American Medical Association Family Medical Guide - American Medical Association [482]
Treatment
Unless the gland is completely blocked, the doctor will probably use lemon juice to stimulate the flow of saliva in the infected gland to flush out the bacteria. He or she will prescribe an antibiotic to treat the infection and may use probes to try to widen the ducts of the salivary gland to increase the flow of saliva and prevent further infection. If the salivary gland has been irreversibly damaged, your doctor may recommend surgery to remove it.
Stones in the Salivary Ducts or Glands
Salivary duct stones are tiny particles that form when chemicals and salts in saliva collect around a tiny amount of solid material or mucus in the duct of a salivary gland. Stones inside the salivary gland itself are more rare. The stone blocks the duct, preventing saliva from getting through and causing the gland to swell. A persistently obstructed salivary gland duct can cause extensive scarring that reduces the gland’s ability to produce saliva. The submandibular glands (on each side of the neck below the jaw) are the most susceptible to blockage. Salivary duct stones most frequently affect middle-aged or older people.
Symptoms and Diagnosis
The main symptoms of a stone in the salivary duct are pain and swelling on each side of the neck below the jaw, above the angle of each jaw, or under the chin, particularly while eating.
To check for a stone in a salivary duct or gland, your doctor may recommend X-rays. If the cause is still not clear, he or she may order a sialogram, an X-ray of the salivary gland and ducts taken after injection of a contrast medium (dye). A sialogram will show the areas of obstruction on X-ray film. In addition, the doctor may recommend a CT scan (see page 112) or ultrasound (see page 111) to help confirm the diagnosis.
Treatment
Salivary duct stones can be removed by a doctor. He or she will try to dislodge the stone by massaging your jaw to widen the salivary duct or by making a superficial cut in the floor of the mouth to allow the stone to pop out. To treat recurring stones, a surgeon can make a permanent opening along the duct to allow saliva to drain into your mouth. Having a permanent opening may help prevent other stones from blocking the duct and can reduce the risk of scarring. If a stone forms inside the salivary gland itself or at the beginning of the duct and causes frequent infections, your doctor may recommend surgery to remove the entire gland. A procedure called extracorporeal lithotripsy (see page 816) can also be used to direct shock waves at the stones to break them up.
Salivary Gland Tumors
Most tumors in the salivary glands form in the parotid glands (located above the angle of each jaw), although they can form in other salivary glands as well. These tumors usually develop slowly over several years. In some cases, salivary gland tumors become cancerous, especially in the parotid glands.
Symptoms
The main symptom of salivary gland tumors is swelling on either side of the face above the jaw. These tumors seldom cause pain. See your doctor about any swelling in or below your jaw that recurs or that doesn’t heal within 2 weeks.
Diagnosis
If you have symptoms of a salivary gland tumor, your doctor may perform an aspiration biopsy to help reach a diagnosis. During an aspiration biopsy, the doctor inserts a small needle into the tumor and uses a syringe to withdraw a small amount of tissue and fluid for examination in the laboratory. A doctor may also order a CT scan (see page 112) or MRI (see page 113) to get a clear image of the tumor.
Treatment
If you have a salivary gland tumor, your doctor will recommend surgery to remove the entire gland, or most of it. If a tumor is cancerous, doctors sometimes recommend radiation therapy (see page 23) to kill any remaining cancer cells. When a submandibular gland is removed, a nerve that controls the lower lip may be injured. During