Primary Care Otolaryngology

Chapter 14

Salivary Gland Disease

A discussion of salivary glands should consider both the major (parotid, submandibular, and sublingual) salivary glands and the minor salivary glands. It is estimated that normal individuals have 750–1,000 minor sali- vary glands located submucosally from the lips to the trachea. Bilateral salivary gland enlargement is commonly caused by viral infec- tions, including human immunodeficiency virus (HIV) and mumps. In addition, patients with autoimmune disorders may have salivary dysfunc- tion (dry mouth), dry eyes, and arthritis. A cluster syndrome known as Sjögren’s disease is frequently associated with parotid enlargement. Diagnosis is based not only on history and physical, but also on serologic studies (SSA and SSB) . Bacterial parotitis is almost always caused by Staphylococcus aureus, and presents with all the classic signs and symptoms of infection, including tumor (swelling), dolor (pain), calor (heat), and rubor (redness). Often, pus can be expressed from Stensen’s duct. A potential cause is a salivary stone, although frequently the etiology is dehydration. Patients with bacte- rial parotitis generally do well when treated with hydration and antibiotics. Local applications of heat and sialagogues, such as lemon drops, are ancil- lary measures. Occasionally, the gland will need to be drained surgically. Salivary gland stones (sialolithiasis) most commonly occur in the sub- mandibular duct. They are usually radio-opaque and can occasionally be palpated by bimanual exam at the orifice of the duct adjacent to the lingual frenulum . Salivary gland stones can cause obstruction leading to stasis with possible secondary bacterial infection. Treatment is removal of the stone. The duct must be incised because the stone cannot be milked out distally. Some institutions are using salivary endoscopy and lithotripsy to treat salivary stones. Masses often present in the salivary glands and need to be evaluated by an otolaryngologist. Physicians often perform fine-needle aspiration to

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