Salivary Gland Disorders



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2014 Jun 1;89(11):882-888.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges. Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis. Inflammation is commonly caused by an obstruction such as a stone or duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. Diagnosis is made by imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging) and biopsy (initially with fine-needle aspiration). Overall, most salivary gland tumors are benign and can be treated with surgical excision.

Saliva is a complex mixture of fluid, electrolytes, enzymes, and macromolecules that function together to perform several important roles1: lubrication to aid in swallowing and digestion2; digestion of starches with salivary amylase3; modulation of taste4; protection against dental caries5; and defense against pathogens. The major salivary glands are the paired parotid, submandibular, and sublingual glands. The minor salivary glands line the mucosa of the lips, tongue, oral cavity, and pharynx.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Patients with chronic sialadenitis should be evaluated with a history, physical examination, and possibly imaging, and the underlying pathology should be treated.

C

3, 13

Sialendoscopy is useful in treating causes of chronic or recurrent sialadenitis, including sialolithiasis and recurrent parotitis of childhood.

C

11, 2023

Salivary tumors generally should be completely excised to confirm the diagnosis and decrease morbidity and mortality.

C

6, 28, 29


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Patients with chronic sialadenitis should be evaluated with a history, physical examination, and possibly imaging, and the underlying pathology should be treated.

C

3, 13

Sialendoscopy is useful in treating causes of chronic or recurrent sialadenitis, including sialolithiasis and recurrent parotitis of childhood.

C

11, 2023

Salivary tumors generally should be completely excised to confirm the diagnosis and decrease morbidity and mortality.

C

6, 28, 29


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Diseases of the major salivary glands are occasionally encountered in the primary care setting (Table 1). Obstructive sialadenitis (from stones or strictures) accounts for approximately one-half of benign salivary gland disorders.1 Neoplasms of the salivary glands are relatively rare; they make up 6% of all head and neck tumors, and their overall incidence is two to eight per 100,000 persons in the United States.2  Infections and inflammation of the salivary glands have a wide range of presentations (Table 2).6 An organized approach to the evaluation improves the likelihood of correct diagnosis and appropriate treatment (Figure 1).3

Table 1.

Salivary Gland Disorders

ConditionEtiologyClinical presentationDiagnosisTreatment

Acute suppurative sialadenitis

Bacterial infection

Sudden onset of pain and swelling

Swollen, indurated, tender gland; purulence from duct may be seen

Antibiotics, gland massage, hydration, sialagogues, warm compresses, oral hygiene

Chronic or recurrent sialadenitis

Obstruction (stone or stricture) of the duct

Repeated episodes of pain and swelling, often with meals; recurrent infections

Swollen or firm gland; may appear normal on examination; imaging (computed tomography or ultrasonography) may show calculus or dilated duct

Hydration, gland massage, sialendoscopy or open surgery

Neoplasm

May be benign or malignant

Painless, firm, slow-growing mass

Imaging (computed tomography or magnetic resonance imaging); fine-needle aspiration

Surgical removal of gland

Recurrent parotitis of childhood

Unknown

Repeated e

The Authors

KEVIN F. WILSON, MD, is an assistant professor of otolaryngology at the University of Utah School of Medicine, Salt Lake City.

JEREMY D. MEIER, MD, is an assistant professor of otolaryngology at the University of Utah School of Medicine.

P. DANIEL WARD, MD, MS, is an assistant professor of otolaryngology at the University of Utah School of Medicine.

Address correspondence to Kevin F. Wilson, MD, University of Utah School of Medicine, 50 N. Medical Dr., SOM 3C120, Salt Lake City, UT 84132 (e-mail: kevin. wilson@hsc.utah.edu). Reprints are not available from the authors.

References

1. Epker BN. Obstructive and inflammatory diseases of the major salivary glands. Oral Surg Oral Med Oral Pathol. 1972;33(1):2–27.

2. Stenner M, Klussmann JP. Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved. Eur Arch Otorhinolaryngol. 2009;266(3):333–341.

3. Rogers J, McCaffrey TV. Inflammatory disorders of the salivary glands. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head and Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010: 1151–1161.

4. McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngol Clin North Am. 1999;32(5):793–811.

5. Berndt AL, Buck R, von Buxton RL. The pathogenesis of acute suppurative parotitis: an experimental study. Am J Med Sci. 1931;182(5):639–649.

6. Isa AY, Hilmi OJ. An evidence based approach to the management of salivary masses. Clin Otolaryngol. 2009;34(5):470–473.

7. Brook I, Frazier EH, Thompson DH. Aerobic and anaerobic microbiology of acute suppurative parotitis. Laryngoscope. 1991;101(2):170–172.

8. Raad II, Sabbagh MF, Caranasos GJ. Acute bacterial sialadenitis: a study of 29 cases and review. Rev Infect Dis. 1990;12(4):591–601.

9. Brook I. Diagnosis and management of parotitis. Arch Otolaryngol Head Neck Surg. 1992;118(5):469–471.

10. Bozzato A, Hertel V, Bumm K, Iro H, Zenk J. Salivary simulation with ascorbic acid enhances sonographic diagnosis of obstructive sialadenitis. J Clin Ultrasound. 2009;37(6):329–332.

11. Quenin S, Plouin-Gaudon I, Marchal F, Froehlich P, Disant F, Faure F. Juvenile recurrent parotitis: sialendoscopic approach. Arch Otolaryngol Head Neck Surg. 2008;134(7):715–719.

12. Saunders JR Jr, Hirata RM, Jaques DA. Salivary glands. Surg Clin North Am. 1986;66(1):59–81.

13. Zou ZJ, Wang SL, Zhu JR, Wu QG, Yu SF. Chronic obstructive parotitis. Report of ninety-two cases. Oral Surg Oral Med Oral Pathol. 1992;73(4):434–440.

14. O'Brien CJ, Murrant NJ. Surgical management of chronic parotitis. Head Neck. 1993;15(5):445–449.

15. Levy DM, Remine WH, Devine KD. Salivary gland calculi. Pain, swelling associated with eating. JAMA. 1962;181:1115–1119.

16. Bodner L. Salivary gland calculi: diagnostic imaging and surgical management. Compendium. 1993;14(5):572, 574–576, 578 passim.

17. Hiraide F, Nomura Y. The fine surface structure and composition of salivary calculi. Laryngoscope. 1980;90(1):152–158.

18. Marchal F, Dulguerov P, Lehmann W. Interventional sialendoscopy. N Engl J Med. 1999;341(16):1242–1243.

19. Marchal F, Becker M, Dulguerov P, Lehmann W. Interventional sialendoscopy. Laryngoscope. 2000;110(2 pt 1):318–320.

20. Witt RL, Iro H, Koch M, McGurk M, Nahlieli O, Zenk J. Minimally invasive options for salivary calculi. Laryngoscope. 2012;122(6):1306–1311.

21. Luers JC, Grosheva M, Reifferscheid V, Stenner M, Beutner D. Sialendoscopy for sialolithiasis: early treatment, better outcome. Head Neck. 2012;34(4):499–504.

22. Maresh A, Kutler DI, Kacker A. Sialoendoscopy in the diagnosis and management of obstructive sialadenitis. Laryngoscope. 2011;121(3):495–500.

23. Zenk J, Koch M, Klintworth N, et al. Sialendoscopy in the diagnosis and treatment of sialolithiasis: a study of more than 1000 patients. Otolaryngol Head Neck Surg. 2012;147(5):858–863.

24. Centers for Disease Control and Prevention. Mumps vaccination. http://www.cdc.gov/mumps/vaccination.html. Accessed January 14, 2014.

25. Schiødt M, Dodd CL, Greenspan D, et al. Natural history of HIV-associated salivary gland disease. Oral Surg Oral Med Oral Pathol. 1992;74(3):326–331.

26. Mehta D, Willging JP. Pediatric salivary gland lesions. Semin Pediatr Surg. 2006;15(2):76–84.

27. Califano J, Eisele DW. Benign salivary gland neoplasms. Otolaryngol Clin North Am. 1999;32(5):861–873.

28. Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. 1986;8(3):177–184.

29. National Comprehensive Cancer Network. NCCN guidelines: head and neck cancers. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site (subscription required). Accessed January 14, 2014.

30. Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg. 1999;120(6):834–840.

31. de Oliveira FA, Duarte EC, Taveira CT, et al. Salivary gland tumor: a review of 599 cases in a Brazilian population. Head Neck Pathol. 2009;3(4):271–275.

32. Hanna EY, Suen JY. Malignant tumors of the salivary glands. In: Myers EN, Suen JY, Myers JN, Hanna EY, eds. Cancer of the Head and Neck. 4th ed. Philadelphia, Pa.: Saunders; 2003:475–510.

33. Simental A, Carrau RL. Malignant neoplasms of the salivary glands. In: Cummings CW, Flint PW, Harker LA, et al., eds. Cummings Otolaryngology Head and Neck Surgery. 4th ed. Philadelphia, Pa.: Mosby; 2004:1378–1405.

34. Sun EC, Curtis R, Melbye M, Goedert JJ. Salivary gland cancer in the United States. Cancer Epidemiol Biomarkers Prev. 1999;8(12):1095–1100.


Copyright © 2014 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

Article Tools

  • Download PDF
  • Print page
  • Share this page
  • AFP CME Quiz

More in Pubmed

Navigate this Article