AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 13

Salivary Gland Disease

A discussion of salivary glands should consider both the major (parotid, submandibular, and sublingual) salivary glands and the minor salivary glands. It is estimated that normal individuals have 750–1,000 minor salivary glands located submucosally from the lips to the trachea. The major salivary glands secrete more than 90 percent of the almost 1.5 liters of saliva we produce each day. Salivary gland enlargement may be classified as infectious or noninfec- tious, neoplastic and non-neoplastic. Bilateral parotid gland enlargement is commonly caused by viral infections, including human immunodefi- ciency virus (HIV) and mumps (paramyxovirus). Noninfectious causes of parotid hypertrophy include chronic diseases, such as diabetes mellitus (sialadenosis) and autoimmune disorders. Sjögren’s syndrome is a chronic autoimmune inflammatory disorder characterized by decreased lacrimal and salivary gland function, resulting in dry eyes and dry mouth. Diagnosis is often based on history and physical exam findings, as well as serologic studies . A lip biopsy can also be an important diagnostic test in patients who lack evidence of systemic autoimmunity. Bacterial parotitis is almost always caused by Staphylococcus aureus and presents with all the classic signs and symptoms of infection, including tumor (swelling), dolor (pain), calor (heat), and rubor (redness) . Often, pus can be expressed from Stensen’s duct . A potential cause is a salivary stone, although frequently the etiology is dehydration. Patients with bacterial parotitis generally do well when treated with hydration and anti- biotics. Local applications of heat and sialagogues, such as lemon drops, are ancillary measures. Occasionally, the gland will need to be drained surgically. Salivary gland stones (sialolithiasis) most commonly occur in the submandibular duct. They are usually radio-opaque and can occasionally be palpated by bimanual exam at the orifice of the duct adjacent to the lingual frenulum . Salivary gland stones can cause obstruction, leading to

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Primary Care Otolaryngology