Salivary glands produce saliva, which keeps your mouth moist, supports healthy teeth and aids in digestion. There are three pairs of major salivary glands located under and behind the jaw. They are- Parotid, Sublingual and Submandibular. There are various tiny salivary glands located in the lips, cheeks and throughout the mouth and throat.
Salivary gland tumours are very rare tumours. They may begin growing in any of the salivary glands. Most salivary gland tumours are non-cancerous, however, some may be cancerous. Treatment for such tumours is usually where the tumour is removed. Patients with malignant tumours may need additional treatment.
What are the symptoms of salivary gland tumours?
Some symptoms include:
- Difficulty eating
- Difficulty swallowing
- Blocked saliva flow
- Pain in the glands
- Swelling in the glands
- Lumps or growths in the gland
- Partial facial numbness
- One-sided facial muscle weakness
- Difficulty opening your mouth widely
What causes a salivary gland tumour?
Salivary gland tumours are very rare and their cause is not yet known to medical science. However, the most common salivary tumours are in the Parotid Gland.
How is a salivary gland tumour diagnosed?
- Clinically– During your physical examination, the doctor will feel your jaw, neck and throat for any swellings or lumps.
- Radiological Imaging– Imaging such as CT scan, MRI, ultrasound or x-ray would help your doctor better judge the exact location and size of the tumour.
- Biopsy– A tissue sample may be collected by fine-needle aspiration or a core needle. The sample is analysed in a lab to determine the type of cells involved and if they are cancerous.
What is the treatment for salivary gland tumours?
Treatment usually involves surgery where the tumour is removed. Patients with malignant tumours may need additional treatment like radiation therapy or chemotherapy.
Salivary gland tumour surgery may include:
- Partial excision of the salivary gland: For small and easy-to-access tumours, the doctor may remove the tumour along with a small part of healthy tissue around it.
- Complete excision of the salivary gland: For larger tumours, the doctor may decide to remove the entire gland. If the tumour extends into nearby structures, it may also need to be removed.
- Neck lymph node excision: The doctor may need to remove some lymph nodes from the neck. This is usually in cases of malignant tumours and if there is suspicion that cancer has spread to the lymph nodes.
- Reconstructive surgery: After the tumour has been removed, the doctor may recommend reconstructive surgery to repair the affected area. However, this is usually required after large tumours requiring extensive surgery.
There are various types of salivary gland surgeries. They are:
- Parotidectomy: Parotid gland tumours are the most common of all salivary gland tumours. A parotidectomy is done to remove a benign or malignant tumour in the parotid glands. Particular care needs to be taken during a parotidectomy due to its proximity to the facial nerve and other important structures. For further information on Parotidectomy, visit our page on Parotid Gland Tumors (Hyperlink to page)
- Submandibular Gland Excision: Submandibular glands are located below the jaw. The surgery involves removing the affected gland and some surrounding tissue. The extent of the surgery depends on the size and type of tumour.
During surgery, special care needs to be taken because of important nerves nearby:
- Marginal Mandibular Nerve- Helps in smiling
- Lingual Nerve- Enables sensation on the tongue
- Hypoglossal Nerve- Enables movement in the part of the tongue involved with speech and swallowing
The surgery takes around an hour and a half. The patient is under general anaesthesia ensuring comfort through the surgery. A 2 to 3 cm long incision is made in the skin crease below the jaw, making the scar less visible. The affected gland is then located and is freed from surrounding tissues and structures. It is then removed entirely and the wound closed.
Maximum effort will go toward preserving these nerves and other structures whenever possible, however, it depends on the location and extent of the tumour.
- Sublingual Gland Excision: Sublingual glands are located under the tongue on both sides of the floor of the mouth. Surgery involves the removal of the entire affected gland along with some surrounding healthy tissue. An incision is made inside the mouth to remove the gland along with some surrounding healthy tissue. The surgical area is often repaired by suturing the gap or using a skin graft.
Special care is taken during a Sublingual Gland Excision due to its proximity to the Lingual Nerve, which controls feeling and taste on that side of the tongue. Doctors will try and preserve this nerve as best they can.
Post-operatively, you may feel numbness on the affected side. However, this is usually temporary and may last from a few weeks to a couple of months.
- Surgeries for Minor Salivary Gland Cancer: Cancer of minor salivary glands can occur in the tongue, lips, inner cheek, palate, throat, voice box, nose and even in the sinuses. Doctors would remove the cancerous tissue along with some surrounding healthy tissue. This tissue sample is sent for a histopathological study to see if the margins contain only healthy tissue. If that is the case, chances are that cancer has been removed in its entirety.
However, the exact surgical details and type of surgery would depend on the size and location of cancer.
- Lymph Node Excision: Cancers of the salivary glands tend to spread to the lymph nodes in the neck before spreading anywhere else. Hence, removing lymph nodes from the neck (and other nearby tissue) is done during surgery to remove cancer. The aim is to remove lymph nodes suspected of containing cancer cells.
What are the risks of Salivary Gland surgery?
Safeguarding the Nerves
Salivary gland surgery is very complex and intricate due to the proximity of various important nerves to the different salivary glands. Avoiding any damage to them is of paramount importance, however, it also depends on the size and extent of the tumour. To prevent damage to these nerves, modern facial nerve monitoring techniques and devices are used during surgery.
A disturbance of these nerves during surgery could result in weakness, temporary changes in facial movement or diminished sensation in the associated area. Permanent damage is a very rare complication.
Other complications
Other possible complications that could arise are:
- Scarring
- Infection
- Bleeding
- Seroma- A build-up of fluid under the skin which could result in a lump or cyst.
Possible signs of these side effects are monitored by the medical team during hospitalization. If any of the above-mentioned complications arise, medical attention is needed.
Post-operative Management
After surgery, a drain will be placed to prevent the collection of fluid and blood in the wound. The drain will be removed after a few days. The patient is usually allowed to leave the day after the surgery.
During discharge, special instructions will be given which must be adhered to. Taking care of the wound and keeping it clean and dry and extremely important to prevent infections.