Treatment of Salivary Gland Disease at UAB

Minimally invasive approach to the salivary gland

The major salivary glands produce approximately one quart of saliva each day, which in turn plays a crucial role in food digestion, swallowing, speech, and protection of teeth against bacteria and decay. Obstruction or blockage of the salivary glands is a relatively common disorder that affects up to 2% of the population. Salivary gland obstruction results in pain and swelling in the cheek or under the jawline while eating, and foul-tasting drainage into the mouth (chronic sialadenitis). Such obstruction can also progress to severe infection associated with high fevers, severe pain and progressive swelling.

Salivary gland blockage can result from multiple causes including salivary stones, narrowing of the duct by scar tissue, dehydration, side-effects of certain medications, auto-immune diseases and tumors. Radioiodine treatment often used in the treatment of thyroid cancer is also associated with salivary gland obstruction due to concentration of radioiodine within the gland parenchyma. The most common cause of salivary obstruction in adults is salivary stones (sialoliths). Approximately 90% of stones occur in the submandibular glands, and 10% in the parotid glands. The sublingual glands are rarely affected. Salivary stones generally form when mucous sludge combines with calcium hydroxylapatite and deposits within the salivary ducts. While some stones can be seen with simple x-rays or computed tomography (cat scan), approximately 60% are radiolucent (invisible to x-rays) and require other tests such as ultrasonography for accurate detection.

Traditional treatment of salivary gland obstruction has focused largely on temporary alleviation of symptoms rather than identification and elimination of the problem. Increasing fluid intake, sucking on sour candies or lemons, applying warm compresses, and massaging the swollen gland were recommendations often given without much thought about why the symptoms existed in the first place. When these recommendations failed to provide relief, it has been common to undergo major surgery to remove the affected gland. While often done successfully and without complications, such surgeries are not without risks of bleeding, infection, and damage to surrounding nerves. The UAB Department of Otolaryngology is one of the few institutions in the U.S. to offer minimally-invasive procedures for the diagnosis and treatment of salivary gland obstruction. Sialendoscopy is a technique that has been developed and successfully applied in Europe over the last decade, but only recently has been introduced in the United States. The technique uses semi-rigid, ultra-thin scopes that are inserted into the gland's natural opening in the mouth in order to visualize and, therefore, diagnose, the cause of the obstruction. Using specialized micro-instruments, stones and scar tissue can be removed in order to relieve the blockage. The scope can also cleanse the glands with an irrigation of saline solution and steroids. This procedure can be performed under general anesthesia, sedation or local anesthesia and is typically performed as an outpatient procedure.

Dr. Kirk P. Withrow