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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