• Clinical science

Diseases of the salivary glands

Summary

The parotid, submandibular, and sublingual glands are the largest salivary glands. These glands may swell repeatedly and often bilaterally (sialadenosis), but are also subject to acute inflammation that is predominantly unilateral (sialadenitis). Diseases that commonly cause sialadenitis include: Sjögren syndrome (chronic immunologic sialadenitis), Heerfordt syndrome, and mumps (epidemic parotitis). Sialadenosis and sialadenitis primarily affect the parotid gland. However, stones in the salivary ducts (sialolithiasis) mainly form in the submandibular gland because of its ascending salivary duct.

Salivary gland tumors manifest mainly in the parotid. Painless and progressive swelling of the gland is the cardinal symptom of benign as well as malignant tumors, while facial palsy is considered a criterion for malignancy. Generally, the smaller the gland, the greater the chance that the tumor is malignant. Clinical examination and ultrasound play the biggest role in diagnosis. For all parotid tumors, the preferred treatment is parotidectomy with retention of the facial nerve. A resection of the facial nerve is indicated only if it is infiltrated by the tumor. Postoperative radiation therapy may benefit patients with malignant tumors.

Sialadenosis

References:[1]

Acute purulent sialadenitis

References:[2][3][4]

Sialolithiasis (salivary stones)

  • Definition: formation of stones in the salivary ducts
  • Etiology
  • Location: may occur in any of the larger salivary glands
  • Clinical features
    • Recurrent, significant pain before and while eating
    • Partial swelling of the glands
  • Diagnostics
    • Sonography
    • Noncontrast CT
    • Sialography (rarely)
    • Possibly x-ray of the skull (particularly the base of the mouth)
  • Complications: acute or chronic sialadenitis
  • Treatment
    • Mainly conservative
      • NSAIDs for pain relief
      • Stimulation of salivary flow by sucking sour candies, massaging the gland, and applying warm compresses
    • Invasive (only in severe cases): dilatation of the salivary duct or ultrasonic lithotripsy

References:[5][3][4]

Ranula

  • Definition: retention cyst arising in the sublingual gland
  • Epidemiology: [6]
    • ♂ ≈ ♀
    • Most common between 10–30 years of age
      • Has been reported in patients aged 3–61 years
    • Rare (∼ 3% of salivary cysts)
  • Etiology: unclear
  • Clinical features
    • Translucent blue swelling below the tongue
    • Can cause problems swallowing and speaking
  • Treatment

Benign tumors

Most salivary gland tumors are benign.

Pleomorphic adenoma (benign mixed tumor)

  • Epidemiology
    • Sex: ♀ > ♂
    • Peak incidence: 40–60 years
    • Most common salivary gland tumor; (accounts for 85% of benign salivary gland tumors)
  • Etiology: ionizing radiation, environmental/occupational exposure (e.g., rubber manufacturing, cosmetologists, nickel compound exposure) [7]
  • Location: usually the parotid gland (∼ 80% of cases)
  • Clinical features
    • Gradual and painless unilateral swelling of the gland
    • Robust, movable tumor
  • Diagnostics
  • Complications: Malignant transformation may occur (∼ 5% of cases).
  • Treatment: : Best treatment is superficial parotidectomy to prevent recurrence. [5]
  • Prognosis
    • Very good overall prognosis
    • Recurrence (∼ 5% of cases): typically due to incomplete resection or rupture of tumor during surgery

Other types of benign salivary gland tumors (monomorphic adenomas)

These benign salivary gland tumors fall under the umbrella term "monomorphic adenoma" because they usually originate in only one type of cell – as opposed to the pleomorphic adenomas, which consist of both epithelial and myoepithelial cells.

Warthin tumor (papillary cystadenoma lymphomatosum)

WARning! Smoking makes GERMs more resilient.

Rare histologic subtypes

  • Oncocytoma (∼ 2% of cases)
  • Basal cell adenoma (∼ 1–2% of cases)
  • Myoepithelioma (∼ 1% of cases)

Malignant tumor

Malignant salivary gland tumors are referred to collectively because of their many etiological, epidemiological, and pathological similarities.

Submandibular gland tumors are less common but more frequently malignant than parotid tumors. Generally, the smaller the gland, the higher the risk a tumor is malignant!

References:[11][12][13]

  • 1. Garcia Garcia B, Dean Ferrer A, Diaz Jimenez N, Alamillos Granados FJ. Bilateral parotid sialadenosis associated with long-standing bulimia: A case report and literature review. J Maxillofac Oral Surg. 2016; 17(2): pp. 117–121. doi: 10.1007/s12663-016-0913-7.
  • 2. Chow AW, Calderwood SB, Bloom A. Suppurative Parotitis in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/suppurative-parotitis-in-adults. Last updated July 31, 2015. Accessed August 9, 2017.
  • 3. Fazio SB, Emerick K, Deschler DG, Sullivan DJ. Salivary Gland Stones. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/salivary-gland-stones. Last updated February 16, 2016. Accessed August 9, 2017.
  • 4. Wilson KF, Meier JD, Ward PD. Salivary gland disorders. Am Fam Physician. 2014; 89(11): pp. 882–8. pmid: 25077394.
  • 5. O'Connel TX, Movalia M. Brochert's Crush Step 2: The Ultimate USMLE Step 2 Review. Saunders; 2012.
  • 6. Golden B, Drake AF, Talavera F, Roland PS, Meyers AD, Kelley DJ. Ranulas and Plunging Ranulas. In: Ranulas and Plunging Ranulas. New York, NY: WebMD. http://emedicine.medscape.com/article/847589. Updated January 12, 2016. Accessed August 9, 2017.
  • 7. Laurie SA, Brockstein BE, Brizel DM, Fried MP, Ross ME. Salivary Gland Tumors: Epidemiology, Diagnosis, Evaluation, and Staging. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/salivary-gland-tumors-epidemiology-diagnosis-evaluation-and-staging. Last updated November 2, 2016. Accessed August 9, 2017.
  • 8. Goel A, Gaillard F. Pleomorphic Parotid Adenoma Imaging. https://radiopaedia.org/articles/pleomorphic-adenoma-of-the-salivary-glands. Accessed May 31, 2018.
  • 9. Fortin F, Gaillard F. Warthin tumour. https://radiopaedia.org/articles/warthin-tumour. Accessed May 31, 2018.
  • 10. Lee SC. Salivary Gland Neoplasms. In: Meyers AD. Salivary Gland Neoplasms. New York, NY: WebMD. http://emedicine.medscape.com/article/852373. Updated March 13, 2017. Accessed March 18, 2017.
  • 11. Brunicardi F, Andersen D, Billiar T, et al. Schwartz's Principles of Surgery. McGraw-Hill Education; 2014.
  • 12. Le T, Bhushan V. First Aid for the USMLE Step 1 2015. McGraw-Hill Education; 2014.
  • 13. Marchese-Ragona R, De Filippis C, Marioni G, Staffieri A. Treatment of complications of parotid gland surgery. Acta Otorhinolaryngol Ital. 2005; 25(3): pp. 174–178. pmid: 16450773.
  • Smith CC, Pariser D, Dellavalle RP, Dahl MV, Ofori AO. Primary Focal Hyperhidrosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/primary-focal-hyperhidrosis. Last updated December 30, 2015. Accessed August 10, 2017.
last updated 09/09/2020
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