Sialadenitis and Submandibular Gland Excision

Sialadenitis and excision of submandibular gland

Salivary glands produce saliva which helps digestion, oral hygiene, and swallowing. Sialadenitis refers to the inflammation of the salivary glands, which are responsible for producing saliva that aids digestion, oral hygiene, and the maintenance of a healthy oral environment. Sialadenitis can impact on oral health and overall well-being.  This condition can be painful, cause swelling and if left untreated can lead to complications.

What is sialadenitis?

Sialadenitis occurs when a salivary gland becomes inflamed or infected. The inflammation can be acute (happen suddenly) or chronic (have been there a long time/be persistent) and can be caused by a number of factors such as bacterial infections, blockages, or medical conditions including autoimmune conditions. Sialadenitis can affect either your parotid glands, located near your cheek in front of your ear, or the submandibular gland (in your neck under your jaw).

Symptoms of sialadenitis

Symptoms can range from mild to severe and may include:

  • Oedema (swelling): the affected gland may become swollen and tender to the touch
  • Pain or discomfort: Pain around the affected gland which can become worse when eating or salivating (particularly if the swelling is caused by a stone blocking the duct – sialolithiasis).
  • Erythema (redness): The area around the affected gland can appear red and feel warm which is a sign of an infection (usually bacterial).
  • Difficulty chewing and swallowing: This can occur from swelling and discomfort which can make chewing and swallowing challenging.
  • Fever and chills: In cases of bacterial infection, a high temperature may be associated with the inflammation.
  • Dry mouth: Caused by a decrease in saliva production.
  • Foul taste: Infected discharge going into the mouth from the saliva glands causes a foul taste in the mouth and can be expressed if pressing on the gland.

Causes of sialadenitis

  • Bacterial infection: Often due to a blockage in the salivary duct, potentially a salivary gland stone (sialolithiasis) or stricture (narrowing) preventing normal salivary flow. Bacteria collects in the stagnant saliva and can causing infection of the duct and gland. Typical bacteria include staphylococcus and streptococcus.
  • Viral infection: There are numerous viruses that can cause infection for example Mumps.
  • Salivary stones: Stones within the salivary ducts can lead to blockages, causing accumulation of saliva and potential infection (sialolithiasis).
  • Dehydration: Insufficient fluid intake can lead to a thickening of saliva, making it more prone to blockages and infection.
  • Medical conditions: Certain medical conditions such as Sjogren’s syndrome, HIV or diabetes can increase the risk of sialadenitis.

Investigations

To investigate your salivary gland swelling you may need an X-ray of your jaw/face, an ultrasound scan of the salivary glands and, if a stone or blockage is suspected, possibly a Sialogram where X-ray contrast is injected into the salivary gland which can show stones or strictures (narrowing) in the salivary gland drainage pathways. Occasionally, blood tests may be required and at times a CT scan or MRI scan might be necessary.

The procedure

In some cases of sialadenitis, particularly when the condition is recurrent or severe, surgery might be considered when other measures such as good hydration, massage, warm compresses and antibiotics have not helped. Surgical options include endoscopic techniques to dilate the ducts or remove stones; open removal of stones or removal of the salivary gland. The type of procedure depends on a number of factors and will be decided on a case by case basis.

Information on submandibular gland surgery is outlined below (known as submandibular gland excision). For parotid gland removal, please see further information HERE about parotid glands and tumours. Parotid glands are rarely removed for inflammation (as opposed to tumours) due to the risk of complications.

Risks of submandibular gland excision

Submandibular gland excision is reserved for persistent or troublesome cases where conservative non-surgical methods, including medication, have failed. Submandibular gland removal is performed under general anaesthetic. An incision is made in the neck a few centimetres under the jaw, often along the natural creases to hide the scar. The potential benefits versus the risks of the procedure will be discussed following a thorough history and examination. The risks of the procedure include:

  • Infection at the surgical site.
  • Bleeding.
  • Damage to surrounding tissues.
  • Nerve injury which could lead to temporary or permanent issues such as weakness of the lower lip, reduced sensation, and reduced movement of the tongue.

Nerve injury which could lead to temporary or permanent issues such as weakness of the lower lip, reduced sensation, and reduced movement of the tongue.

Post-operative information

Following the procedure, you will either go home the same day or remain in hospital for one night and will probably have a small drain (plastic tube) in the neck to stop a collection of fluid building up where the gland has been removed (this is removed within 24 hours before you go home). Stitches will either be dissolvable or will need removal at 5 to 7 days post-operatively, and the wound will need to be kept dry until then. You will be followed up in clinic a few weeks later to discuss the histopathology of the removed gland and to check everything has healed well.

If you have any questions or you think you may be suffering with sialadenitis, please contact Kent ENT Partnership to arrange a consultation.