Salivary glands are all-important exocrine glands that secrete saliva. Saliva is a key part of the overall digestive system as it aids in the mastication or the breakdown of food into smaller pieces. Not only is saliva important in the digestive process, it also plays a vital role in keeping the mouth moist which assists the person when speaking.
There are three different pairs of salivary glands and they are located in the head and neck region of the body. These include the parotid glands, the submandibular glands and the sublingual glands.
The largest salivary gland, the parotid gland, rests in front of each ear and can be found on both sides of the face. The second largest salivary gland is the submandibular gland, located just below the jaw. The smallest of the major salivary glands is about the size of an almond and is known as the sublingual gland. It is found beneath the tongue.
When salivary glands are injured or obstructed, this can inhibit the ability of the major salivary glands to produce saliva. This in turn has a domino effect on the patient’s day-to-day life which is now impeded because they are unable to chew or swallow food particles.
ENT doctors usually recommend salivary gland surgery in order to remove tumours. In less serious circumstances, salivary gland surgery is recommended to rid the person of a persistent infection or harmful obstruction of the salivary gland.
There are a variety of salivary gland surgeries that ENT doctors engage in to rid the patient of a part or all of the infected salivary gland. As we will discuss in today’s article, the three most common types of salivary gland surgery include parotidectomy, submandibular gland excision and sublingual gland surgery.
As the name suggests, parotidectomy is the surgical removal of a part or all of the parotid gland. This type of salivary gland surgery is required when there is a benign or cancerous tumour within the salivary gland. According to the Parotid Patient Project, 80% of such tumours tend to be benign. However, parotidectomy is usually recommended to the patient since these lumps can continue to grow and may eventually become cancerous.
There are two primary types of parotidectomy that can be performed. The first type is the superficial parotidectomy, which involves removing the outermost part of the parotid gland. This is usually done to remove non-cancerous lumps that tend to develop in the superficial lobe.
The second type is the total parotidectomy which is the removal of the entire parotid gland. This form of parotidectomy may be required when non-cancerous tumours form within or extend into the deeper lobe of the salivary gland. More commonly, it is performed when the tumour removed in a superficial parotidectomy is found to be cancerous on frozen section (quick test done during surgery) or if cancer was suspected in the first place.
With high grade or aggressive cancers, a neck dissection might be performed in addition to total parotidectomy. This is to remove lymph nodes in the region where cancer might have extended to.
2. Submandibular Gland Excision
Submandibular gland excision is often recommended if there is a chronic infection of the gland known as sialadenitis. The onset of this infection is usually caused by persistent salivary stones known as sialolithiasis. While these stones may not present themselves with any obvious symptoms, these salivary stones have the potential to become enlarged and eventually block the salivary duct.
When the duct is obstructed, the flow of saliva is impeded which leads to infection, inflammation and painful aching around your jaw. During the submandibular excision, the surgeon will make a cut in the upper portion of the neck and below your jaw. At this point, he will carefully remove the submandibular gland. Submandibular gland excision is also recommended for tumours. Unlike parotid gland tumours, 50% of these tend to be cancerous.
3. Sublingual Gland Surgery
Under normal circumstances, saliva is created by the salivary gland and released into the mouth. However, the damaged or injured sublingual gland prevents saliva from reaching the mouth. Due to this obstruction, the saliva seeps out of the sublingual gland and extends into the tissue around it. This unnatural flow of saliva into the surrounding tissues then causes the formation of a swelling or cyst on the bottom of the mouth. This swelling is known as a ranula.
When there is a blockage of these drainage channels, patients will need to undergo a sublingual gland surgery. As part of this salivary gland surgery, a small incision is made just under the tongue and on the inside of the bottom row of teeth. The surgeon will then remove the sublingual gland. Sometimes, a large ranula can extend into the neck and is known as a plunging ranula. In such situations, a neck incision may be necessary.
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Make an appointment with our doctors at Amandela ENT Head and Neck Centre if you need treatment for issues with your salivary glands. Our doctors are determined to deliver patient-centric care so that you receive the right help to ease the inflammation and pain. Click here to arrange a consultation session with our team of ENT doctors at Amandela ENT Head and Neck centre.