Laurence Chu, MD, FACS

SALIVARY GLAND PROBLEMS
AND THEIR
TREATMENT

The quick summary:
To Treat Salivary Obstructions and/or Infection

• Drink plenty of liquid and don’t take medicines that dry you out. 
• Sip Sour Juice frequently (for example Lemon or Lime juice 4 – 5 x/hour, at least).  This will be uncomfortable.
• Massage the affected gland from back to front 4 -5 x/hour.
• Hot packs to affected gland 4 x/day.
• If there is infection, take the antibiotics as directed.

The Details:
 Brief Description of Salivary Gland Problems

SALIVARY GLAND ANATOMY AND PHYSIOLOGY

DISEASES OF THE SALIVARY GLAND

• The main disease of the salivary gland this pamphlet will discuss, are limited to the two largest glands:  the parotid gland and the submandibular gland.  These are the only two glands which have long ducts and are the only glands which usually become blocked or infected.  The treatment of these problems are the same for either gland.  There are basically two ways in which salivary glands can become blocked. Firstly, occasionally a stone can form in the salivary gland duct as a result of natural body salts crystallizing and forming solid masses within the ducts.  These stones gradually become larger with time, as more and more salts crystallize around a smaller stone.  The other way that the salivary glands can become blocked is if mucous becomes dried out and thickened in the gland or the duct and blocks the flow of saliva.  This thickening of the mucous is more likely to occur if a person fails to take adequate liquids and becomes dehydrated. In addition, taking diuretic, antihistamines, anti-dizziness medicines, or a variety of other medications that have anticholinergic effects, can contribute to thickening the secretions.
• Obstruction of the salivary flow can cause infection of the gland because germs (bacteria) that get into the saliva gland are not flushed out normally and consequently can grow and create an infection. Thus obstruction and infection of the gland tend to go hand in hand, although it is possible to have obstruction with no infection. 

SIGNS OF SALIVARY GLAND OBSTRUCTION AND/OR INFECTION

• If the salivary glands become blocked, either by a stone or thickened mucous, the gland will usually swell as it tries to secrete liquid.  This is most common around times when a patient attempts to eat  because the gland is stimulated to secrete saliva at this times. This can cause a lump just in front of or underneath the ear if it is the parotid gland, or a lump underneath the jaw if the  submandibular gland is blocked.  If the obstruction is partial, the gland may gradually reduce in size after the person is done eating and may resolve more rapidly with gentle massage of the swelling. If there is an infection in the gland, the gland may become excessively tender and there may be pus coming from the duct.  If the gland becomes obstructed from the prolonged period of time, of if it becomes obstructed repeatedly, it can cause dilation of the small sacks within the substance of the gland that are more prone to accumulate mucous. This dilation of the tubules of the salivary gland is called “sialoectasis”.  If this occurs, it can predispose to recurring obstruction and possibly infection of the salivary glands.

TREATING SALIVARY GLAND OBSTRUCTION

• If there is stone blocking the salivary gland duct that can be removed, then removal of this stone will remove the obstruction and this is the appropriate therapy for this.  Sometimes the stone will come out through the opening of the duct on its own with appropriate manipulation, but more often it requires surgical removal through the inside of the mouth. This sometimes can be done under local anesthesia or may require general anesthesia if it is in a child, or otherwise is more difficult to accomplish. 
• Very frequently no stone exists, and the problem is primarily thickened mucous blocking the ducts or gland itself.  In this case the steps to reduce obstruction of the gland are as follows:
• 1. Drink plenty of fluids so that the gland can secrete adequate liquid to flush out the blockage.  Generally, this means drinking three 8 oz. glasses of liquid per day, but the way you can be sure that your are drinking enough liquid is that when you urinate, your urine is clear. 
• 2. Use Sialogogues: that is, frequently put substances in your mouth that will cause you to salivate intensely.  Basically, anything that is very sour or bitter will accomplish this best.  A good example of this would be to get a container of lemon or lime juice (a small plastic lemon that can be obtained from the grocery store) and take sips of this frequently throughout the day, may be as many as 4 – 5 times per hour, or more. This will stimulate the salivary glands to secrete saliva and flush out any blockage. 
• 3. Massage the glands frequently.   Basically, take your fingers and gently massage the gland from back to forward frequently throughout the day.  This should be done as many as 4-5 times per hour, or whenever you can think of doing it.  Once again, this helps to gently squeeze the saliva out of the gland and flush out the obstruction. 
• 4. Apply hat packs to the affected gland. This is best done with a washcloth dipped in very hot water and held to the affected area approximately 15 minutes, 3 – 4 times per day. The washcloth should be as hot as you can stand but not so hot that it burns. Also, when the washcloth begins to cool down, heat it up in the water again and reapply.  You will notice that the skin over the gland becomes somewhat red when you do this. This increases the blood supply to the gland and generally helps improve its health and helps to thin the secretions. (It is especially helpful if there is an infection in the gland).
• 5. Be careful to avoid any medications that might dry you out unless you must take them for other medical reasons.
• 6. Occasionally your physician will supply Medications that thin the secretions, such as Guaifenesin.

Treating Infection of Salivary Gland

• In order to treat infection in the salivary gland it is important to do all of the things described above to reduce obstruction and to flush out the salivary gland. In addition, you will be instructed to take antibiotics to help kill the bacteria as well. Also note that it is especially important to perform the hot packs if there is infection in the gland.  Occasionally, if the infection is severe, you will be given steroid medication for a few days (such as Prednisone) to help get the swelling down more rapidly. Read the instructions for these medications carefully.

Prognosis (what you can expect in the future)

• While you may only have a single episode of obstruction or infection and never have a problem again, individuals who have had obstruction of the salivary glands tend to be predisposed to have this recur in the future. Although it may not occur, it is not uncommon for an individual who has had one episode of obstruction to have an occasional episode of recurrent obstruction and/or infection of the salivary glands.  If this can be managed adequately with the conservative methods described above, then usually that is the treatment of choice. If the obstruction of infections become too severe or too frequent to manage in that fashion, then it is usually necessary to remove the affected salivary gland. If it is necessary to remove the parotid gland this can be done using an incision just in front of the ear as is made for a facelift. However, it is necessary to dissect the gland away from the facial nerve.  (the nerve that controls the motion of the face) and so it is a somewhat meticulous procedure. If the submandibular gland needs to be removed then it can be done using an incision that is hidden in a crease on the neck.  A question many people have about removing the salivary gland is “Can the person continue to make enough saliva if a salivary gland is removed”? The answer is yes, if only one salivary gland is removed the rest of the salivary glands are more than adequate to provide adequate saliva. Fortunately, in the majority of cases salivary gland disease can be managed with repeated use of the above conservative methods as well as precautions to avoid dehydration before the glands become obstructed or infected. 

Back