Salivary gland conditions
Swelling of the cheek or under the jaw, especially at mealtimes, may be caused by a salivary stone or narrowing. Will offers sialendoscopy, a keyhole technique that can often treat the problem while keeping the gland. Most lumps in the parotid gland are benign.
Who it may help
- Painful swelling of a salivary gland when eating
- Salivary stones or narrowing of a duct
- Repeated gland swelling or infections
- A lump in the parotid or submandibular gland
Recovery
Sialendoscopy is often a day case with a few days of mild swelling. After gland surgery you may stay one night and have a small drain; most people return to normal activities within one to two weeks.
What is involved
Assessment usually includes an ultrasound scan and, for lumps, a needle biopsy. Sialendoscopy passes a very fine camera into the gland through its natural opening in the mouth to remove stones or widen narrowings, so the gland can often be kept. When a gland or lump must be removed, the operation is under general anaesthetic through a carefully placed neck or facial incision, with the facial nerve monitored throughout.
Sialendoscopy
A very fine endoscope, around 1 mm wide, is passed into the gland through its natural opening inside the mouth, under local or general anaesthetic. Typical reasons for sialendoscopy include:
- Salivary stones (sialolithiasis) – small stones are removed with a tiny basket; larger ones may be broken up or removed through a small cut inside the mouth
- Narrowing of a salivary duct (stricture), which can be gently widened
- Repeated swelling of the parotid or submandibular gland without a clear cause
- Juvenile recurrent parotitis – repeated parotid swelling in children
- Gland swelling after radioactive iodine treatment for thyroid disease
- Recurrent swelling in Sjögren’s syndrome, where flushing the gland can ease symptoms
After sialendoscopy
The gland is usually flushed with saline and sometimes a steroid. A small plastic stent may be left in the duct for about two weeks to help it heal open. Drinking plenty, massaging the gland and sucking sour sweets help saliva flow while it settles.
Risks and side effects
All surgery carries some risk. The main ones for this treatment are listed below; your own risk depends on your health and the details of your operation.
- Swelling, bleeding or infection
- After parotid surgery: temporary facial weakness, which is not uncommon, permanent weakness, which is rare, earlobe numbness, and gustatory sweating (Frey’s syndrome)
- After submandibular surgery: weakness of the lower lip or, rarely, altered tongue sensation or movement
- A collection of saliva under the skin
- Duct narrowing or failure to remove a stone after sialendoscopy
Alternatives
Mild symptoms may be managed with fluids, gland massage and sour sweets to stimulate saliva. Some small benign lumps can be monitored with scans rather than removed.
Guidance and standards
Suspicious salivary lumps are assessed on urgent pathways and discussed in the head and neck MDT in line with BAHNO standards.
Questions worth asking at your appointment
- Benefits – what will this treatment do for me?
- Risks – what could go wrong, and how likely is it for me?
- Alternatives – what other options are there?
- Nothing – what happens if I wait, or decide not to have treatment?
Based on the Choosing Wisely UK BRAN questions.