Salivary glands backup

Author: Miguel Lopes Oliveira

August 1, 2022

Saliva is a multifaceted bodily fluid.
Moisturizing the oral cavity, saliva has an essential role in:

• Initiating the digestion process and acting as a food lubricant to help swallowing
• Modulates food taste and aromatic sensitivity;
• Protects against tooth decay;
• Has antibacterial and antifungal functions, helping to regulate oral flora
• Important in avoiding bad breath;
• To moisture those “French Kisses”.

Saliva is produced and secreted by the salivary glands. These are classified into major and minor glands.

There are 6 major salivary glands, 3 on each side of the face.
The largest are the parotid glands, located in front of the ears. Their draining ducts open in the buccal mucosa, at the upper first molar level. Then the submandibular glands represent the second largest glands and can be found beneath the floor of the mouth. Anteriorly to them, lie the sublingual glands.

There are around 800 minor salivary glands throughout the aerodigestive track, but most are concentrated in the buccal mucosa (inside of the cheek), lips and tongue.

Saliva is mainly comprised of water, proteins, ions and enzymes.

Salivary flow can be disrupted and saliva may get retained and collected inside a cyst, creating a mucocele. They usually occur in the minor salivary glands of the lip and cheek mucosa.

It may also leak through the floor mouth tissues, appearing as large translucent swelling, resembling the belly of a frog, therefore called ranulla.

In young ages, mucoceles and ranullas tend to resolve spontaneously. But if they are symptomatic, persistent, and are not self-resolving they can be surgically managed.

Salivary flow can also be interrupted by a stone. Salivary glands can form stones, sharing some similarities to kidney stones.

It usually happens in the submandibular gland, because the highly viscous saliva from this gland, flows against gravity, stagnating more easily and contributing to ion precipitation. It may also occur in the parotid glands or any other salivary gland.

In these cases, the gland size may fluctuate. It rises suddenly during meal times, when there is saliva stimulus, but no drainage due to the mechanical blockade caused by the calculus. Then, in between meal times, the size tends to reduce partially.

Stones may be expelled on their own, but sometimes they need a surgical intervention, either with local or general anesthesia, occasionally using an endoscope, if the calculs location is favourable for that method.

Tumors originating from salivary glands are usually benign, presenting more frequently in the parotid gland, as a solid slow growing lump.

Pay attention, do not disregard benign tumors, as some types of benign tumors carry a considerable risk for malignant transformation.
A painful, fast growing lump, neck nodal lump and facial paralysis are some red alert signals pointing toward a possible malignant mass. The smaller the size of the salivary gland, the higher the probability of a malignant tumor.

The usual diagnostic workflow includes imaging exam and a fine-needle aspiration.

Surgery is the mainstay therapy. One of the main concerns, is to preserve the facial nerve structure and function, not only in the submandibular, but in particular in the parotid gland. Because the nerve crosses the gland interior it therefore requires a high level of expertise to remove the tumor, preserving all nerve ramifications as far as possible.

In malignant cases, surgery might have to include the resection of neck lymph nodes. Radiotherapy is an also a main or complementary treatment option.