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  1. Diagnosis of salivary gland disorders
  2. Introduction
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  4. Salivary Gland Cancer Tests
  5. Salivary Gland Disorders

People with salivary gland infections triggered by underlying medical conditions will require additional specialized treatment. If a person has an infection caused by a large abscess, a doctor may need to open and drain the abscess. For people taking medications linked to salivary gland infections, a doctor may need to switch their medication or change the dosage. Aside from medications, there is a variety of home remedies that may help the body clear salivary gland infections. People can try:.

To diagnose salivary gland infections, a doctor will often ask a person questions about their symptoms, review their medical history, and perform a physical exam of the area. Where a tumor or growth has caused the infection, a doctor may also take a sample to send to a lab for testing. If there is a blockage in the salivary gland, a doctor may also order imaging tests to get a better view of the area, such as a:. A wide range of lifestyle factors, medications, and medical conditions can reduce the flow of saliva and trigger salivary gland infections, such as:. A majority of salivary gland infections clear up on their own or with the aid of medications, self-care, and at-home remedies.

People with severe or chronic salivary gland infections will need ongoing medical care, especially if the infection is related to underlying medical conditions. Always talk with a doctor about head and neck symptoms of any kind that are severe, last for more than two weeks, do not respond to primary care or interfere with the mouth opening and closing.

Article last reviewed by Sat 14 July Visit our Ear, Nose and Throat category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Ear, Nose and Throat. All references are available in the References tab. Chandak, R. Acute submandibular sialadenitis—a case report. Abdel Razek, A.

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Imaging of sialadenitis. Sasaki, C.

Diagnosis of salivary gland disorders

Salivary gland disorders. The salivary glands. Wilson, K. American Family Physician , 89 11 , — MLA Huizen, Jennifer. MediLexicon, Intl. APA Huizen, J. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

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  • Privacy Terms Ad policy Careers. Visit www. All rights reserved. More Sign up for our newsletter Discover in-depth, condition specific articles written by our in-house team. Search Go. Please accept our privacy terms We use cookies and similar technologies to improve your browsing experience, personalize content and offers, show targeted ads, analyze traffic, and better understand you. Scroll to Accept. Get the MNT newsletter. Enter your email address to subscribe to our most top categories Your privacy is important to us. Email an article.

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    You have chosen to share the following article: How elderberries can help you fight the flu To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf. Optional Comments max. Send securely. Message sent successfully The details of this article have been emailed on your behalf. Reviewed by Judith Marcin, MD. The submandibular gland is susceptible to salivary gland infections. People may experience pain and swelling in the neck area. Everything you need to know about dry mouth. A person with dry mouth may be more likely to get a salivary gland infection.

    Learn more about this condition here. An ultrasound may be necessary to look at the blockage in more detail. Related coverage.

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    Please use one of the following formats to cite this article in your essay, paper or report: MLA Huizen, Jennifer. Oropharyngeal swallowing difficulties are best evaluated by ultrasound studies. Food bolus formation and translocation can be perturbed in patients with reduced salivary output. One of the most common infections in patients with salivary dysfunction is oral candidiasis e.

    This fungal infection manifests itself as angular cheilitis of the lips, erythematous candidiasis beneath prostheses, and pseudomembraneous candidiasis as a white plaque that can be removed from all oral mucosal surfaces. A second frequent infection is new and recurrent dental caries. Recurrent carious lesions are particularly common among today's elderly, because of the high prevalence of retained natural teeth and previously restored dental surfaces Edentulous and partially edentulous adults using removable prosthetic devices have diminished denture retention, which will impact adversely chewing, swallowing, speech, and nutritional intake Speech and eating difficulties can impair social interactions and may cause some patients to avoid social engagements.

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    The majority of questions relate to xerostomia experienced during mealtime, and therefore these items may be most useful. However, there is substantial variability in flow rates that makes it difficult to define diagnostically useful ranges of glandular fluid production. Unstimulated secretions are probably more indicative of dry mouth complaints compared with stimulated secretions The best strategy is to simply monitor a patient's salivary health both objectively and subjectively over time The composition of saliva also exhibits considerable variability While salivary exocrine proteins are critical for oral physiological performance, there are no common disease situations resulting in the deficiency of any single major salivary protein.

    Therefore, there is no practical reason to monitor the protein composition of a patient's saliva. Intraoral and extraoral salivary gland swellings should be evaluated using histopathological and imaging techniques, depending upon the clinical scenario. Minor salivary gland mucoceles can undergo excisional biopsies, whereas larger tumors will benefit from incisional biopsies for histopathologic diagnosis and tumor staging in order to plan subsequent therapies Sialograms can identify changes in the salivary gland architecture, and are useful for major salivary gland swellings Radioactive isotype scintiscans e.

    T 99 pertechnetate can provide a qualitative functional assessment of the major salivary glands 79 ; ; Magnetic resonance imaging and computerized tomography CT scans will help rule out salivary gland tumors and other pathoses associated with the craniofacial region that may adversely affect salivation.

    All salivary gland infections should be cultured to identify organisms that may be resistant to commonly used antibiotics. Bacterial infections are more common in older persons who experience salivary hypofunction secondary to medications, head and neck radiation, systemic diseases, or dehydration 4 ; 3. Acute parotitis was commonly seen before the antibiotic era in terminally ill and dehydrated patients and contributed to mortality by sepsis. Now, acute parotitis is observed infrequently. Chronic parotitis is not unusual, and it follows obstruction of a major salivary gland duct with subsequent bacterial colonization and infection.

    Signs and symptoms of bacterial salivary infections include swelling, purulence from the major salivary gland duct, and pain Viral infections occur in persons of all ages, particularly in immunocompromised patients, and preferentially involve parotid glands. Mumps is caused by paramyxovirus, and presents as bilateral parotid gland swellings in children. Acute sialadenitis usually results from an immediate partial or complete ductal obstruction i. Mucoceles are the most common reactive lesion of the lower lip, and are caused by local trauma.

    When a minor salivary gland duct is severed, mucin leaks into the surrounding connective tissue, resulting in a smooth surfaced painless nodule in the submucosal tissues. Mucous cysts of the sublingual and submandibular glands are referred to as ranulas.

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    • They present as either unilateral circumscribed lesions subsequent to ductal obstruction and cystic dilatation or plunging lesions following extravasation of saliva herniating through the tissues of the floor of the mouth and the mylohyoid muscle 5. Salivary gland swellings are also caused by calculi sialoliths, stones , which are calcifications of mucous plugs and cellular debris resulting from dehydration and glandular inactivity. They most frequently develop in the submandibular duct system. Sialoliths can occasionally be palpated using bidigital palpation techniques in the floor of the mouth for submandibular and sublingual calculi and parotid regions.

      Salivary gland tumors are the subject of a future review in this series, and will only be briefly mentioned herein. Most salivary gland tumors are benign. Malignant salivary gland tumor incidence increases with age, and these tumors are more common in the submandibular and sublingual glands. Pleomorphic adenomas tend to be unilateral and most commonly present as an asymptomatic mass in the tail of the parotid gland.

      They are slow growing, well delineated, and encapsulated. Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, followed by adenoid cystic carcinoma cylindroma 85 , acinic cell carcinoma, adenocarcinoma, squamous cell carcinoma, and carcinoma arising in a pleomorphic adenoma. The most frequently affected intraoral site is the palate followed by the upper lip. Signs and symptoms of a malignant salivary gland tumor include a swelling with facial nerve paralysis, pain, or facial paresis.

      SS is primarily a disease of women it may be as prevalent as one out of every females with a typical onset during the fourth or fifth decade of life ; 61 ; This is a debilitating systemic autoimmune disorder associated with inflammation of epithelial tissues, particularly exocrine glands , and is classified as primary SS or secondary SS. Primary SS involves salivary and lacrimal gland disorders with associated decreased production of saliva and tears.

      In secondary SS, the disorder occurs with other autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis, and polyarteritis nodosa Typical oral findings in the SS patient with xerostomia are as described above for other xerostomic patients.

      Swollen major salivary glands are common, because of salivary hypofunction, ductal inflammation, and acinar destruction. However, it is important to rule out malignancy in the presence of persistently and significantly enlarged salivary glands and neck lymph nodes. Diagnostic imaging e. CT scans and needle aspirates for cytological and flow cytometric analyses are helpful for establishing a diagnosis.

      If these investigations are equivocal, biopsy or removal of the swollen gland must be considered. Other signs and symptoms of SS can be ascertained from a clinical examination. Impaired tear production results in inflammation and damage in the lacrimal glands.

      Salivary Gland Cancer Tests

      Systemic manifestations are frequent, including synovitis, neuropathy, vasculitis, and disorders of the skin, thyroid gland, urogenital system, respiratory, and gastrointestinal tracts. The key characteristics of SS are oral and ocular symptoms and signs of dryness, a positive labial salivary gland biopsy focal, periductal, mononuclear cell infiltrates and the presence of autoantibodies.

      Other autoimmune conditions associated with SS have salivary dysfunction, including rheumatoid arthritis, scleroderma, and lupus 7 ; Diabetes may cause changes in salivary secretions 31 , 32 , and associations have been made between poor glycemic control, peripheral neuropathies, and salivary dysfunction Alzheimer's disease, Parkinson's disease, strokes, and cystic fibrosis will inhibit salivary secretions. The most common types of medications causing salivary dysfunction have anticholinergic effects see future article in this series , via inhibition of acetylcholine binding to muscarinic receptors on the acinar cells Any drug that inhibits neurotransmitter binding to acinar membrane receptors, or that perturb ion transport pathways, may also adversely affect the quality and quantity of salivary output.

      Therefore, patients taking one or more drugs with antisialogogue sequelae should be followed carefully for developing signs and symptoms of salivary disorders. Chemotherapy for cancer treatment has been associated with salivary disorders 29 ; 90 , 91 ; These changes appear to occur during and immediately after treatment. Radiation therapy RT is a common component of treatment for head and neck cancers. In addition, patients often experience the spectrum of oral—pharyngeal problems as a result of permanent salivary gland destruction ; All cancer patients should be followed closely for developing salivary disorders and their adverse oral sequelae.

      The effects of RT on salivary gland function will be the subject of a subsequent article in this series. As discussed earlier, treatment for salivary dysfunction begins with appropriate diagnosis. Once a diagnosis has been established, treatment is designed based upon the etiopathogenesis of the disorder and the prognosis. If the prognosis for restoration of normal salivation is poor, such as with head and neck radiotherapy for oral cancers, then use of salivary replacements and stimulants may help.

      Frequent dental evaluations are critical with a focus on preventing the myriad of oral disorders that develop because of salivary hypofunction, and for instructing patients on proper oral hygiene 10 ; Patients, particularly older adults, must be reminded to maintain hydration water is the drink of choice to assist with xerostomia. Limiting or stopping these practices should lessen the severity of dry mouth symptoms In the absence of remaining salivary tissue, artificial saliva and lubricants may ameliorate some xerostomic symptoms.

      These products tend to diminish the sensation of oral dryness and improve oral functioning. Preference of products depends on effect duration, lubrication, taste, delivery system, and cost; many patients nevertheless primarily use water Secretogogues such as pilocarpine can increase secretions and diminish xerostomic complaints in patients with sufficiently remaining exocrine tissue e. Adverse effects include increased perspiration, greater bowel and bladder motility, and feeling hot and flushed. Patients with a history of bronchospasm, severe chronic obstructive pulmonary disease, congestive heart disease, and angle closure glaucoma should not take pilocarpine.

      Like pilocarpine, it is a muscarinic agonist that increases production of saliva. As M2 and M4 receptors are located on cardiac and lung tissues, cevimeline can enhance salivary secretions while minimizing adverse effects on pulmonary and cardiac function. Patients with uncontrolled asthma, significant cardiac disease and angle closure glaucoma should not take cevimeline. Over the last decade there has been some interest in using acupuncture techniques to enhance salivation 20 ; 6 ; Although this treatment modality is not commonly utilized, it presents a treatment option for patients who respond well to muscarinic agonists e.

      Strategies are directed towards prevention and early detection of various lesions, remineralization of incipient lesions, and permanent restoration of new and recurrent decay. Stronger prescription fluoride formulations 1. The secondary effects of salivary hypofunction on soft tissues also require appropriate diagnosis and treatment.

      Desiccated oral mucosal tissues are more susceptible to ulcerations and traumatic lesions. Soft tissue management includes maintaining mucosal integrity to avoid local 30 or systemic infections from oral microflora. Initial therapy for salivary infections e. Viral infections of salivary glands usually resolve after symptomatic treatment, but in the severely medically compromised patient, systemic antiviral therapy acyclovir, valacyclovir, ganciclovir, foscarnet should be initiated.

      Concomitant use of antimicrobial mouth rinses e. Oral candidiasis is the most frequent oral infection secondary to dry mouth, and is treated initially with topical antifungal agents ; Ketaconazole, Fluconazole should be reserved for refractory disease and immunocompromised patients. Dentures may harbor fungal infections and thus require treatment. Patients must be instructed to perform daily hygiene of the appliance, and to keep the prosthesis out of the mouth for extended periods and while sleeping.

      Salivary Gland Disorders

      A few drops of Nystatin oral suspension or a thin film of Nystatin ointment can be applied to the inner surface of a denture after each meal. It is important to note that Nystatin and Clotrimazole troches contain sugar, and therefore the patient with severe salivary gland dysfunction at risk for dental caries should use vaginal Nystatin tablets.

      Retention of removable prostheses can become impaired and painful in the presence of desiccated oral mucosa tissues and the lack of adequate salivary output. Careful chewing and swallowing is advised with the addition of frequent sips of liquids to avoid choking and aspiration. Problems with swallowing may be treated with oral moisturizers and lubricants and careful use of fluids during eating.