Associates In Facial and Oral Surgery
Oral Surgery
Monroeville PA

Salivary Gland Surgery

The salivary glands provide the needed saliva to assist in the food chewing process and to provide early digestion of certain carbohydrates. The salivary glands are located in the region of the mouth, face and neck. There are major and minor salivary glands. The major salivary glands are called the parotid, submandibular, and sublingual glands.

Dr. Catone, oral surgeon, also treats salivary gland pathologies

There are also numerous minor salivary glands in the mouth and lips. All of the major and minor salivary glands secrete saliva into the mouth via small tubes or ducts. The parotid gland secretes its salivary through a duct which exits the inside of the cheeks near the upper back teeth on each side. The submandibular glands secretes its contents from ducts exiting the front part of the floor of the mouth. The sublingual gland puts forth its saliva from numerous small ducts in the floor of the mouth under the tongue. The minor salivary glands located in the lips, cheeks, and in the other mucous membrane linings of the mouth and throat also produce saliva which along with the major glands produce the saliva which moistens your mouth, initiates digestion and help to cleanse and protest your teeth from decay.

There are several diseases or disorders of the salivary glands which can cause clinical symptoms. These are obstruction, inflammation, infection and benign and malignant tumors.


The parotid and submandibular glands are often sites of obstruction due to the formation of calculi or stones in the ducts of these glands. The sublingual gland can be the site of stone formation but this is rare. When the sublingual gland becomes obstructed a condition called “ranula” or mucus escape phenomenon may result. In such cases the floor of the mouth swells and will cause the tongue to elevate. Doctor Catone has written a seminal article on this disease and offered a unique surgical procedure to correct it in 1979. This procedure has been accepted worldwide for the management of this process. All of the minor salivary glands especially in the lips can be obstructed and this is usually the result of trauma such as biting or orthodontic appliances (braces). The obstructed gland continues to secrete its saliva but the fluid cannot exit the ductal system resulting in retrograde or backup of the saliva and swelling and pain the gland. Significant pain and infection can be the result. When the parotid gland is involved the face is swollen and asymmetric on the affected side. When the submandibular gland is affected the neck will swell on the offending side. Obstructed minor salivary glands will often manifest themselves as small rounded “bubbles” or mucoceles which swell and break on a regular basis. When the major or minor salivary glands are infected the lymph nodes either within the glands or in the neck draining the sites of the glands will become enlarged and tender. The skin overlying the infected gland will become tender and red. Enlarged lymph nodes usually not painful will occur in instances of tumors or primary inflammation.


In many instances the stones within the ducts of the salivary glands will not be totally obstructive and the major salivary gland will swell during eating when the nervous system induces the glands to produce saliva and gradually the swelling will subside only to swell again at the next meal. The presence of unevacuated saliva within the gland may lead to infection causing an increase in pain and swelling in the gland. Abscess formation is the result of longstanding inflammation of the glands. There are occasions when patients will have congenital abnormalities or narrowing of the ductal system of the salivary gland. These constrictions can result in infection and obstructive symptoms in the absence of clinical or radiographic evidence of the presence of a stone within the duct system.


The most frequent infection of the salivary glands is mumps, which usually involves the parotid gland. This, of course, is more common in children but can occur in adults. In adults the presence of swelling (usually painless) in the area of the parotid gland on one side is more likely to be due to an obstruction or the presence of a tumor. Infections are often seen in patients who are taking medications which slow down the production of saliva. These are often seen in patients taking chronic antihistamine therapy. Older patients who have been hospitalized and may be somewhat dehydrated will often present with a staphylococcus parotitis.


Benign and malignant tumors can occur in any major or in minor salivary glands. Most major glands will manifest tumors by a painless or painful swelling in the involved gland. Most minor salivary glands will present in the mouth and the majority of these tumors are malignant. When a malignant tumor is present in the parotid gland there may be weakness or paralysis of the Facial nerve on the affected side. Most tumors will rarely involve more than one major salivary gland and these are manifested as growths in the parotid, submandibular area, palate, floor of the mouth, cheeks or lips. These enlargements should be evaluated by Dr. Catone, a head and neck surgeon or ear, nose and throat surgeon. The malignant tumors of the salivary glands can be aggressive and can growth rapidly, can be painful, and can cause facial paralysis. Such manifestations should be immediately evaluated.

Enlargement of the salivary glands can be seen in auto-immune diseases which can result in severe inflammation. Patients, for example with Sjogren’s syndrome and other auto-immune diseases may have significantly dry mouth (xerostomia), dry and inflamed eyes, and other systemic manifestations such as rheumatoid arthritis. Enlargement of the parotid glands are often seen in diabetic patients. Major salivary gland enlargement is also seen in alcoholic patients.

Salivary “Stones”

The saliva that is secreted by salivary glands contains a host of minerals and cellular components. These materials can coalesce and form what are referred to as salivary “stones” or calculi. These entities can partially or completely block the salivary duct in which they reside. When this occurs the normal saliva produced by the salivary gland backs up into the gland and causes it to swell. Inflammation and infection of the gland are complications of this phenomenon. Salivary stones forming in the more external or distal portions of the salivary ductal system may be removed by a simple surgical procedure thus relieving pressure on the gland. Stones appearing in the ductal system near the gland itself are more problematic and may result in the need to surgically remove the salivary gland. When multiple salivary stone occur over a period of time and are removed it often causes the salivary gland to degenerate and reduce the volume of saliva produced. This causes chronic salivary gland infections (sialadenitis) even without the presence of a current salivary stone. The surgeon may recommend the removal of the gland in these circumstances. Accumulation of large amounts of saliva in an obstructed sublingual gland will often dictate the removal of the gland in a hospital setting

Diagnosis Of Salivary Gland Disease

Dr. Catone will take a thorough history and head and neck examination and order appropriate blood studies and imaging scans if deemed appropriate. Often it is possible after identifying the exact location of a salivary stone by plain X-ray in the more remote portion of a salivary duct to remove the stone under local anesthesia by dilating the duct with probes and allowing the stone to be removed.

In the case of masses in the salivary gland Dr. Catone will usually order a CT scan and/or an MRI. The scan will usually indicate whether the mass is part of the salivary gland or a lesion that is near the gland. Many surgeons will recommend what is referred to as a fine needle biopsy (FNA). This is usually done in a Cytology Department at a hospital since all of the laboratory requirements are present and the specimen can be stained and examined by the Cytologist immediately. Fine needle biopsies are not as accurate (80-90%) as direct incisional biopsy of the gland or mass. There are false positives and false negatives. The open biopsy is more definitive and is done by making a skin incision of the mass or gland. In view of the possible injury to the gland and contiguous structures such as nerves, this procedure is performed in a hospital setting.

Management Of Salivary Gland Disease

Because of the varied nature of salivary gland pathology the treatment of salivary gland disease can be either medical or surgical. The use of medical or surgical methods will depend on the nature of the pathology. In the case of diseases which are systemic in nature and involve the entire body such as Sjogren’s disease then the problem may be generally managed medically and other consultants may be called upon to provide assistance. Even in Sjogren’s syndrome the surgeon is often called upon to take a biopsy specimen of the lip to assist in the initial diagnosis. If the disease is purely salivary gland in presentation, and is characterized by obstruction and/or infection, usually antibiotics will be prescribed. Peripheral stones in the salivary ducts can often be managed by appropriate instrumentation and dilation of the involved duct to enable the patient to pass the stone.

Masses within the Salivary Glands

Most masses or tumors arising in the major salivary glands i.e., parotid, submandibular and sublingual are benign in nature. Masses occurring in the minor salivary glands which are present throughout the oral cavity and throat exhibit a higher incidence of malignancy. When benign tumors present in the parotid gland these must be removed because they may continue to increase in size and become disfiguring. When such tumors of the parotid gland are to be removed, it is important that the surgeon avoid injury to the Facial nerve which is necessary for the movement of the muscles of facial expression. Most tumors of the parotid gland can be removed without injury to the Facial nerve. This is also true in the case of malignant tumors of the parotid gland. Radiation therapy is often required after surgery in the parotid gland for malignant tumors. This therapy is conducted at least 6 weeks after the surgery.

Tumors involving the submandibular gland are similarly managed as parotid lesions. Benign tumors of the submandibular gland can be treated by surgical removal of the submandibular gland by an incision in the upper neck just below the gland. Such benign tumors as mixed tumors (Pleomorphic adenomas) usually do not recur and the surgical procedure is curative. The incision in the neck is usually managed so that a there is a cosmetic result. In the case of malignant lesions of any major salivary gland it is important to determine whether or not the tumor has spread to lymph nodes near the gland. In such cases of local spread of tumor neck surgery may be recommended followed by radiation therapy. Dr. Catone will refer you to a qualified head and neck surgeon whose team manages such issues on a regular basis.

When malignant lesions occur in minor salivary glands, for example arising in the hard palate it is important that the patient have the benefit of a head and neck surgeon, an oral and maxillofacial surgeon and a qualified prosthodontist to assist the patient in oral rehabilitation after the primary surgery for the tumor is completed. In most cases Dr. Catone can provide reconstructive procedures designed to rehabilitate the patient to enable proper dental appliances to facilitate eating and speech. The prosthodontist can provide assistance to the head and neck surgeon at the time of primary surgery by fabricating a splint to be used at that time to begin the rehabilitative process. Later Dr. Catone can provide dental implants to hold a dental prosthesis in place constructed by the prosthodontist.

Most head and neck tumors especially malignancies require a team approach involving both medical and surgical consultants. Such tumor management is complex and the patient is better served by the incorporation of multiple specialists who will bring a unique level of expertise in each stage of care.