Salivary Gland disorders

Objectives
• At the end of this presentation the student well be
able to:
 Define salivary gland disorders.
 Enlist causes & signs and symptom of salivary gland
disorders.
 Explain diagnosis and treatment of salivary gland
disorders.
 Discuss prevention of salivary gland disorders.
 Identify nursing diagnosis and nursing intervention
for salivary gland disorders.
 Salivary Gland
• The salivary glands make saliva and release it into the
mouth. There are three pairs of relatively large, major
salivary glands:

1. Parotid glands
2. Submandibular glands
3. Sublingual glands
 Cont….
• Parotid glands: Located in the upper part of
each cheek, close to the ear. The duct of each
parotid gland empties onto the inside of the
cheek, near the molars of the upper jaw.
 Cont…
• Submandibular glands:
Under the jaw. They
have ducts that empty
behind the lower front
teeth.
• Sublingual
glands: Beneath the
tongue. They have
ducts that empty onto
the floor of the mouth.
 Cont…
• In addition to
these major
glands other
minor salivary
glands are
scattered
throughout the
mouth and
throat.
 Salivary Gland Disorders
Common salivary gland disorders include:
 Sialolithiasis
 Sialadenitis
 Viral infections e.g. mumps
 Cysts
 Benign tumors
 Malignant tumors
 Sjogren's syndrome
 Sialadenosis
 Sialolithiasis
 Sialolithiasis (salivary gland stones) Tiny, calcium-rich
stones sometimes form inside the salivary glands.
• Etiology: The exact cause of these stones is unknown.
Some stones may be related to:
o Dehydration, which thickens the saliva.
o Decreased food intake, which lowers the demand for
saliva.
o Medications that decrease saliva production, including
certain antihistamines, anti-hypertensive drugs and
psychiatric medications.
 Cont…
• Some stones sit inside the gland without causing any
symptoms. In other cases, a stone blocks the gland's
duct, either partially or completely. When this
happens, the gland typically is painful and swollen,
and saliva flow is partially or completely blocked.
This can be followed by an infection called
sialadenitis.
• Signs & Symptoms The most common symptom are
dry mouth and a painful lump, usually in the floor of
the mouth. Pain may worsen during eating.
 Conti….

• Treatments If the
stone is located near
the end of the duct, the
doctor may be able to
press it out gently.
Deeper stones can be
removed with surgery.
 Sialadenitis
 Sialadenitis: (infection of a salivary gland)
Sialadenitis is a painful infection. It is more common
among elderly adults with salivary gland stones.
Sialadenitis also can occur in infants during the first
few weeks of life.
• Etiology It is usually caused by bacteria.
• Sign and symptoms Symptoms may include:
o A tender, painful lump in the cheek or under the
chin.
o In severe cases, fever, chills and general weakness.
 Conti….
 Treatment Treatment includes:
o Drinking fluids or receiving fluids intravenously
o Antibiotics
o Warm compresses on the infected gland
o Encouraging saliva flow by chewing gums,
sugarless candies or by drinking juice.
• If these methods do not cure the infection, surgery
can be done to drain the gland.
 Viral infections
 Viral infections: Systemic (whole-body) viral
infections sometimes settle in the salivary glands.
This causes facial swelling, pain and difficulty in
eating. The most common example is mumps.
• Etiology These infections are caused by viruses.
• Sign and symptoms The first symptoms often
include:
o Fever and poor appetite
o Headache,
o Muscle aches
o Joint pain and malaise.
 Conti….
• Treatment: These infections almost always go away
on their own. Treatment focuses on relieving
symptoms through:
o Rest
o Drinking fluids to prevent dehydration
o Taking acetaminophen (Tylenol) to relieve pain
and fever
 Cysts
 Cysts: (tiny fluid-filled sacs)
Babies sometimes are born with cysts in the parotid
gland because of problems related to ear
development before birth. Later in life, other types of
cysts can form in the major or minor salivary glands.

• Etiology They may result from traumatic injuries,

infections, or salivary gland stones or tumors.
 Conti….
• Sign and symptoms: A cyst causes a painless lump.
It sometimes grows large enough to interfere with
eating.

• Treatment : A small cyst may drain on its own

without treatment. Larger cysts can be removed by
surgery.
 Benign tumors
 Benign tumors: (noncancerous tumors)
Most salivary gland tumors occur in the parotid gland.
The majority are benign. The most common type of
benign parotid tumor usually appears as a slow-
growing, painless lump at the back of the jaw, just
below the earlobe.
• Etiology Risk factors include radiation exposure and
possibly smoking.
 Conti…
• Sign and symptoms A slow-growing lump is the
most common symptom. The lump is sometimes
painful. This lump may be found in the cheek, under
the chin, on the tongue or on the roof of the mouth.
• Treatment Non cancerous tumors usually are
removed surgically. In some cases, radiation
treatments are given after surgery to prevent the
tumor from recurrence.
 Malignant tumors
• Malignant tumors: (cancerous tumors)
Salivary gland cancers are rare. They can be more or
less aggressive.
• Etiology The only known risk factors for salivary
gland cancers are Sjogren's syndrome and exposure
to radiation. Smoking also may play some role.
 Conti….
• Sign and symptoms A slow-growing lump is the
most common symptom. The lump is sometimes
painful. This lump may be found in the cheek, under
the chin, below the tongue or on the roof of the
mouth.
• Treatment Smaller, early stage, low-grade tumors
often can be treated with surgery alone. However,
larger, high-grade tumors usually require radiation
following surgery. Inoperable tumors that cannot be
operated are treated with radiation or
chemotherapy.
 Sjogren's syndrome
 Sjogren's syndrome Sjogren's syndrome is a chronic
autoimmune disorder. The body's immune defenses
attack the salivary glands, the lacrimal glands (glands
that produce tears), and occasionally the skin's sweat
and oil glands.
• Etiology Over activity of the immune system.
• Sign and symptoms The main features of Sjogren's
syndrome are swelling of the salivary glands, dry
eyes and a dry mouth.
 Conti….
• Treatment The main symptom related to the salivary
glands is a dry mouth. Options include:
o Medication to stimulate more saliva secretion,
such as pilocarpine (Salagen) and cevimeline
(Evoxac).
o Sugarless gum and candy to stimulate saliva
production.
o Avoiding medications that can make dry mouth
worse.
o Avoid smoking.
• Good oral hygiene is must. People with Sjogren's
have teeth and gum problems because of low
saliva secretion.
 Sialadenosis
 Sialadenosis (nonspecific salivary gland
enlargement)
Sometimes, the salivary glands become enlarged
without evidence of infection, inflammation or
tumor. This nonspecific enlargement is called
sialadenosis. It most often affects the parotid gland.
• Etiology Its cause remains unknown.
 Conti….
• Sign and symptoms This condition typically causes
painless swelling of the parotid glands on both sides
of the face.

• Treatment Treatment is aimed at correcting any

underlying medical problem. Once the medical
problem improves, the salivary glands should shrink
to normal size.
 Medical Diagnosis
• Medical history.
• Physical examination.
• Current medications.
• Blood tests.
• X-rays.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scans.
• Salivary gland biopsy.
 Complications
• Abscess of salivary gland.
• Spread of infection.
• Facial nerve injury (Sialorrhea).
• Dry mouth (xerostomia).
 Prevention
• We can lower our risk of viral infections of the
salivary glands. To do so, get immunized against
mumps and influenza.
• There are no specific guidelines to protect against
other types of salivary gland disorders. However, it is
helpful to:
o Avoid smoking.
o Eat a healthy diet.
o Drinking plenty of water daily to avoid dehydration.
o Practice good oral hygiene, with regular tooth
brushing and flossing.
 Nursing Diagnosis
• Dry mouth related to blockage of saliva.
• Pain related to tumor & inflammation in the mouth.
• Difficulty in eating related to painful lump in the
mouth.
• Poor appetite related to disease.
• Fever related to infection of salivary gland.
 Nursing Interventions
• Give medication to stimulate more saliva secretion,
such as pilocarpine (Salagen) and cevimeline
(Evoxac).
• Give sugarless gum and candy to stimulate saliva
production.
• Avoiding medications that can make dry mouth
worse.
• Provide analgesic to relief pain.
• Administer tube feeding.
• Give acetaminophen (Tylenol) to relieve fever.
• Cold sponging to relieve from fever.
 References
• Elluru RG. Physiology of the salivary glands. In:
Cummings CW, Flint PW, Haughey BH, et al,
eds.Otolaryngology: Head & Neck Surgery. 5th ed.
Philadelphia, Pa: Mosby Elsevier;2010:chap 84.
• Rogers J, McCaffrey TV. Inflammatory disorders of the
salivary glands. In: Cummings CW, Flint PW, Haughey
BH, et al, eds. Otolaryngology: Head & Neck Surgery.
5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap
86.