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Salivary Gland Surgery


Saliva is a watery substance found in our mouth produced by salivary gland. Saliva is made of water, enzymes, anti-bacterial compounds, electrolytes, mucus, glycol-proteins, and a few bacterial compounds. It serves as a lubricator, wetting food and initiates swallowing of food and also protects the teeth and mucosal surfaces of the oral cavity.

The salivary glands are located around the mouth and throat and arecategorized as major and minor salivary glands. The major salivary glands that drain saliva through ducts are the parotid,

submandibular and sublingual glands and a number of minor salivary glands are located on the lips, cheeks, lining of mouth and throat.

Problems to the salivary gland indicated with clinical symptoms include obstruction, infection, enlargement and tumour. Obstruction of major salivary glands that prevents flow of saliva may be due to the formation of stones. Infection of the parotid gland, lymph nodes or ducts due to bacteria formation, also results in poor flow of saliva. Benign and malignant tumours also grow on the salivary glands and should be investigated. Autoimmune diseases also attack salivary glands.

Diagnosis of salivary gland disease is done by observing the history of the patient, physical examination and tests in the laboratory. Treatment method adopted may be medical or surgical and the selection depends on the nature of the problem. However, most of the problems of the salivary gland are successfully treated with surgery.

HOW THE SURGERY IS PERFORMED

Generally, parotid, the largest salivary gland is removed and the procedure is called Parotidectomy. Surgeons may prefer to remove a part or whole of the gland and this depends on the ailment. The procedure, performed under general anesthesia, may involve removal of the superficial lobe or both superficial and deep lobes. The procedure, performed for diagnosis of tumours, necessitates removal of tissues of the gland. The sample is sent to a pathologist, who then slices a thin section, freezes and colours it with special dyes and examines it under a microscope to find out the type of tumour.

Sometimes Submandibular Sialadenectomy, which involves removal of the submandibular gland, is performed to treat chronic infections, stones and tumours. Tumours that grow on these glands are often malignant and may require the removal of the entire gland. The procedure, performed under general anaesthesia, requires making two inch incisions in the lower jaw and the complete gland may be removed. But its loss is not felt because many other glands produce enough saliva.

Sometimes, the sublingual gland may have to be removed when there is a blockage in the ducts of the gland. The procedure, performed under general anaesthesia, involves making 2cm long incisions under the tongue, inside the lower set of teeth. The gland is spotted and removed and the incision is stitched. The stitches dissolve by themselves.

After the surgery of any of the above said salivary glands, the patient may find the throat very sore accompanied by swelling. Pain killers may have to be taken to suppress pain and the effectiveness of the surgery may be realized after the patient restores normalcy.

Authored by Dr Shailesh Pandey, ENT Specialist

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