There are 3 major pairs of major salivary glands:
 

•    Parotid glands: The largest salivary glands, found in front of & just below each ear. 
•    Sublingual glands:  Found under the tongue in the floor of the mouth.
•    Submandibular glands: Found below the jawbone.
 

There are also hundreds of minor salivary glands in the mouth, nose, and larynx. They can only be seen with a microscope.

  • Parotid duct obstruction is when part of your parotid duct becomes blocked. 
  • Saliva then can’t flow normally from the parotid gland into your mouth.
  • Salivary gland stones are the most common cause of this condition.
  • Parotid duct obstruction can cause symptoms like pain and swelling in the area around the back of your jaw.
  • The condition often goes away on its own with minimal treatment.

How is parotid duct obstruction treated?

Your healthcare provider may start with treatments such as:

  • Increasing fluids
  • Applying moist heat to the area
  • Massaging the gland and duct
  • Sucking on candies to promote saliva secretion
  • Using pain medicines
  • Stopping use of any medicines that decrease saliva production, if medically possible

Many symptoms go away quickly with these types of treatments. If your symptoms don’t improve, over time you might need treatments such as:

  • Lithotripsy. This uses shock waves to break up the stone.
  • Wire basket retrieval. This removes the stone through the duct.
  • Sialoendoscopy. This also accesses the stone through the duct.
  • Open surgery. This might include removal of the parotid duct, if other methods fail.

Complications from parotid duct obstruction might require treatment as well.

Most of the time, your parotid gland will work as normal after the blockage is removed.

SAINT LUKE'S HEALTH SYSTEM



Frequently asked questions about salivary glands

What and where are salivary glands?

Salivary glands make the saliva in your mouth, which is very important for the health of your mouth and teeth (eg it stops your mouth drying out) - and also for the first stages of digestion of food (it contains some enzymes and salts).

Both the major and minor glands have ducts, which are the channels down which the saliva travels on its way to the mouth.


What can go wrong with salivary glands?

The most common problem with salivary glands that people notice is a swelling and/or infection of glands. This is usually because of a sudden blockage (obstruction) of the salivary ducts.

This can be caused by either a 'stone' or thicker saliva in the ducts of the major salivary glands or because of injury to the minor salivary glands and ducts (eg you might have bitten your cheek or lips accidentally).


Does a swelling in my glands mean I might have cancer?

It is very common for people to notice lumps and swellings of their salivary glands. Some of these get better on their own and your dentist (or doctor) will be able to work out the cause.

It is possible to get cancer of the salivary glands but this is very rare.

As for all changes in your body that you might notice, it is better to have things 'checked out' by your dentist, doctor or an oral and maxillofacial surgeon than worry about them - especially if they haven't got better on their own after about two or three weeks.


Where are the parotid glands and what can go wrong with them?

You have two parotid glands, which are situated on either side of your face between the back part of the lower jaw and the ear.

The ducts of each gland open inside the mouth in the upper cheek on both sides (you can feel this as a small lump and can even see saliva dribble out of it if you are patient).

One of the most common problems of the parotid glands is mumps, which is an acute virus infection that gives pain and swelling usually on both sides.

The ducts of parotid glands can also get blocked, leading to swelling, infection and pain.


Where are the submandibular glands and what can go wrong with them?

You have two submandibular glands, which are situated under the lower jaw at the corner on both sides.

The ducts open close to each other behind the lower front teeth under the tongue (you can see these as raised bumps).

These ducts often develop stones, which can block them causing swelling, infection and pain. You might be able to see or feel the stone under the tongue.


What are the sublingual glands and what can go wrong with them?

You have two sublingual glands, which are situated in the front of the mouth under the tongue. They share ducts with the submandibular glands (see above).

They can develop the same type of stones as the other major glands, with similar consequences.


What are salivary stones and what do you do to treat them?

The saliva stone is full of calcium and other minerals and sometimes, when the salivary flow is sluggish and thick, stone formation is enhanced.

What is a mucocoele ('mew-co-seal')?

The minor salivary glands are scattered throughout the mouth, including on the inner aspect of the lips and cheek.

The most common problem with minor salivary glands is called a mucocoele.

A mucocoele is a swelling of a minor salivary gland, and is often on the inner aspect of the lower lip or cheek. It happens when the duct is blocked and therefore the saliva collects in the gland.

Sometimes these are small and will 'pop' on their own without the need for treatment.

Sometime they can get quite large or recur frequently. If this is the case, your oral and maxillofacial surgeon will probably recommend having them removed, which can be done under local anaesthetic with dissolving stitches to close the small wound.


When are salivary glands active?

When you are at rest, up to 75% of your saliva comes from your submandibular and sublingual glands. When the glands are stimulated by the smell or sight of food, up to 95% of your saliva is from your parotid glands.


When might I need to have an operation on my salivary glands?

The following problems with salivary glands can need attention from an oral surgeon:

  • When the ducts are blocked, for example by a stone (or calculus).
  • When a cyst has formed in the gland, which is sometimes because of a previous infection. See also dental cysts
  • When repeated infections of your salivary gland have caused scarring, inflammation and continuous discomfort.
  • If you have an uncoordination between your nerves to the glands and the muscles of your mouth (neuromuscular uncoordination), which can lead to an excess of saliva, which can't be easily swallowed or wiped away (leading to drooling/dribbling).
  • Your oral and maxillofacial surgeon might advise removal of the selected salivary gland or redirection of salivary duct(s).
  • Swollen salivary glands. Some people develop swelling of the parotid glands, giving the appearance of mumps. This is often on one side at a time, but can eventually become bilateral. The swelling can be without symptoms, can come and go, and eventually, just persist. This occurs because the glands are inflamed.                                                        Some people with Sjögren’s Syndrome actually develop episodes of “parotitis”. During such attacks, the parotid gland becomes quite painful and swollen; there can be fever. Antibiotics do not always work in this situation, and the pain and swelling usually abate spontaneously over two or three weeks. This can become recurrent, and sometimes the glands can become chronically infected, needing to be removed.  
From Sjögren’s Syndrome, Part I Clinical Manifestations Arthur A.M.Bookman MD FRCPC, Associate Professor of Medicine, University of Toronto Coordinator, Multidisciplinary Sjögren’s Clinic University Health Network Published February 2007, The Sjogren’s Society of Canada, Newsletter 
  • Q. What is a salivary test? 
  • A. A Salivary test is a nuclear medicine scan which can measure how well your salivary glands are functioning.
  • During the scan, a radioactive "tracer" will be injected into a vein. A special camera will take pictures from different angles as the tracer moves through your blood to your salivary glands. After the first set of pictures has been taken, you will be asked to bite down on a lemon wedge for a second set of pictures.
  • A salivary flow test (sialogram) can determine how much saliva you are producing. During the sialogram, a small, flexible tube will be inserted through your mouth and into the duct of your salivary gland. A special dye will then be injected into the duct to allow it to be more visible on an X-ray.
  • A lip biopsy can be used to detect inflammation of the salivary glands. During the biopsy, your lip will be numbed and a small amount of tissue will be removed to be examined under a microscope.

  • From Northwestern Memorial HealthCare, used by Northwestern University.