SALIVARY GLAND DISEASE

Submandibular Gland Disease

Your submandibular glands are found just under your lower jaw bones. They produce around 70% of the saliva that is found in your mouth during a resting state. The saliva produced by your submandibular glands is a combination of serous fluid and a thicker mucous secretion that also contains lots of calcium and phosphorous, which helps top keep your teeth healthy.

What conditions can affect my submandibular glands?

There are various conditions that could affect your submandibular glands. These include:

Sialolithiasis (Salivary stones)

Saliva from your submandibular glands reaches your mouth via a thin tube called Wharton’s duct. This duct is around 5 cm long and empties into your mouth just under your tongue. Because of the high calcium content in submandibular saliva, crystals can settle out in this duct and form stones. These stones can cause blockage of the gland; particularly around mealtimes, and can occasionally block the gland completely causing swelling and pain. Massaging the gland and drinking lots of fluids can help, but if stones cause too many problems they are best removed. If they are located at the front of the duct they can be removed with a minor operation via the mouth. Stones located further back in the gland itself may mean that the gland itself has to be removed.

Sialadenitis (Salivary gland inflammation)

Sialadenitis, or inflammation of the salivary gland, may be caused by a bacterial infection, especially if a stone obstructs the Wharton duct. Acute salivary gland infection results in a sudden onset of pain and gland swelling, and may cause fever. Sometimes, a salivary gland infection may result in an abscess (a collection of pus). Acute sialadenitis is usually treated with antibiotics. If there is an abscess, surgical drainage is sometimes required.

In some patients, sialadenitis can be recurrent or ongoing (chronic). Chronic sialadenitis is usually caused by a narrowing or a blockage of the Wharton duct or autoimmune disease and may require surgery to remove the gland.

Sialosis (Enlargement of the salivary glands)

Sialosis is a painless, non-cancerous enlargement of the salivary glands. It usually affects the parotid glands on both sides but may occasionally affect the submandibular glands. Itis more common in patients with systemic conditions like:

Sialosis doesn’t usually require treatment other than management of the underlying systemic illness.

Tumours

Tumours of the submandibular glands are relatively rare. When they do occur, they have around a 30% chance of being malignant. Submandibular gland tumours are typically first noted as a painless, progressive lump in the gland.

What can I expect during a consultation for a submandibular gland problem?

Your GP may have referred you to Dr McGuinness for a submandibular gland problem. Dr McGuinness will begin your consultation by taking a thorough history, and conducting a physical examination.

Depending on the suspected cause, the following investigations may be required:

Swab for bacterial culture - taken from the opening of the duct.
Blood tests - to assess for possible infection or autoimmune conditions.
Imaging studies - Imaging studies may be used to assess stones or a potential abscess, and could include an ultrasound, plain x-ray or CT scan. A sialogram is a test that uses contrast to view the salivary duct. An MRI could be used to assess a possible tumour.
FNA cytology - A small needle may be used to collect cells from the gland for analysis in the laboratory. This is done to exclude the presence of cancer cells.

Treatment of a submandibular gland problem depends on the underlying cause. Dr McGuinness will conduct a thorough assessment and advise you on the best course of action.