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Symptoms of Blocked Salivary Glands



   M. Allison Ogden
 treats patients at
.

  Ear, Nose and Throat Center
  Center for Advanced Medicine
  4921 Parkview Place, 11th Floor, Suite A
  St. Louis, MO 63110

  Phone:  314-362-7509
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Question: My husband has a painful swelling under his jaw on the left side when he eats. It lasts for several days, then gradually goes away. What could this be?

Answer: Your husband likely has blockage of the saliva producing gland, located under the jaw. Saliva is produced by three large major salivary glands (parotid, submandibular, sublingual) on each side and about a thousand smaller salivary glands dispersed throughout the mouth and throat. Saliva is produced in specialized groups of cells within these larger glands and then travels through a duct system to reach the mouth.

Blockage of saliva flow in the submandibular gland is most often caused by a small stone trapped in the channel, or duct, leading to the mouth. Stones occur in 1% of the adult population, but do not always cause problems. Small stones may pass through the duct opening into the mouth spontaneously. Larger or multiple stones can become impacted in the duct system and result in recurrent swelling and/or infections.

Blockage may result in pain and swelling from accumulation of saliva within the ducts or gland itself. The swelling can occur suddenly and is often associated with meals. Typically the gland decompresses slowly. An infection of the pooled saliva can occur and is generally painful with skin redness and warmth, thick and/or foul tasting saliva and possibly fever. Antibiotics are used to treat an infected saliva gland.

The initial therapy for symptoms of gland obstruction is typically conservative: hydration to produce thin and watery saliva, gentle massage of the swollen gland, warm compress, and occasionally lemon or sour candy to stimulate flow of saliva. If the blockage is persistent or recurrent, further intervention should be considered. Evaluations with ultrasound, CT or MRI can often provide more information regarding the cause of the obstruction.

In rare instances, tumors can be a cause of gland obstruction. If a stone is identified or suspected in the submandibular gland or duct, surgery may be warranted. Sialendoscopy, or salivary endoscopy, is a new option that is gaining popularity in the United States. Sialendoscopy is a minimally invasive procedure that involves introducing a small 1-2 mm endoscope (fiberoptic camera) into the salivary duct through the natural openings in the mouth. Small stones can often be removed through the duct with the endoscope.  In the case of larger stones, the endoscope can assist with open surgical removal. Traditional surgical interventions include incisions in the mouth or gland removal through a small neck incision.
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Copyright 2014 Washington University School of Medicine