The salivary glands are small organs located in and around your mouth and throat that produce saliva. This fluid plays a role in digestion, moistening food for easier chewing and swallowing, and contains enzymes that begin breaking down starches and fats. Saliva also helps maintain oral health by lubricating the mouth, protecting teeth from bacteria, and preventing infections. When abnormal cell growths, known as tumors, develop in these glands, surgical removal often becomes a necessary treatment.
Understanding Salivary Gland Tumors
Salivary glands are categorized into major and minor glands. The three pairs of major glands include the parotid glands, located in front of each ear, the submandibular glands, found under the jaw, and the sublingual glands, situated beneath the tongue. Hundreds of minor salivary glands are distributed throughout the mouth, throat, tongue, lips, and cheeks. Tumors can arise in any of these glands, with most occurring in the parotid glands.
Salivary gland tumors can be either benign (non-cancerous) or malignant (cancerous). Common benign examples include pleomorphic adenoma (the most frequent benign parotid tumor) and Warthin’s tumor (often linked to smoking, common in older men). Malignant tumors are less common but include mucoepidermoid carcinoma (often originating in the parotid glands) and adenoid cystic carcinoma (which can begin in the neck and head glands).
Symptoms include a firm, often painless, swelling in a gland (e.g., in front of the ear, under the chin, or on the floor of the mouth). Swelling rate can indicate slow growth (suggesting benign) or rapid enlargement (suggesting malignant or infection). Other symptoms include persistent pain (face, neck, jaw, mouth), facial nerve palsy, difficulty opening the mouth, or difficulty swallowing.
Planning for Salivary Gland Surgery
Surgery is often chosen for salivary gland tumors to remove the growth and prevent spread. The specific surgical approach depends on the tumor’s location and characteristics, aiming for complete removal while preserving healthy tissues.
The diagnostic process begins with a physical examination of the affected area, followed by imaging studies. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans define the tumor’s size, location, and relationship to nearby structures. A fine needle aspiration biopsy (FNAB) is often performed, where a thin needle collects cells from the tumor, aiding preoperative diagnosis.
During pre-operative consultations, patients meet with a multidisciplinary team, including a surgeon specializing in head and neck operations, an anesthetist, and a clinical nurse specialist. These discussions cover the planned surgical procedure, its risks, and what to expect during and after surgery. Additional tests (e.g., blood tests, ECG, breathing tests) ensure the patient is healthy enough for surgery.
Performing Salivary Gland Surgery
Salivary gland surgery aims to remove the tumor while safeguarding adjacent nerves. The specific technique varies based on the gland involved and the tumor’s characteristics. Anesthesia is administered to ensure patient comfort throughout the procedure, and incisions are strategically placed to minimize visible scarring.
For tumors in the parotid gland, the largest salivary gland, a parotidectomy is performed. If the tumor is confined to the superficial lobe, a superficial parotidectomy removes only that portion. If the tumor is in the deeper lobe or involves both, a total parotidectomy removes the entire gland. The facial nerve runs through the parotid gland; its preservation is a primary concern.
Submandibular gland excision involves removing the entire submandibular gland. An incision is made under the jawline. This procedure requires careful attention to nearby nerves such as the marginal mandibular nerve, affecting smiling, and the lingual and hypoglossal nerves, involved in tongue sensation and movement. Tumors in the sublingual glands require excision of the entire gland through an incision inside the mouth. Similarly, minor salivary gland tumors are removed depending on their location, often involving surrounding tissue.
Recovery and Potential Considerations
Following salivary gland surgery, patients remain in the hospital, and pain is managed with medication. Surgical drains may be placed and are removed within a few days. The recovery timeline varies, but many patients return to normal activities over several weeks, with full recovery taking a few months.
Salivary gland surgery has several potential complications. Facial nerve weakness or paralysis can occur, ranging from temporary bruising during surgery to permanent damage if the nerve must be partially or fully removed. Numbness in the surgical area is common due to nerve manipulation.
Frey’s syndrome, or gustatory sweating, is a long-term complication, occurring when eating or thinking about food causes sweating and flushing over the surgical site. This happens because damaged nerves that normally stimulate saliva production mistakenly regenerate to innervate sweat glands. While it can affect many patients, it is often mild; symptomatic cases might be managed with topical antiperspirants or botulinum toxin injections. Less common complications include salivary fistula and a seroma (a collection of fluid under the skin). Follow-up appointments are important to monitor recovery and address long-term concerns.