Salivary gland swellings (brief)

Question 1

Who does it affect?

Answer 1

Most common in adults, especially the old and dehydrated.

Question 2

What causes it?

Answer 2

Occur most commonly within the submandibular gland, 80%, and to a lesser extent the parotid. Composed of calcium phosphate and carbonate and may be related to sialadenitis (inflammation of the salivary gland).

Question 3

How does it present?

Answer 3

Pain and swelling of the affected gland on eating and drinking. If there is partial obstruction of the duct the swelling can last minutes or several hours. Complete obstruction leads to persistent swelling and infection. The patient may also experience colicky pain in the duct when eating.

Question 4

Investigations

Answer 4

Radiographs of the submandibular gland and duct and parotid gland and duct are helpful, even if many calculi are not radio-opaque.

Question 5

Treatment

Answer 5

Stones in the intra-oral part of the duct can be removed under general anaesthesia. Stones in the submandibular gland are an indication for the removal of the submandibular gland. Don’t usually operate on the parotid. Most parotid gland disease is treated conservatively with sialagogues and intermittent massage of the gland towards the duct.