The salivary glands play an essential role in maintaining oral health and facilitating proper digestion. These glands produce saliva, which moistens food to make it easy to swallow and contains enzymes that help break down food for easier digestion . There are three major pairs of salivary glands in the mouth: the parotid glands, the largest pair, lie just behind the jaw below and in front of the ears; the submandibular glands lie under the side of the jaw; and the sublingual glands lie under the side of the tongue . In addition to these major glands, many tiny salivary glands are distributed throughout the mouth.
Salivary gland disorders encompass any condition that impairs saliva production or flow, including painful duct blockages, infections, benign or malignant tumors, and gland involvement in systemic diseases such as Sjögren’s syndrome or HIV . While many of these conditions are relatively rare—with salivary stones affecting approximately 1 in 100 adults and salivary gland cancers occurring at a rate of about 3 in 100,000—prompt evaluation by an ENT specialist is essential when symptoms arise .
Types of Salivary Gland Disorders
Salivary Gland Stones (Sialolithiasis)
Salivary stones, also known as sialolithiasis, are deposits of minerals that form in the ducts draining the salivary glands . The submandibular glands are responsible for more than 80% of salivary stones due to their mucinous secretions, which are high in calcium and phosphate salts and flow against gravity . Dehydration is a major risk factor: when fluids are insufficient, saliva becomes more concentrated and sluggish, making stones more likely to form .
Symptoms of salivary stones include swelling and pain over the affected gland, typically worsening during meals when saliva production increases but has nowhere to go . The swelling may subside between meals and return with the next episode of eating .
Salivary Gland Infection (Sialadenitis)
Sialadenitis is an inflammation or infection of the salivary glands that can be acute or chronic, with diverse causes including bacterial, viral, allergic, obstructive, and autoimmune origins . The condition usually occurs after reduced saliva production or duct obstruction but may develop without an obvious cause .
Bacterial sialadenitis is most common in the parotid gland and typically affects patients in their 50s and 60s, chronically ill patients with dry mouth, adolescents and young adults with anorexia, and children with juvenile recurrent parotitis . The most common causative bacterium is Staphylococcus aureus . Mumps, caused by paramyxovirus, is the most common viral cause of salivary gland inflammation .
People with bacterial sialadenitis typically experience fever, chills, and unilateral pain and swelling, with the overlying skin becoming red and swollen . Pus can often be expressed from the duct by compressing the affected gland .
Salivary Gland Malfunction (Dry Mouth)
Salivary gland malfunction is more common among adults and usually involves too little saliva production, a condition called xerostomia (dry mouth) . Causes include diseases such as Sjögren syndrome, rheumatoid arthritis, and lupus; medications such as antidepressants, antihistamines, and diuretics; and radiation therapy or chemotherapy for cancer treatment . Dry mouth due to radiation is typically permanent, especially with high radiation doses, while chemotherapy-induced dry mouth is usually temporary .
Inadequate saliva leads to increased risk of tooth decay, particularly in the roots of teeth, and can cause difficulty speaking and swallowing .
Salivary Gland Swelling and Tumors
Swelling of the salivary glands can result from viral infections, bacterial infections, autoimmune diseases, or tumors . Salivary gland tumors, though rare, require prompt evaluation .
Benign tumors are more common than malignant ones. Swelling from a tumor is usually firmer than that caused by an infection . If the tumor is cancerous, the gland may feel stone-hard and may be fixed firmly to surrounding tissues . Most noncancerous tumors are moveable and painless initially .
Systemic Diseases Affecting Salivary Glands
Systemic conditions can cause salivary glands to become enlarged or inflamed. These include HIV, Sjögren’s syndrome, rheumatoid arthritis, diabetes, sarcoidosis, and IgG4-related disease . Sjögren syndrome may manifest as parotid or submandibular gland swelling and is associated with autoantibodies such as anti-SSA (Ro) and anti-SSB (La) .
Diagnostic Evaluation
Accurate diagnosis is the foundation of effective treatment. A comprehensive evaluation by an ENT specialist typically includes:
Medical History and Physical Examination
The physician will take a detailed medical history, including the nature and duration of symptoms, relationship of symptoms to meals, and any associated systemic conditions. The physical examination involves palpation of the glands and inspection of the duct openings. The physician may massage the gland to observe saliva flow and may express pus from the duct for culture if infection is suspected .
Imaging Studies
Ultrasound is considered first-line imaging for salivary gland disorders and is the preferred test in children due to its high specificity, sensitivity, and accuracy in identifying and differentiating between causes . CT and MRI can confirm sialadenitis or abscess and identify stones or tumors . CT is often used to confirm salivary stones . Diffusion-weighted MRI can aid in differentiating sialadenitis from salivary gland tumors .
Sialendoscopy
Sialendoscopy is a minimally invasive technique that uses a small camera (1–2 mm wide) inserted through the natural opening of the salivary duct inside the mouth . Through the camera, the surgeon can locate stones or narrowed areas, remove small stones using tiny instruments, dilate strictures, and flush the duct with saline to clear debris . No external incisions are needed for this procedure.
Biopsy
If an autoimmune etiology is suspected, biopsy may be considered . Tissue biopsy can help determine if there is an underlying autoimmune disease such as Sjögren’s syndrome . Fine needle aspiration biopsy can also be used to obtain samples for identifying potentially cancerous cells .
Treatment Options
Treatment for salivary gland disorders depends on the underlying cause and ranges from conservative measures to advanced surgical interventions .
Conservative Management for Stones and Obstruction
For small salivary stones, conservative measures may be effective. Patients are advised to drink extra fluids, massage the glands toward the mouth, apply warm compresses, and trigger saliva flow with lemon juice, sour candy, or sugar-free lemon drops . Pain relievers can help manage discomfort .
These measures are often sufficient for small stones to pass naturally. However, if the stone does not pass, further intervention is needed.
Sialendoscopy for Stone Removal
Sialendoscopy is the primary treatment for salivary obstruction. This gland-sparing technique allows for direct visualization and removal of stones using tiny instruments passed through the camera . For larger stones that cannot be removed through the camera alone, an incision inside the mouth may be needed to access and remove the stone, with no visible external scar .
Antibiotic Treatment for Infections
Bacterial sialadenitis is treated with antibiotics active against Staphylococcus aureus, modified according to culture results . With the increasing prevalence of methicillin-resistant S. aureus (MRSA), especially in elderly patients in nursing facilities, vancomycin is often required . Chlorhexidine mouth rinses help reduce bacterial burden and promote oral hygiene .
Hydration, sialagogues (substances that trigger saliva flow), warm compresses, gland massage, and good oral hygiene are also important components of treatment . Abscesses require drainage .
Management of Dry Mouth
For dry mouth, patients should avoid medications that decrease saliva production, sip fluids throughout the day, brush and floss regularly, use fluoride rinses, and visit their dentist for examination and cleaning every three to four months . Saliva substitutes containing carboxymethylcellulose can be used as a mouthwash, and sugarless gum or xylitol lozenges can stimulate saliva flow . Medications that increase saliva production, such as cevimeline or pilocarpine, may help relieve symptoms .
Surgical Intervention for Tumors
Both noncancerous and cancerous salivary gland tumors can usually be removed surgically . Malignant masses are treated using surgery, sometimes followed by radiation therapy . If the growth is found to be non-cancerous, the surgeon may recommend either monitoring or surgical removal, depending on the tumor’s features and the patient’s symptoms .
In severe cases of chronic or relapsing sialadenitis that do not respond to other treatments, superficial parotidectomy, parotid duct ligation, or submandibular gland excision may be indicated .
Treatment for Systemic Disease Involvement
If there is an associated systemic disease such as Sjögren’s syndrome or HIV, managing the systemic condition well will also help treat the salivary gland disorder .
When to Seek Medical Attention
Red flag symptoms requiring prompt specialist evaluation include:
-
Facial nerve weakness
-
Rapidly growing lump
-
Ulceration or induration of the mucosa or skin
-
Numbness of skin
-
Severe progressing pain
-
History of skin cancer, Sjögren’s syndrome, or radiation of the head and neck
Salivary lumps that persist for three weeks should be referred to an ENT specialist . Fever or abscess formation should prompt immediate medical attention .
Prevention and Long-Term Care
Maintaining good salivary gland health involves several preventive measures. Staying well hydrated by drinking plenty of water throughout the day helps prevent stone formation . Using sour candies or lemon drops stimulates saliva flow and can help keep ducts clear . Gently massaging the gland toward the mouth may help move saliva along if mild swelling is noticed .
For patients with chronic conditions or previous salivary gland issues, regular follow-up with an ENT specialist is essential to monitor disease progression, adjust treatment as needed, and prevent complications.
About Dr. Somayeh Moin
Dr. Somayeh Moin is a board-certified Ear, Nose, and Throat (ENT) specialist with dedicated expertise in the diagnosis and treatment of salivary gland disorders. Holding prestigious board certifications from both Iran and Turkey, Dr. Moin brings a unique international perspective and comprehensive training to the management of complex salivary gland conditions.
Dr. Moin’s dual-board certification reflects a commitment to the highest standards of otolaryngological care. Her extensive training in both countries equips her with a diverse range of diagnostic and therapeutic approaches, including sialendoscopy for minimally invasive stone removal, medical and surgical management of sialadenitis, comprehensive evaluation and treatment of salivary gland tumors, management of salivary gland involvement in systemic diseases, and surgical intervention for chronic or recurrent salivary gland disorders.
As an ENT and Head & Neck Surgery specialist, Dr. Moin possesses an in-depth understanding of the complex anatomy and function of the salivary glands. She recognizes that even minor salivary gland disorders can significantly affect quality of life and that each patient requires a thorough evaluation and individualized treatment plan.
Dr. Moin’s practice emphasizes comprehensive diagnostic evaluation using state-of-the-art imaging and sialendoscopy, evidence-based treatment protocols with proven outcomes, individualized treatment plans tailored to each patient’s specific needs, patient-centered care with a focus on comfort and understanding, and close follow-up and support for optimal outcomes.
For patients experiencing salivary gland disorders—whether painful stones, recurrent infections, or suspicious growths—Dr. Somayeh Moin offers the expertise, international training, and compassionate care required to achieve optimal outcomes. Her dual-board certification from Iran and Turkey represents a commitment to excellence and a deep understanding of the complexities of salivary gland disorders.