Salivary gland pathology (sialadenitis, stones, cancer)
GGC - Primary Care
Background:
The major salivary glands are made up of the parotid glands located anteroinferior to the ear, the submandibular glands located beneath the body of the mandible and the sublingual glands located on the floor of the mouth.
Saliva gland problems can be tumour, infectious or ductal in origin.
Tumour causes are indicated by a palpable lump. The majority of these lesions will be benign. In the parotid gland, 80% of tumours are benign. In the submandibular gland, 50% are benign.
Infectious sialadenitis can be viral or bacterial in origin. In younger patients, viral causes are more common e.g. mumps. In the elderly, bacterial causes are more common and indicate significant frailty and often follow a period of dehydration.
Ductal causes include salivary duct stones which impede salivary flow. This can cause intermittent swelling and discomfort in the saliva gland on eating. This can also increase the risk of developing an infection of the salivary gland.
Figure – location of parotid duct
How to assess:
Be sure to compare sides. Occasionally, salivary glands can be appreciated more by patients following significant weight loss, or become more obvious with age.
Feel for a discrete lump – if this is present, consider tumour as a cause
Feel for generalised swelling of the gland – if this is present, consider infective or ductal causes. Please feel in the mouth with a gloved finger for a ductal stone. The parotid duct is located opposite the 2nd upper molar tooth. The submandibular duct is located in the floor of the mouth under the tongue.
How to manage:
If the whole gland is swollen, consider infection or ductal stone and advise warm compresses, gland massage, sialogogues (e.g. lemon juice) and prescribe a 7 day course of oral co-amoxiclav.
Referral guidance:
If a persistent neck lump >3 weeks, refer to ENT as urgent, suspicion of cancer
Any persistent floor of mouth lesion >3 weeks should be referred to the Maxillofacial department
If you suspect a ductal stone, refer to ENT as routine