or a stone. The gland becomes hot, swollen and painful, and pus may come from the duct when the gland is pressed. Treatment is antibiotics, fluids, warm compresses, massage and sour candies to stimulate flow. An abscess may need draining.

Viral infection

Mumps causes painful swelling of one or both parotid glands, often with fever, and is preventable with the MMR vaccine. Other viruses, including flu, Epstein-Barr virus and HIV, can also cause parotitis. HIV can cause painless cystic swelling of both parotids.

Sjögren's syndrome

Sjögren's syndrome is an autoimmune disease that attacks the salivary and tear glands. It causes dry mouth, dry eyes and sometimes swelling of the parotid glands. It carries a small increased risk of lymphoma, so a new, persistent or hard gland swelling in someone with Sjögren's needs evaluation.

Tumors

Salivary gland tumors are uncommon. About 80 percent arise in the parotid gland, and most parotid tumors are benign, usually a pleomorphic adenoma or Warthin tumor. The smaller the gland, the more likely a tumor is to be cancerous: about half of sublingual and minor gland tumors are malignant. Warning signs of cancer include rapid growth, pain, a hard fixed lump, numbness, or weakness of the face.

Other conditions

• Dry mouth (xerostomia): from medicines, radiotherapy to the head and neck, dehydration or Sjögren's. See xerostomia.
• Mucocele and ranula: fluid-filled cysts from a damaged minor gland (lip) or sublingual gland (floor of mouth).
• Sialadenosis: painless, soft swelling of both parotids linked to diabetes, alcohol use disorder, bulimia and malnutrition.
• Juvenile recurrent parotitis: repeated parotid swelling in children, which usually stops by puberty.
• IgG4-related disease and sarcoidosis: causes of firm, persistent gland enlargement.

Telling them apart

A swollen lymph node under the jaw or a dental abscess can look like a gland problem, and a doctor will examine your teeth and neck.

Diagnosis

1. History and exam, including feeling the gland from inside and outside the mouth, pressing to see what comes from the duct, and checking facial nerve function.
2. Ultrasound: first-line imaging for stones, abscesses and lumps.
3. CT or MRI: for deeper lumps, tumors and complex infection.
4. Fine-needle aspiration or core biopsy: for any persistent lump.
5. Sialendoscopy: a tiny camera passed into the duct to view and treat blockages.
6. Blood tests: for Sjögren's antibodies, mumps, inflammation, IgG4 and HIV when relevant.

Treatment

• Self-help for stones and mild blockages: drink plenty of water, massage the gland toward the duct, apply warm compresses, and suck sugar-free lemon drops to boost flow.
• Antibiotics for bacterial infection.
• Stone removal through the mouth or by sialendoscopy; rarely gland removal.
• Dry mouth care: sipping water, sugar-free gum, saliva substitutes, prescription saliva stimulants and fluoride to protect teeth.
• Surgery: parotidectomy or submandibular gland removal for tumors, with care to protect the facial nerve.
• Radiotherapy for some salivary cancers.

Prevention

• Stay well hydrated, especially when ill or after surgery.
• Keep up good oral hygiene and dental checkups.
• Get the MMR vaccine.
• Review medicines that cause dry mouth with your doctor.

Frequently asked questions

What causes a swollen salivary gland?

The most common causes are a stone blocking the duct, a bacterial infection, a viral infection such as mumps, and dehydration. Sjögren's syndrome, tumors and conditions such as diabetes or alcohol use disorder can also cause swelling. The pattern of swelling helps your doctor identify the cause.

How do I unblock a salivary gland at home?

Drink plenty of water, massage the gland gently toward the duct opening, apply warm compresses, and suck sour sugar-free sweets or lemon to increase saliva flow. This can help small stones pass. See a doctor if there is fever, pus, or swelling that does not improve within a few days.

Is a lump in the salivary gland cancer?

Usually not. About 80 percent of parotid gland tumors are benign. However, lumps in smaller glands are more often malignant, and features such as rapid growth, pain, hardness or facial weakness raise concern. Any salivary lump lasting more than 2 to 3 weeks should be checked.

What are the symptoms of a salivary gland infection?

Symptoms include painful swelling in front of the ear or under the jaw, redness and warmth over the gland, a bad taste or pus in the mouth, difficulty opening the mouth, and fever. Infection is more likely when you are dehydrated or have a blocked duct.

Which doctor treats salivary gland problems?

A primary care doctor or dentist usually makes the first assessment. Persistent swelling, stones, recurrent infections and lumps are managed by an ear, nose and throat (ENT) specialist or oral and maxillofacial surgeon. Sjögren's syndrome is managed by a rheumatologist.