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Introduction
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Consultant maxillofacial surgeons deal with the diagnosis and surgical treatment of salivary gland benign and malignant conditions.
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What are Salivary Glands and what is their function?
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Salivary glands produce saliva, which enters the mouth via tubes called ducts. The saliva is a watery substance which wets and lubricates the lining of the mouth and assists in taste.
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What types of glands are there?
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Essentially there are two groups of glands: Small minor Salivary Glands and Major Salivary Glands.
Minor salivary glands
These salivary glands are scattered throughout the mouth, including the inner aspect of the lips. The most common problem with minor salivary glands is mucocele. This is the swelling of a minor salivary gland, usually on the inner aspect of the lower lip. Surgical removal under local anaesthetic with dissolving stitches to close wound.
Major Salivary Glands
These can be split into three types:
- The parotid glands:
- Situated between the back part of the lower jaw and the ear.
- The ducts of the gland open inside the mouth in the upper cheek on both sides.
- The submandibular glands:
- Situated under the lower jaw at the angle on both sides.
- The ducts open behind the lower front teeth under the tongue.
- Frequently affected by stones in the duct.
- The sublingual glands:
- Situated in the front of the mouth under the tongue.
- The ducts link with the submandibular ducts.
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When are the glands active?
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During normal resting conditions saliva is mainly produced from the submandibular glands - up to 75% of the saliva. During stimulation, such as the smell or sight of food, up to 95% is from the parotid glands.
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Surgery
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When salivary gland problems may require surgical intervention
- Neuromuscular incoordination leading to drooling.
- Too little saliva is produced, in conjunction with salivary gland infection
- Blocked ducts (e.g. a stone or calculus in the duct)
- Cyst formation
- Tumour formation in the gland.
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General Overview of Salivary Operations
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- Removal of duct obstruction.
- Removal of a gland and re-routing of the ducts.
- Removal of part or all of the gland.
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General overview of what to expect from the Surgery
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- Scar on the skin - this fades with time and designed to lie in skin creases so it is less noticeable
- Some swelling - usually lasts up to two weeks
- Mild bruising - usually last up to a week
- Some discomfort - kept to a minimum with the use of painkillers
- Drains - small tubes which are left in for a day or two to keep the wound dry
- Fine sutures - removed after five to seven days
- Residual effects from the anaesthetic - feeling tired.
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Some points to note regarding parotid gland surgery
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- Temporary facial nerve weakness - caused by manipulation, usually recovers with time
- Permanent facial nerve weakness - this is very rare
- Numbness of the earlobe and skin associated with the scar
- Frey's syndrome - occasionally the nerves that control the saliva link with the nerves that supply the skin after surgery.
This leads to sweating of the skin at meal times
- Salivary fistula - this is very rare.
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Some points to note regarding submandibular gland surgery
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- Facial nerve weakness - temporary, rarely permanent and only affects lower branches of nerve which control lower lip
- Numbness of the tongue - again this is a result of manipulation during surgery. This is very rare and is due to the bruising of the lingual nerve
- Weakness of the tongue - extremely rare and caused by the bruising of the hypoglossal nerve
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Some points to note regarding if you have sublingual gland surgery
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- Some swelling inside the mouth
- Some temporary discomfort when swallowing
- Lingual nerve bruising - numbness of the tongue
- No facial scarring.
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Review
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Following surgery, a review appointment is made for the removal of any stitches and to talk through any problems or queries with the surgeons.
REMEMBER:
- Healing takes time.
- Any problems - there is always someone to talk to you about any questions that you or your family may have.
If you do have any questions or concerns, please contact your consultant maxillofacial surgeon.
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