Common Salivary Gland Disorders

The salivary glands comprise of the parotid, submandibular, and sublingual glands, and other minor unnamed glands within the oral cavity. They play a vital role in producing saliva, which aids in digestion and keeps the mouth moist. Disorders of these glands can lead to significant discomfort and other complications. Here, we explore common salivary gland conditions such as salivary gland stones, tumors, and autoimmune causes of salivary gland swellings.

Understanding the Salivary Glands
The salivary glands are essential structures that produce saliva, aiding digestion, lubricating the mouth, and protecting against infection. There are three major pairs of salivary glands, each with distinct locations and functions:
- Parotid Glands
- Located on each side of the face, just in front of the ears.
- These are the largest salivary glands and produce serous, enzyme-rich saliva, crucial for breaking down starches during digestion.
- Submandibular Glands
- Found beneath the jawline, near the angle of the mandible.
- These glands contribute most of the saliva (approximately 60–70%), which is a mix of serous and mucous secretions. They are also the most common site for salivary gland stones due to their long, upwardly curved ducts, which can trap minerals.
- Sublingual Glands
- Situated under the tongue, these are the smallest of the major salivary glands.
- They primarily secrete mucous saliva, aiding in mouth lubrication.
- Minor Salivary Glands
- In addition to these major glands, there are hundreds of other unnamed minor salivary glands scattered throughout the mouth and throat.
Blockages, such as salivary gland stones, can impair gland function, causing pain, swelling, and infections. Understanding the location and role of each gland is crucial for diagnosing and managing such conditions effectively.
A. Salivary Gland Stones (Sialolithiasis)
Clinical Presentation of Salivary Gland Stones
Salivary gland stones, or sialolithiasis, are calcified deposits that form in the salivary ducts, most commonly in the submandibular gland. Their clinical presentation includes the following features:
- Pain and Swelling: Intermittent pain and swelling in the affected gland, especially during or after eating. The pain may be mild initially but can become more intense if the duct becomes completely obstructed.
- Dry Mouth (Xerostomia): Decreased saliva flow due to obstruction can lead to a sensation of dry mouth.
- Palpable Lump: In some cases, the stone may be palpable as a hard mass in the floor of the mouth or along the salivary duct.
- Recurrent Infections: Persistent obstruction may lead to sialadenitis (infection of the salivary gland), presenting with redness, tenderness, and pus discharge from the duct. Severe cases can cause trismus (difficulty opening the mouth) due to inflammation and pain.
- Asymptomatic: Small stones may not give rise to any symptoms and be detected incidentally during imaging or physical examination.
If salivary gland stones are suspected, imaging studies like ultrasound or CT scans are often used for diagnosis, and treatment may involve stone removal or addressing underlying obstruction.
Causes and Risk Factors
Salivary gland stones are formed by the deposition of calcium salts. Factors contributing to the formation of salivary gland stone include reduced salivary production, obstructed flow within the salivary duct, and increased calcium concentration in the saliva. Certain medications that reduce saliva production, a history of previous trauma or instrumentation to the gland, and factors causing dehydration can also increase the risk of developing salivary gland stones (sialolithiasis).
Prevention Methods to Reduce the Risk of Developing Salivary Gland Stones
- Stay Hydrated: Drink plenty of water throughout the day to help maintain healthy saliva flow and prevent thickening of saliva, which can contribute to stone formation.
- Sour Foods to Stimulate Salivation: Eating sour or tart foods, like citrus fruits or sugar-free candies, can help stimulate saliva production and prevent saliva from becoming too thick.
- Avoid Dehydrating Substances: Limit the intake of alcohol, caffeine, and tobacco, as these can contribute to dehydration and reduced saliva production.
- Massage the Glands: Gently massaging the area around the salivary glands, particularly the submandibular glands, can help stimulate saliva flow and reduce the chances of blockages.
- Maintain Good Oral Hygiene: Regular brushing and flossing help prevent bacterial buildup in the mouth, which can contribute to salivary gland infections and increase the risk of salivary gland stones.
- Regular Dental Checkups: Regular visits to the dentist help detect early signs of oral health issues, such as infections or blocked ducts, that could lead to the formation of salivary gland stones.
Investigation Modalities
Diagnosis of salivary gland stones is often clinical, supported by imaging techniques. Ultrasound is commonly used due to its high sensitivity and non-invasive nature. Sialography, a special type of X-ray with contrast dye, and CT scans can also help in identifying salivary gland stones, especially those not visible on ultrasound.
Clinical Examination
The initial step in diagnosing sialolithiasis involves a thorough clinical examination by your doctor. They may palpate the affected salivary glands to check for tenderness or a palpable lump, which could indicate the presence of a salivary gland stone.
Diagnostic Tests
Several diagnostic tests are used to confirm the presence of a salivary gland stone:
- Sialography
Sialography is an imaging technique in which a contrast dye is injected into the salivary duct system, allowing radiographic visualization of any obstructions, including salivary gland stones. This test helps identify the location and size of the stone.
- Ultrasound
Ultrasound is a non-invasive, highly effective test for detecting salivary gland stones. It uses sound waves to produce real-time images of the salivary glands and can clearly identify the stone’s size, location, and whether it is blocking saliva flow.
- X-rays
Conventional X-rays, particularly in the case of submandibular stones, can sometimes reveal salivary gland stones, especially if they contain enough calcium to show up on the image. However, this method may not be as effective for detecting smaller or less radiopaque stones.
- CT Scan (Computed Tomography)
A CT scan offers detailed cross-sectional images of the salivary glands and can detect salivary gland stones that are difficult to visualize with other imaging methods. It is particularly useful for evaluating deeper or larger stones.
- MRI (Magnetic Resonance Imaging)
Although less commonly used for diagnosing salivary gland stones, an MRI can provide high-resolution images of the soft tissues and ducts of the salivary glands, making it useful for cases where other tests are inconclusive.
Treatment Options of Salivary Gland Stones
Small salivary gland stones may be managed conservatively with hydration, warm compress and massages, and sialogogues (substances that stimulate saliva production). Larger salivary gland stones may require more invasive procedures such as sialendoscopy (endoscopic removal) or surgery. Lithotripsy, the use of shock waves to break up salivary gland stones, is another option.

B. Salivary Gland Tumors
Clinical Presentation
Salivary gland tumors can be benign or malignant, with the parotid gland being the most common site. Benign tumors, such as pleomorphic adenomas, present as painless, slow-growing masses. Malignant tumors, like mucoepidermoid carcinoma, may present with rapid growth, pain, facial nerve palsy, or ulceration.
Causes and Risk Factors
The exact cause of salivary gland tumors is unknown. Risk factors include radiation exposure, certain viruses (e.g., Epstein-Barr virus), and genetic predispositions. Smoking has been implicated in some cases.
Investigation Modalities
Evaluation begins with a thorough clinical examination and imaging. Ultrasound, MRI, and CT scans help in assessing the tumor’s size, extent, and characteristics. Fine-needle aspiration biopsy is often used to obtain a tissue sample for cytological examination.
Treatment Options of Salivary Gland Tumors
Treatment depends on the tumor type, size, location, and whether it is benign or malignant. Surgical removal is the primary treatment for both benign and malignant tumors. Malignant tumors may require additional treatments like radiotherapy and, in some cases, chemotherapy. Close follow-up is essential to monitor for recurrence or metastasis.
Treatment options vary depending on the size, location, and severity of the salivary gland stone.
- Conservative Medical Management
For small, non-infected salivary gland stones, conservative measures may be sufficient. Drinking plenty of fluids and gently massaging the affected area may help to flush out smaller stones from the duct. Sucking on sour candies or using a warm compress can stimulate saliva production, aiding the movement of the stone towards the duct opening.
If a salivary gland stone causes an infection (sialadenitis), antibiotics may be prescribed to treat the infection before any surgical intervention. Infected glands may require drainage through an incision to remove pus and relieve pressure.
- Interventional Procedures
If conservative methods fail or the stone is larger or deeper in the gland, surgical removal is often necessary. The type of surgery depends on the stone’s size, location, and the gland involved:
- Intraoral Surgery: This procedure involves making a small incision inside the mouth, near the affected duct, to remove the stone. It is commonly used for stones located in the submandibular gland, as the duct is accessible.
- Extraoral Surgery: For larger stones or those in deeper locations, a surgeon may make an incision outside the mouth (beneath the jaw) to remove the stone. This approach is typically reserved for more complex cases where intraoral removal is not possible.
- Salivary Duct Dilation and Stenting: In certain cases, particularly if there is significant ductal narrowing caused by repeated stone formation, salivary duct dilation and the placement of a stent may be recommended. This allows for better drainage of saliva and prevents further obstruction, though it may not directly remove the stone.
- Surgery for Gland Removal
In rare, severe cases where the salivary gland is repeatedly affected, and other treatments fail, the entire salivary gland may need to be removed. This is typically a last resort to prevent recurrent infections and protect the patient’s overall health.
Conclusion
Treatment for sialolithiasis ranges from conservative methods, like hydration and massage, to more invasive surgical approaches. The choice of treatment depends on the stone’s size, location, and whether complications like infection are present. Early diagnosis and prompt intervention are essential to preserving gland function and preventing long-term damage.
C. Autoimmune Causes (Sjogren’s Syndrome)
Clinical Presentation
Sjogren’s syndrome, an autoimmune disorder, primarily affects the salivary and lacrimal glands, leading to dry mouth (xerostomia) and dry eyes (xerophthalmia). Patients may also experience swelling of the parotid glands and systemic symptoms such as fatigue and joint pain.
Causes and Risk Factors
Sjogren’s syndrome is caused by the immune system attacking the glands that produce saliva and tears. It is more common in women and often associated with other autoimmune diseases like rheumatoid arthritis and lupus.
Investigation Modalities
Diagnosis involves a combination of clinical evaluation, blood tests (looking for specific autoantibodies like anti-Ro/SSA and anti-La/SSB), and imaging studies. A salivary gland biopsy may be performed to confirm lymphocytic infiltration, a hallmark of the disease.
Treatment Options
Treatment focuses on symptom management. Artificial saliva and tear substitutes can relieve dryness. Immunosuppressive drugs, such as corticosteroids and hydroxychloroquine, are used to control systemic inflammation. Pilocarpine and cevimeline may be prescribed to stimulate saliva production.
Schedule a Salivary Gland Disorder Consultation With Dr Natascha Today
Salivary gland disorders encompass a range of conditions from benign salivary gland stones and autoimmune disorders to potentially life-threatening tumors. Understanding the clinical presentation, risk factors, and appropriate diagnostic methods is crucial for effective management.
Early detection and intervention can significantly improve outcomes, particularly in cases of malignancy. With advances in diagnostic imaging and minimally invasive procedures, the prognosis for many salivary gland disorders, such as salivary gland stones continues to improve. Regular check-ups and prompt evaluation of symptoms are essential for maintaining salivary gland health. Dr. Natascha’s expertise and dedication to her patient’s well-being makes her an exceptional choice for managing Salivary Gland Disorders. Schedule your consultation today to receive expert care and support for your salivary gland stones and conditions today.