Benign Salivary Gland Diseases
Broadly speaking these can be minor gland pathology or major gland diseases.
Minor salivary glands are microscopic collections that can coalesce and be visible after they are surgically accessed. The benign diseases of these glands is managed by Oral and Maxillofacial Surgeons.
These lesser glands can be involved with malignant disease also and their management is then the domain of a Head and Neck Surgeon. Dr Younessi has an excellent working relationship with these allied colleagues.
Major salivary glands are in their smallest units identical to the minor salivary glands but are considered organs in their own rights due to their complex anatomy. Dr Younessi has a special interest in management of benign sub-mandibular gland pathology. Parotid disease management in this country, however, typically falls in the skill sets of the ENT or Head and Neck Surgeons.
Pathology of the Minor Salivary Glands
These generally present as lip or cheek pouch swellings. They are commonly soft or rubbery and more often than not are painless. Patients often report biting them and some have even noted clear (mucus) discharge from them. They may be straw coloured but can also be purplish if there is blood tinging.
Trauma can cause a non-salivary lesion to occur known as a fibro-epithelial polyp which is roughly tantamount to a callus. Also there could be wart-like viral infections presenting similarly. It is not always easy to tell these other lesions from a swelling of the minor salivary glands.
The young are more prone to these salivary gland swelling called a mucocele. Whilst they are benign they can be annoying and even cosmetically troublesome.
They are caused by an injury that causes a seepage of saliva into adjacent structures that in turn stimulates the adjacent tissues to respond. The resultant inflammation can cause a swelling (Mucus Extravasation Cyst).
Alternatively a blocked salivary gland can cause a mucocele that microscopically is no more than a swollen and cystic gland. This is then called a Mucus Retention Cyst.
Dr Younessi will carefully examine any swelling in your mouth to determine their cause.
A mucocele is usually removed in its entirety and the tissue sent to a laboratory for examination under a microscope. These are notorious for recurrence and unless the cause, such as an ill-fitting crown, is addressed will usually return.
Pathology of the Major Salivary Glands
Similar to a gall stone, major salivary glands can develop stones (calculi). These are called sialoliths.
When they are accessible through the duct of the gland that opens into the mouth a lesser procedure can allow for them to be retrieved with little consequence. When they are in the gland proper, which is located in the neck beneath the floor of the mouth, they are not readily accessible through the mouth.
Stones can cause stagnation of saliva and in turn a significant and painful infection called ascending bacterial sialadenitis. There is often swelling that may look quite impressive. It is somewhat similar to one sided mumps!
There can be sufficient frank gland injury to render the gland non-functional. Under these circumstances a neck dissection needs to be carried out and the gland retrieved. It is not possible to remove the stone and leave the gland behind in these circumstances.
This is a more complex procedure and does warrant hospital care. If you think you may be a candidate for this operation you should arrange to have a consultation with Dr Younessi.