Salivary Gland Disorders and Stones
We have three pairs of major salivary glands: the parotid in front of the ear, the submandibular under the jaw and the sublingual under the tongue. Saliva is vital for digestion, dental health and the oral flora. Salivary gland disease presents in three main groups: infections, stones and masses.
Salivary stones (sialolithiasis)
Stones form by mineral deposition in the salivary duct, most often in the submandibular gland (about 80%) because its saliva is thicker and its duct longer and uphill.
Typical symptom: sudden swelling and pain under the jaw while eating — or even when thinking of food — easing by itself an hour or two after the meal. The stone obstructs the stimulated flow of saliva. With complete blockage the gland becomes infected: redness, severe pain and fever may develop.
Salivary gland infections
Bacterial sialadenitis usually develops on a background of stones, dehydration or poor oral hygiene. The gland is swollen, painful and red, and pus may drain into the mouth. The classic viral example is mumps. Treatment includes generous fluids, gland massage, saliva stimulants (lemon, chewing gum), warm compresses and antibiotics when needed.
A lump in a salivary gland
A slowly growing, painless firmness is the most common sign of a tumour. Most parotid tumours are benign, but fine-needle biopsy and imaging (ultrasound, MRI) are required for definitive assessment. Rapid growth, pain, facial weakness or skin involvement raise concern for malignancy and must be evaluated without delay.
Diagnosis and treatment
- Examination plus ultrasound is the usual first step; the duct opening is inspected inside the mouth.
- Small stones near the duct opening may pass with massage and saliva stimulation, or be removed through a small intraoral procedure.
- Stones lodged within the gland causing recurrent infection may require removal of the gland.
- Tumours are treated surgically; in parotid surgery the facial nerve is carefully preserved.
When should you see a doctor?
Meal-related swellings, any gland swelling lasting over 2 weeks, or a palpable lump all require ENT evaluation.
Frequently Asked Questions
Why does the area under my jaw swell when I eat?
Sudden swelling and pain under the jaw while eating, or even when thinking of food, is typically a sign of a salivary stone. The stone obstructs the stimulated flow of saliva, so the gland swells, and the swelling usually eases by itself an hour or two after the meal.
Where do salivary stones form most often?
Salivary stones form most often in the submandibular gland under the jaw, in about 80 percent of cases. This is because its saliva is thicker and its duct is longer and runs uphill.
What causes a salivary gland infection and how is it treated?
Bacterial salivary gland infection usually develops on a background of stones, dehydration or poor oral hygiene, and the gland becomes swollen, painful and red. Treatment includes generous fluids, gland massage, saliva stimulants such as lemon or chewing gum, warm compresses and antibiotics when needed.
Is a lump in a salivary gland dangerous?
A slowly growing, painless firmness is the most common sign of a tumour, and most parotid tumours are benign, but fine-needle biopsy and imaging are needed for a definitive assessment. Rapid growth, pain, facial weakness or skin involvement raise concern for malignancy and must be evaluated without delay.
When should I see a doctor for salivary gland swelling?
Meal-related swellings, any gland swelling lasting more than two weeks, or a palpable lump all require ENT evaluation. Examination plus ultrasound is usually the first step in reaching a diagnosis.
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