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Salivary Gland Disorder

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What are Salivary Gland Disorder?

Your salivary glands play an important role in various bodily functions. They are pertinent in keeping your mouth and throat lubricated for chewing and swallowing, facilitating your faculty of speech, maintaining oral health against harmful bacteria, and aiding digestion. Thus, when diagnosed with a salivary gland disorder in Singapore, one is usually confronted with an array of issues. 

The salivary gland can be broken down into three segments:

  • Parotid glands: largest salivary gland, located in front of the ears and upper part of the cheek. 
  • Submandibular glands: second largest glands found under the jaw. 
  • Sublingual glands: located beneath the tongue, contain a series of short ducts that secretes onto the floor of the mouth. 

Whilst the major salivary glands produce 92%-95% of saliva, the mouth is also lined with 600-1000 minor salivary glands that produce the rest. Salivary gland disorders can occur virtually anywhere due to the spread of salivary glands in the mouth. Below are some common salivary gland disorders one may encounter.

Condition Description 
SialolithiasisCommonly known as salivary gland stones and can be asymptomatic in many patients. When symptoms are present, it is usually due to blockages present in the salivary gland. 
SialadenitisA bacterial infection that occurs due to the progression of underlying salivary gland disorders. Sialadenitis causes persistent swelling of the salivary glands and may also result in drainage of pus. 
Mumps A viral infection that results in palpable and visible swelling in one or both parotid salivary glands. Mumps are preventable with the measles-mumps-rubella (MMR) vaccine
Salivary Duct Cysts (SDC) A growth made up of tiny sacs of fluid that form as a result of traumatic injuries, infections, or salivary gland stones or tumours.
Salivary Gland Tumour 
Lumps or growths that are commonly benign (non-cancerous) but can occasionally be malignant (cancerous). 
Xerostomia 
More commonly known as dry mouth. While it is often a symptom of an underlying condition, it may also indicate structural damage or degeneration of the salivary glands. 

What are the common causes of Salivary Gland Disorder in Singapore? 

The exact cause of salivary gland disorder will depend on the diagnosis. Most salivary gland disorders can be attributed to the blockage of the glands, consequently causing saliva to pool and obstruct the duct passages. The retention of saliva may lead to swelling and inflammation, resulting in the progression of conditions such as infections and cysts.  

In conditions such as salivary stones, persistent dehydration can be the leading cause, but even then, congestion of the salivary duct is evident. The congestion manifests in the form of calcium deposits commonly described as “stones”.  Dehydration can also lead to the formation of tumours, especially when paired with radiation exposure and habits such as smoking. 

What are the symptoms of Salivary Gland Disorder? 

The presentation of symptoms varies depending on the diagnosis received. However, some common manifestations occur when dysfunction of the salivary gland is present; these are: 

  • Abnormal growth: a lump within the mouth that may become visible externally (appears as growth on the cheek or beneath the ears). 
  • Foul smell (halitosis): may be due to pus draining into the mouth or dehydration. Bacteria buildup from both these conditions will result in foul odour. 
  • Dry mouth and throat: roughness of the tongue with the possibility of developing cold sores. Dryness can progress to the throat, which may cause sore throats. 
  • Facial pains: swelling from the salivary glands may result in pain and tenderness of the face, which may become more prominent during facial movements (talking or chewing). 

Are Salivary Gland Disorder painful?

Salivary disorders can cause certain levels of pain, especially when they progress and become critical. The pain also tends to spread to the ears, jaw, and throat and sometimes even causes headaches. If infections have occurred, these can result in fever accompanied by bodily aches. Where swellings and lumps form, these can cause pain at the growth site, which gradually spreads. 

Who is at risk of Salivary Gland Disorder in Singapore?

The risk factors for salivary gland disorders vary by the specific diagnosis; however, some factors increase one’s risks of developing a salivary gland disorder: 

  • Smoking: smokers, particularly those above the age of 40, may find themselves more vulnerable to salivary gland disorders such as sialolithiasis. Smoking also increases the risks of benign tumour growth (Warthin tumour) on the salivary gland.  
  • Older adults: ageing causes structural changes to the salivary glands and changes in the composition of the saliva itself. Thus, this makes the ageing population prone to salivary gland disorders due to the natural degeneration of salivary glands. 
  • Underlying health condition: certain conditions can cause salivary glands to dysfunction, such as Sjögren’s syndrome, where salivary glands undergo chronic inflammatory reactions. Other health conditions, such as diabetes and rheumatoid arthritis, can also impact the function of salivary gland functions, manifesting as persistent swelling. 
  • Gender: certain salivary gland disorders such as sialadenosis and adenoid cystic carcinoma (ACC) (salivary gland cancer) are more common in women than men. The prevalence of some gland disorders in one gender compared to the other can be attributed to anatomical and hormonal differences. 

If you suffer from a salivary gland disorder, schedule an appointment with ACE Surgery & Endoscopy for a detailed medical assessment and personalised treatment options. 

Sjögren’s syndrome
Underlying health issues like Sjögren’s syndrome can reduce salivary gland functions. 

Investigation and Treatment of Parotid & Submandibular Salivary Gland Tumours/Swellings in Singapore

What is the investigation and treatment of parotid and submandibular salivary gland tumours or swellings? 

At ACE Specialist Surgery and Endoscopy, we specialise in investigating and treating conditions specifically affecting the parotid and submandibular salivary glands. As both these glands are significantly larger, they are most vulnerable to swellings or tumour growth. 

More often than not, patients tend to misidentify swellings as tumour growth and vice versa. Prompt and accurate diagnosis must be conducted to identify the true nature of the enlargement of the salivary gland. Only then can an effective treatment pathway be provided with the assurance of reduced risk of disease progression. 

Salivary gland
The large nature of the parotid and submandibular glands makes them prone to swellings and tumour growth. 

How does the investigation and treatment of parotid and submandibular salivary gland tumours or swellings work? 

Investigating and treating parotid and submandibular salivary gland tumours or swellings is a sequential process. Below is the general process that patients may anticipate. Further investigation may not be required if a diagnostic conclusion is attained during the initial steps. Therefore, your experience may vary from case to case. 

Step 1: Physical examination

In this stage, your endocrinologist will physically examine the area where enlargement is present. The nature of the enlargement will be determined within this phase, whether it is merely a swelling or signs of a tumour. 

However, physical examination alone may not reveal the underlying cause of the granular swelling or if the tumour (if any) is malignant or benign. During the physical examination, your doctor will also examine the spread of pain to the facial or neck region and the level of discomfort patients are undergoing. 

Physical examination
A physical examination of the mouth will help your doctor gauge the nature of salivary gland enlargement.

Step 2: Biopsy and/or blood test 

If deemed necessary, you may also be requested to undergo a biopsy to extract tissue samples from the swelling or tumour site. This will aid in clarifying the cells' activity in the region with a more accurate analysis from the lab. A blood test may also be requested to identify any rise of tumour markers or the presence of bacterial or viral infections. 

Step 3: Imaging tests

If further clarification is necessary, you will be requested to obtain an MRI, ultrasound, X-ray, or CT scan to visualise the exact size or location of a tumour or the areas of inflammation or infection. This will provide a clearer indication of the severity of your condition and, consequently, a definitive diagnosis. 

Step 4: Treatment plan 

You will receive a treatment plan, necessary medication, or even surgery recommendations based on the analysis drawn. The investigation may also reveal underlying health conditions such as Sjögren’s syndrome. 

Depending on your specific condition, you may be prescribed the following: 

  • Antibiotics: mainly where infections are present, this may be taken orally or administered intravenously if necessary. 
  • NSAIDs: non-steroidal anti-inflammatory drugs will be prescribed if signs of inflammation are detected. This will also help with symptoms of fever or generalised body aches caused by salivary gland disorders. 
  • Sialendoscopy: a minimally invasive technique which will be utilised to drain abscesses or pus or remove salivary stones found on the parotid and submandibular salivary gland. 
  • Surgery: depending on your condition, surgery may be necessary to excise the tumour or even the glands themselves (submandibular salivary glands excision), especially if glands are severely obstructed. 
sialendoscopy
Sialendoscopy may be used to drain abscesses or pus or remove salivary stones.

Benefits of investigation and treatment of parotid and submandibular salivary gland tumours or swellings

  • Provides definitive diagnosis 
  • Avoids progression of the disease 
  • Salvages salivary gland structures 
  • Prevents degeneration of salivary glands 

What conditions can investigation and treatment of parotid and submandibular salivary gland tumours or swellings treat?  

The investigation and treatment of parotid and submandibular salivary gland tumours or swellings provide an opportunity to treat: 

  • Sialolithiasis (salivary gland stones) 
  • Sialadenitis (salivary gland bacterial infection) 
  • Salivary gland cysts 
  • Salivary gland tumours, such as parotid tumours
  • Salivary gland cancers, such as adenoid cystic carcinoma
  • Xerostomia (dry mouth) 
  • Halitosis (bad breath) 
halitosis
Bad breath or halitosis is a symptom of salivary gland disorders.

What results can I expect from investigating and treating parotid and submandibular salivary gland tumours or swellings?

Issues pertaining to the salivary glands can cause extreme discomfort and significantly affect one’s quality of life. Apart from the somatic disturbances, salivary gland disorders can also impact your social life due to embarrassment caused by bad breath or speech impediments that gradually develop from dry mouth. When left untreated, salivary gland issues can progress to cause digestive and dental issues or even spread of cancer (metastasis) in more severe cases. 

The investigation and treatment of parotid and submandibular salivary gland tumours or swellings provide an opportunity for early intervention to preserve your health and introduce appropriate treatment promptly. Here at ACE Specialist Surgery and Endoscopy, we advocate for people to live their highest quality of life and will work collaboratively with you to attain it. 

How many sessions of investigation and treatment of parotid and submandibular salivary gland tumours or swellings are needed?

The frequency of sessions needed depends on your investigation process and diagnosis. Where the underlying condition is more elusive, you will be required to return until a definitive diagnosis is obtained. Upon obtaining a diagnosis, you will then be requested to return for treatment and to monitor your response to treatment. 

Our doctor will thoroughly brief you on what the process will look like, subjective to your specific condition. You will be guided and armed with all the necessary information to ensure you make an informed decision every step of the way. 

If you suffer from a salivary gland disorder, schedule an appointment with ACE Surgery & Endoscopy for a detailed medical assessment and personalised treatment options. 

Frequently Asked Questions 

What forms of medication can fix salivary gland disorders?

This will purely depend on your diagnosis. If an infection is present, you will be given a cycle of antibiotics. Where salivary stones are present, removal may be necessary. You will also be guided to increase fluid consumption or replace medication that is inducing dehydration. You may even be administered IV fluids to improve your hydration levels. Surgery may also be deemed necessary where tumours and cysts are present. The medication prescribed will vary, and there is no one-size-fits-all solution to salivary gland problems. 

What are the first signs of salivary gland tumours?

Tumours can be differentiated from swellings based on the way they feel. Tumours are palpably harder and can even cause difficulty in facial movements. The growth rate of the tumour will vary depending on if it is benign or malignant. If you suspect tumour growth, seek immediate medical intervention (link to contact us), and we advise against self-diagnosing your condition. 

What are some remedies to ease salivary gland disorder symptoms? 

Whilst awaiting doctor visitation, you may consume more liquid, non-steroidal anti-inflammatory drugs (NSAIDs), or suck on sour or tart foods to induce saliva flow. However, if you are in extreme discomfort or pain or show signs of facial paralysis, avoid home remedies and visit the emergency department at your nearest hospital. 

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.