Salivary glands

 Salivary Glands

Location of 3 major salivary glands
(Click to enlarge)

The primary function of saliva glands is to make and release saliva into the oral cavity.

Functions of saliva are:

• Enzymes in saliva help digest food
• Prevent cavity by removing food particles from tooth surfaces
• Improve taste
• Tissue lubrication
• Helps chewing and swallowing
• Prevent bad breath
• Aid in retaining full dentures
• Reduces the acidity produced by waste products, protect the enamel from being damaged by high acidity
• has antibodies to help with infection

There are three major saliva glands:

1. Parotid glands, the largest of the saliva glands, located in front and just below each ear.
2. Sublingual glands, located under the tongue on the floor of the mouth
3. Submandibular glands, situated beneath the jaw bones

Moreover, there are many small salivary glands in the palate and larynx that can only be seen through a microscope.   

Swelling of salivary glands:
Conditions that involve in the swelling of salivary glands are:

Mucocele

Mucocele (mucous retention cyst) is a mucous-containing cyst that occurs in the salivary gland areas of the oral mucosa of any age.

Cause by a traumatic rupture of the excretory duct of a saliva gland and the subsequent accumulation of saliva in the tissues.

Treatment consists of removal of the cyst as well as the associated salivary gland.

Characteristic of Mucocele: the cyst, usually small, round, elevated, translucent, bluish of the mucosa.  If deep-seated, it can be palpated as the round freely movable lesion.  Mucocele can be found anywhere except in the anterior half of the palate. Common locations are the lip and tongue.  The lesion tends to have a cycle of rupture, discharge of mucus, collapse and recur.  The period can last for months.

Ranula

Ranula is a large soft mucus-containing cyst similar to mucocele but affects more major glands of adulthood, e.g., a defect in Wharton's duct (submaxillary gland) and Bartholin's duct (Sublingual gland). Ranula can be unilateral or bilateral and can be congenital.

When superficial, it appears as bluish, translucent color.  If larger than 2 centimeters, may elevate the tongue and interfere with the speech.  When found deeper in a floor of the mouth, Ranula will cause swelling of the neck with or without the swelling of the floor of the mouth along with typical color appearance.

Cause: An obstruction or trauma in Wharton's duct (Submaxillary Salivary Gland) or Bartholin's duct (Sublingual Salivary Gland under the tongue).

Wharton's duct is the excretory duct of the submaxillary glands, open at the mucous membrane of the floor of the mouth posterior to the mandibular incisor teeth.

Treatment: Performing "Partsch" procedure. This method involves removing the entire Ranula cyst, the associated salivary gland.  Then, suture the edge of the opened wall to the mucous membrane (marsupialization). This procedure prevents the recurrence of Ranula cyst.

Marsupialization is a conversion of a closed cavity cyst into an open pouch. The cyst sac is opened and emptied of the mucus. The cyst edges are sutured to the adjacent tissues with a drainage left in place for several months.  The healing process begins when the secretion decreases; sac space becomes smaller.

Sialolithiasis - Saliva Calculus

Calculus in sublingual glands

Cause:
Saliva calculus created by the formation of stones in the ducts of salivary glands. The stones in the salivary duct are the accumulation of calcium and phosphate crystals. These stones can be present in any one of the three glands including the parotid, the sublingual or the submandibular gland.

In people with dehydration or dry mouth as in Sjogren syndrome, have a greater risk of having a stone formation in the salivary ducts. Certain medications also predispose a person's likelihood of stone formation, e.g., antihistamines, antidepressants, and diuretics. Formation of a salivary calculus (stones) is rare in children.

Symptoms:

Patient experiences pain at the salivary glands. The cause of pain is due to the enlargement of salivary glands from the obstruction of the duct. The pain becomes worst during eating. Larger salivary stones inside the ducts may cause localized irritation and secondary infection.

Diagnosis: 

• By physical exam; The stone sometimes can be palpated, especially at the submandibular gland
• Dental x-ray reveals the calculus, helps confirm the diagnosis and provides appropriate information about its size and location. 
• Usual location: submaxillary or sublingual glands

Treatment: 

• manipulated the stone through the duct, if the stone is small 
• Small incision can be made to remove the stone
• In severe case, the salivary gland has to be surgically removed
• Using sour hard candy to increase saliva flow, and drink 6-8 glasses of water

Mumps(Infectious parotitis)

Cause: Virus

Mumps is a highly infectious viral disease that affects the parotid glands. It transmitted through saliva in children age 5-15 years.  Mumps has an incubation period of 2-3 weeks.

Symptoms:
Fever, malaise, pain and enlargement of the parotid gland (unilateral or bilateral), loss of appetite, and has bad taste.  The disease lasts one week.

Treatment:
Symptomatic treatment.  Patient has lifelong immunity after contracting the disease.

Sjögren's syndrome

Cause
Sjögren's syndrome is a chronic auto-immune disease caused by the white blood cells attacking the moisture producing glands. It, usually, affects the parotid glands,  submaxillary glands and minor salivary glands of the lip.  Sjögren's syndrome often occurs in middle age and elderly women.

Symptoms include:

• Enlargement of the salivary glands
• Dry mouth (xerostomia)
• Dry conjunctiva (conjunctivitis sicca)
• Dry pharyngeal, nasal, and laryngeal mucosal
• Arthritis

Treatment:
 Hormonal, vitamin, or antibiotic therapy