Owing to the close proximity of the salivary glands to various facial nerves, salivary gland surgery requires a high level of surgical skill and experience.
Salivary gland conditions
Humans have a variety of salivary glands which produce saliva to help transport food from the mouth to the stomach and initiate the process of digestion. There are three pairs (left and right) of major salivary glands: the parotid glands located close to the ears, the submandibular glands under the lower jaw and the sublingual glands beneath the tongue. In addition, there are many minor salivary glands which can be identified as palpable small nodules in the lips or cheeks, for example. Salivary consistency varies by the gland of origin.
Due to the consistency and mineral content of the saliva, salivary stones may develop in various locations. Sialoliths are most frequently encountered in the parotid and, especially, in the submandibular gland due to their long secretory ducts. A salivary stone may remain completely asymptomatic for a long period of time and is often discovered as an incidental finding on an X-ray. A large calculus may block the flow of saliva and thus cause acute
Inflammation of the salivary glands may be the result of impaired salivary flow. This may be caused by various factors: obstruction of the secretory ducts (due to salivary stones or scars at the duct orifices), tissue changes within the salivary glands (resulting from repetitive inflammation, for example) or benign or malignant neoplasms within the salivary glands. Inflammation of the salivary glands may also be caused by viral infections such as mumps.
In the majority of cases, acute sialadenitis is managed conservatively with antibiotic therapy. When the inflammatory symptoms have abated, it is important to treat the cause of the condition and, if necessary, remove the salivary gland affected.
Mucous retention cysts
Mucous retention cysts (also referred to as ranulas) are small encapsulated sacs filled with pooled saliva. They may be caused by a minor injury (e.g. mucosal lesion) or by a simple bite trauma. If the swelling increases during meals or when you feel hungry, the lesion is likely to be a mucous retention cyst. A ranula is commonly observed as a bluish swelling bulging into the floor of the mouth, for example. It can be removed in a minor surgical procedure under local anaesthetic. Usually, there are no complications.
Salivary stones (sialoliths)
Due to the consistency and mineral content of the saliva, salivary stones may develop in various locations. Sialoliths are most frequently encountered in the parotid and, especially, in the submandibular gland due to their long secretory ducts. A salivary stone may remain completely asymptomatic for a long period of time and is often discovered as an incidental finding on an X-ray. A large calculus may block the flow of saliva and thus cause acute inflammation of the salivary gland (sialadenitis). This condition usually occurs suddenly and may cause a general feeling of severe malaise.
In the majority of cases, sialadenitis is managed conservatively with antibiotic therapy until the acute inflammatory symptoms have abated. Depending on the location of the salivary calculus, it may be necessary to remove only the stone (endoscopic removal may be an option) or the stone plus the affected salivary gland. Owing to the specific composition of calculi found in the facial region, stone fragmentation, commonly performed to remove stones in other parts of the body (e.g. gallstones) is not promising in the treatment of sialolithiasis.
Tissue neoplasms in glandular structures are identified as palpable nodules or discovered as an incidental finding in slice images (CT or MRI). In the majority of cases, these neoplasms are benign, but specimens should be collected and examined to exclude malignancy. However, salivary glands are located close to various facial nerves. So instead of collecting specimens, the affected glands are usually removed partially or completely to ensure better protection of the nerves.
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