Pediatric ENT

Although children are often affected by the same ear, nose and throat conditions as adults, they are often more susceptible to these conditions and require special care to treat these conditions. Our doctors are specially trained to diagnose and treat a wide range of ear, nose and throat conditions affecting children including Tonsillitis, Sleep Apnea, Ear infections such as Otitis Media and Otitis Externa (Swimmer’s Ear), Hearing Loss, Tympanic membrane perforations (holes in the ear drum), Nosebleeds, Sinusitis, Nasal obstruction, Tongue Tie, as well as other disorders such as neck lumps and masses.

Salivary Glands


What are your salivary glands?

There are multiple gland found in and around your mouth and throat.  These are divided into two groups:  major salivary glands-- the parotid (in your cheeks), submandibular (below your jaw), and sublingual glands (under your tongue), and minor salivary glands (tiny glands in your lips, cheeks and throughout the lining of your mouth and throat).  All salivary glands secrete saliva into your mouth to moisten your mouth, initiate digestion, and help protect your teeth from decay.

What causes salivary gland problems?

There are many different problems that can arise from the salivary glands.  These include:

Obstruction:

Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands.  This can be due to infection, inflammation or stones.  Symptoms typically occur when eating. Eating triggers saliva production, but the saliva cannot exit the ductal system, leading to swelling of the involved gland and significant pain. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed.

It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small areas of narrowing which decrease salivary flow, leading to infection and obstructive symptoms.

Infection:

The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults and in those who have been immunized.

Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria.

Tumors:

Salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips.  Rarely these tumors can cause loss of movement of part or all of the affected side of the face.

Other Disorders:

Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjögren's syndrome where the body's immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.

How does your doctor make the diagnosis?

Diagnosis of salivary gland disease depends on the careful taking of your history, a physical examination, and possibly laboratory tests.

Imaging such as Ultrasounds, CT scans or MRIs can be used to evaluate the gland for stones, masses, or abscesses.  Sometimes, a fine needle aspiration biopsy is helpful.

A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.

How is salivary gland disease treated?

Treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on the nature of the problem.

Infections and inflammation of the glands are most often treated with medications.

For chronic obstruction or smaller stones sialendoscopy can be utilized.  Sialendoscopy uses a very small endoscope passed through the natural opening of the duct in the mouth into the salivary duct to retrieve the stone, dilate a narrowing or flush out the gland.  This procedure is performed as an outpatient procedure, is minimally invasive, has few side effects and is well tolerated by patients.

If a mass has developed within the salivary gland, removal of the mass may be recommended. Most masses in the salivary glands are benign (noncancerous). When surgery is necessary in the parotid gland, great care must be taken to avoid damage to the facial nerve (the nerve that moves the muscles of the face, eye and mouth) that runs through this gland. When malignant (cancerous) masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended after surgery for cancers of either the parotid or submandibular gland. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation.

Removal of a salivary gland does not produce a dry mouth, called xerostomia. However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances.

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