The salivary glands make saliva and release it into the mouth. There are three pairs of relatively large, major salivary glands:

• Parotid glands are located in the upper part of each cheek, close to the ear. The duct of each parotid gland empties onto the inside of the cheek, near the molars (back teeth) of the upper jaw.
• Submandibular glands, in the floor of the mouth, have ducts that empty behind the lower front teeth.
• Sublingual glands, beneath the tongue, have ducts that empty onto the floor of the mouth.

In addition to these major glands, 600 to 1,000 very tiny, minor salivary glands are scattered throughout the mouth and throat. They lie under the moist skin that lines the inner lips, inner cheeks, palate, back of the throat, back portion of the tongue, pharynx and sinuses.

Some of the most common salivary gland disorders include:

• Sialolithiasis (salivary gland stones) – Tiny, calcium-rich stones, called sialoliths or salivary calculi, sometimes form inside the salivary glands. Although the exact cause of these stones is unknown, some stones may be related to dehydration, which thickens the saliva; decreased food intake, which lowers the demand for saliva; or medications that decrease saliva production, including certain antihistamines, blood pressure drugs and psychiatric medications. Some stones sit inside the gland without causing any symptoms. In other cases, a stone blocks the gland's duct, either partially or completely. When this happens, the gland typically is painful and swollen, and saliva flow is partially or completely blocked. This can be followed by an infection called sialadenitis.



• Sialadenitis (bacterial infection of a salivary gland) – Sialadenitis is a painful infection that usually is caused by staphylococcus, streptococcus, Haemophilus influenzae or anaerobic bacteria. Although it is very common among elderly adults with salivary gland stones, sialadenitis also can occur in infants during the first few weeks of life. Many things increase the risk of this condition, including dehydration, recent surgery, prematurity, malnutrition, eating disorders, chronic illness, cancer, medications (antihistamines, diuretics, psychiatric medications, beta-blockers, barbiturates), Sj�gren's syndrome and certain occupations (trumpet playing, glass blowing). Without proper treatment, sialadenitis can develop into a severe infection, especially in people who are debilitated or elderly.



• Viral infections – Systemic (whole-body) viral infections sometimes settle in the salivary glands, causing facial swelling, pain and difficulty eating. The most common example is mumps. Similar symptoms can be caused by other viral illnesses, including flu, parainfluenza, Coxsackie viruses, echovirus and cytomegalovirus.



• Cysts (tiny fluid-filled sacs) – Babies sometimes are born with cysts in the parotid gland because of problems related to ear development before birth. Later in life, other types of cysts can form in the major or minor salivary glands as a result of traumatic injuries, infections, or salivary gland stones or tumors. One of the most common types is a mucocele, a mucus-filled cyst that often occurs inside the lower lip.



• Benign tumors (noncancerous tumors) – About 80 percent of all salivary gland tumors occur in the parotid gland, and the majority are benign (noncancerous). The most common type of benign parotid tumor, a pleomorphic adenoma, usually appears as a slow-growing, painless lump at the back of the jaw, just below the earlobe. More than 95 percent of all benign salivary gland tumors occur in adults. Risk factors include radiation exposure and possibly smoking.



• Malignant tumors (cancerous tumors) – Salivary gland cancers are rare and most often occur in people between the ages of 50 and 60. They can be either low-grade (less aggressive) tumor or a high-grade (more aggressive) tumor. The only known risk factors for salivary gland cancers are Sj�gren's syndrome and exposure to radiation, although smoking also may play some role.



• Sj�gren's syndrome – Sj�gren's syndrome is a chronic autoimmune disorder in which the body's immune defenses attack the salivary glands, the lacrimal glands (glands that produce tears), and occasionally the skin's sweat and oil glands. In some cases, the illness also affects the lungs, liver, vagina, pancreas, kidneys and brain. Most people with this disease are women who first develop symptoms during middle age. In about 50 percent of cases, the illness occurs together with rheumatoid arthritis, systemic lupus erythematosus (lupus), scleroderma or polymyositis.



• Sialadenosis (nonspecific salivary gland enlargement) – Sometimes, the salivary glands become enlarged without evidence of infection, inflammation or tumor. This nonspecific enlargement, called sialadenosis, most often affects the parotid gland, and its cause remains unknown. Sialadenosis may develop in people who are obese, in women who are pregnant or breastfeeding, and in people with malnutrition, eating disorders, alcoholic cirrhosis, kidney failure, thyroid problems or other illnesses.

Symptoms vary, depending on the specific type of salivary gland disorder:

• Sialolithiasis – The most common symptom is a painful lump, usually in the floor of the mouth. Pain may worsen during eating because the stone blocks the flow of saliva.



• Sialadenitis – Symptoms may include a tender, painful lump in the cheek or under the chin; a foul-tasting discharge of pus from the duct into the mouth; and in severe cases, fever, chills and malaise (a generally sick feeling).



• Viral infections – The first symptoms may include fever, headache, muscle aches, joint pain, poor appetite and malaise. These are followed by swelling in the parotid glands, usually on both sides of the face, in the cheeks and below the ears, and difficulty opening the mouth.



• Cysts – A cyst causes a painless lump that sometimes grows large enough to interfere with eating, speaking, chewing or swallowing. Mucoceles can burst, releasing a straw-colored liquid.



• Tumors – A slow-growing lump – sometimes painful – is the most common symptom of both cancerous and noncancerous salivary gland tumors. This lump may be found in the cheek, under the chin, on the tongue or on the roof of the mouth.



• Sj�gren's syndrome – Sj�gren's syndrome causes dry mouth, tooth decay, frequent mouth infections, mouth sores, swelling of the salivary glands, sialoliths and recurrent salivary gland infections. It also causes dry eyes, which may lead to chronic eye infections, corneal ulcers and vision loss. There may also be muscle pain, joint pain, malnutrition, weight loss and many other symptoms.



• Sialadenosis – This condition typically causes painless swelling of the parotid glands on both sides of the face, in the cheeks and below the ears.

After you describe your symptoms, the doctor will review your medical history, smoking history, current medications and diet. The doctor also may ask whether you:

• Have recently been hospitalized for surgery, because decreased intake of food and liquids after surgery can increase the risk of salivary gland stones and infections
• Have ever received radiation treatments for cancer of the head or neck
• Were ever diagnosed with mumps or immunized against mumps
• Have recently been exposed to anyone with the flu or another viral illness
• Have any autoimmune condition, such as rheumatoid arthritis

Next, your doctor will examine your head and neck, including the area inside your mouth. The doctor will press gently on areas of your cheeks and jaw to feel for lumps, areas of tenderness and salivary gland stones. Then, depending on your symptoms, history and physical findings, the doctor may order one or more of the following tests:

• X-rays to detect salivary gland stones
• Magnetic resonance imaging (MRI) or computed tomography (CT) scans to check for tumors and for stones that are not visible on X-rays
• A fine-needle aspiration (using a thin needle to remove cells from the salivary gland) to determine whether a tumor is cancerous
• Sialography, in which dye is injected into the gland's duct so that the pathways of saliva flow can be seen
• Blood tests to measure antibodies against specific viral infections or autoantibodies for Sj�gren's syndrome
• A salivary gland biopsy (removal of a small piece of tissue) to diagnose a cyst, tumor, or Sj�gren's syndrome
• A salivary function test to help diagnose Sj�gren's syndrome
• Blood tests to check for nutritional or hormonal problems that can cause sialadenosis
• Special eye tests to look for evidence of Sj�gren's syndrome

How long a salivary gland problem lasts depends on the specific disorder:

• Sialolithiasis – Small stones sometimes pass out of the duct on their own. However, larger stones usually stay in the gland until they are removed.
• Sialadenitis – When the infection is treated with appropriate antibiotics, symptoms usually begin to subside within 48 hours.
• Viral infections – In mumps, symptoms usually last about 10 days.
• Cysts – A small, shallow cyst can be a short-term problem that drains on its own. Large cysts, however, often grow larger until they are removed surgically.
• Tumors – Tumors last until they are removed.
• Sj�gren's syndrome – This is a lifelong illness.
• Sialadenosis – When sialadenosis is related to a medical problem, it generally persists as long as the medical problem does.

You can lower your risk of viral infections of the salivary glands by being immunized against mumps and influenza.

Although there are no specific guidelines to protect against other types of salivary gland disorders, it is helpful to do the following:

• Avoid smoking.
• Eat a healthy diet.
• Drink six to eight glasses of water daily to avoid dehydration.
• Practice good oral hygiene, with regular tooth brushing and flossing.

The treatment varies, depending on the disorder:

• Sialolithiasis – If the stone is located near the end of the duct, your doctor may be able to press it out gently. Deeper stones can be removed with surgery.



• Sialadenitis – Treatment includes drinking fluids or receiving fluids intravenously (through a vein); antibiotics; warm compresses on the infected gland; and encouraging saliva flow by chewing sour, sugarless candies or by drinking orange juice. If these methods do not cure the infection, surgery can be done to drain the gland.



• Viral infections – Because these infections almost always go away on their own, treatment focuses on relieving symptoms through bed rest, drinking fluids to prevent dehydration, and taking acetaminophen (Tylenol) to relieve pain and fever.



• Cysts – A small cyst may drain on its own without treatment. Larger cysts can be removed using traditional surgery or laser surgery.



• Benign tumors – Noncancerous tumors usually are removed surgically. In some cases, radiation treatments are given after surgery to prevent the tumor from returning.



• Malignant tumors – Smaller, early stage, low-grade tumors often can be treated with surgery alone. However, larger, high-grade tumors usually require radiation following surgery. Inoperable tumors are treated with radiation or chemotherapy.



• Sj�gren's syndrome – For treatment of symptoms related to the salivary glands, options include pilocarpine (Salagen), a medication to help relieve dry mouth; sugarless gum and candy to stimulate saliva production; and avoiding smoking, caffeinated beverages, alcohol, spicy foods and acidic foods.



• Sialadenosis – Treatment is aimed at correcting any underlying medical problem. Once the medical problem improves, the salivary glands should shrink to normal size.

Contact your doctor or dentist if you develop a persistent lump or swelling anywhere in your neck, jaw, cheek, tongue or hard palate. Call your doctor or dentist immediately if the lump:

• Is painful, red or tender
• Occurs together with fever and chills
• Interferes with your ability to open your mouth, speak, chew or swallow

The outlook depends on the disorder:

• Sialolithiasis – If a stone is removed promptly, the prognosis is usually excellent. About 20 percent of people have stones return.
• Sialadenitis – With prompt antibiotic treatment, the prognosis is usually very good. The highest risk of complications is in elderly people and those with chronic, debilitating illnesses.
• Viral infections – Most people recover fully without complications.
• Cysts – In most cases, the prognosis is good. Although cysts develop again in some people, these usually can be removed without complications.
• Benign tumors – The prognosis is usually very good, although tumors develop again in some people as late as 10 to 15 years after the first tumor was removed.
• Malignant tumors – The prognosis is usually best for parotid tumors and poorest for cancers of the sublingual or minor salivary glands; cancers that have invaded the nearby facial nerve; or bulky cancers that have spread (metastasized).
• Sj�gren's syndrome – The prognosis varies. Some people have only mild symptoms, and others have more severe forms of the illness that affect the quality of life.
• Sialadenosis – Once any underlying illness is treated, the salivary glands usually return to their normal size.

National Institute of Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
Phone: 301-496-4261
E-Mail: nidcrinfo@mail.nih.gov
http://www.nidcr.nih.gov/

American Academy of Otolaryngology – Head and Neck Surgery
One Prince St.
Alexandria, VA 22314-3357
Phone: 703-836-4444
E-Mail: info@entnet.org
http://www.entnet.org/

American Association of Oral & Maxillofacial Surgeons
9700 West Bryn Mawr Ave.
Rosemont, IL 60018-5701
Phone: 847 678-6200
Toll-Free: 1-800-822-6637
Fax: 847-678-6286
E-Mail: inquiries@aaoms.org
http://www.aaoms.org/

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: 301-435-3848
Toll-Free: 1-800-422-6237
TTY: 1-800-332-8615
E-Mail: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/

American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/