None — BACKGROUND: There are three pairs of major salivary glands in the mouth that secrete saliva. The glands produce up to one quart of saliva each day, which is composed of 98 percent water and 2 percent of electrolytes, mucus, antibacterial compounds and enzymes. The purpose of saliva is to help with digestion, lubricate the mouth and protect teeth from bacteria
SALIVARY OBSTRUCTION: Up to 2 percent of the population suffer from sialadenitis, or blockage of the salivary ducts. Such obstructions may be due to salivary stones, scar tissue, allergic reactions, dehydration, medication side effects, autoimmune diseases or tumors, causing symptoms such as swelling of the cheek or jaw while eating, pain, infection, fever, foul-tasting drainage in the mouth and severe infection. "There are cases where it can cause infection that can spread outside of the gland and into the neck, and if that occurs, it can potentially be life-threatening by causing blockage of the airway," M. Boyd Gillespie, M.D., an associate professor of otolaryngology and head and neck surgery at the Medical University of South Carolina in Charleston, told Ivanhoe. Patients receiving radioiodine as treatment for thyroid cancer are especially likely to develop salivary obstructions as the radioiodine concentrates within the glands.
Salivary stones are the most common reason for salivary gland obstruction. They're believed to form as mucous is mineralized with calcium hydroxylapatite deposits. "If the natural flow of saliva through the gland becomes blocked, the saliva becomes hard and can start forming a stone," Dr. Gillespie explained. Ninety percent of stones develop in the submandibular glands, and the other 10 percent develop in the parotid glands. Most stones are too small to be seen with X-rays or CT scans.
TREATMENT: To improve their condition, patients are often advised by physicians to drink more water, suck on sour candies or lemons, apply a warm compress and massage the affected gland. When these methods are not effective, there are several methods of removing the stone. Lithotripsy uses shock waves to break apart stones to eject them from the gland. Or, the more invasive intraoral open surgery may be performed to remove larger stones. Sometimes, a gland may be removed entirely in cases involving multiple stones or persistent infections.
SIALENDOSCOPY: There is now a new, minimally invasive option to treat salivary gland obstruction. For the last decade, sialendoscopy has been performed in Europe and has recently been brought to the United States. Semi-rigid, very thin scopes are inserted into the mouth and into the gland's opening in order to see the reason for the obstruction. Then surgeons use micro-instruments to remove stones or scar tissue. The scope may also be used to wash the glands with saline and steroids.
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