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Babak Larian, M.D.
9401 Wilshire Blvd #650
Beverly Hills, CA 90212
Phone: (310) 776-6913
Fax: (310) 461-0310

 


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Salivary Gland Disorders

Salivary Gland Disorders & Tumors – Ear, Nose, and Throat Specialist Serving Southern California

Salivary glands produce saliva, which is not only responsible for moistening the food we eat and allowing us to swallow it, but also aids in the digestion process. Saliva contains enzymes that begin to break down food before it reaches the stomach. Furthermore, saliva helps to keep the mouth clean, and the antibodies contained in saliva help to defend the body from germs. Unfortunately, there are several disorders that may impede the salivary glands from functioning properly and some that may even affect one's overall health.

The Salivary Glands
Salivary Gland Disorders and Treatments
Sialadenitis
Sialolithiasis
Mucocele and Ranula
Salivary Gland Tumors

The Salivary Glands

The major salivary glands include three pairs of salivary glands, two parotid glands, two submandibular, and two sublingual:


Fig. 16 - Salivary Glands

  • Parotid glands are located near the ear, in the upper portion of each cheek.
  • Submandibular glands are found on both sides, just under the jaw, towards the back of the mouth.
  • Sublingual glands reside beneath the tongue and supply saliva to the floor of the mouth.
  • Minor salivary glandsare smaller glands that are found throughout the mouth, nose and throat.

Salivary Gland Disorders and Treatments

There are a number of different salivary gland disorders. Below, you will find a description of some of the most common salivary gland disorders, accompanied by a brief overview of the methods our ear, nose, and throat specialist in the Los Angeles area uses to treat them.

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Sialadenitis

Often painful, sialadenitis is a bacterial infection of a salivary gland. Sialadenitis most commonly affects elderly people and often associated with the presence of salivary gland stones (sialolithiasis). Those who have xerostomia (chronic dry mouth) or who are anorexic may also be prone to the condition. Swelling, pain, fever, and chills are frequently reported symptoms of sialadenitis. Most patients respond very well with a simple course of antibiotics, increased water intake, massaging the area of the gland to squeeze the infected saliva out of the gland, and warm compresses. In the rare complicated cases the facial nerve may become inflamed and paralyzed, this requires immediate attention, and potentially surgical drainage.

With each infection of the saliva glands there is a risk of causing scarring in the gland and especially in the ducts of the gland causing narrowing of the duct. When this happens then the saliva can be blocked behind the area of narrowing and lead to recurrent swelling of the gland. This progresses over time and can become very painful. When this problem starts to recur over and over again it is called chronic sialoadenitis. The most important way to prevent this problem is to increase your water intake and treat salivary gland infections immediately. For those with chronic sialadenitis that is very symptomatic a surgical removal of the gland may be the only treatment option. These procdures are called , a superficial parotidectomy or submandibular gland excision may be recommended.

Because the symptoms of sialadenitis are similar to those of other illnesses, a thorough examination may be recommended by an ear, nose, and throat specialist. Individuals in respected ear, nose, and throat specialist who provides a number of safe, innovative treatment options for his patients. Contact Dr. Babak Larian to schedule an appointment today.

Mucocele and Ranula

A mucocele is a cyst-like lesion that is caused by a blocked gland duct. This blockage does not allow the saliva to be released into the mouth, thus saliva backs up into the gland increasing its size. A mucocele that develops on the floor of the mouth is called a ranula. While most mucoceles are not painful, they may interfere with eating or speaking. Although some mucoceles resolve themselves, most remain large and continue to grow and cause problems. Simply "popping" or removing the fluid out of the gland does not resolve the problem because the duct will continue to stay blocked. The treatment of choice for a mucocele is surgical removal, which is usually very simple. Most mucoceles occur on the lips or inside the mouth and can be easily removed by a simple small incision over them and removal of the small involved gland. An ear, nose, and throat specialist can safely and easily remove them.

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Sialolithiasis (Salivary Gland Stones)

The development of tiny calcium deposits, or stones, within a salivary gland is called sialolithiasis. Although the exact cause of sialolithiasis is unknown, a number of risk factors have been identified. Those who do not consume enough food and those who are taking certain medications that reduce the flow of saliva may be at risk for sialolithiasis. Dehydration is another risk factor, as it thickens the saliva. Salivary gland stones that block the saliva ducts may lead to sialoadenitis, and chronic infections.


Fig. 7 - Salivary Gland Stone

A stone can be diagnosed by feeling the duct of the gland to see if there is a firm object within it. The diagnosis can, at times, be confirmed by a CT scan (not all stones show on CT scans). Stones that are at the outer most portion of the duct can be squeezed out, but those that are further deeper towards the main substance of the gland are more difficult to deal with, and may require the whole gland to be removed.

Salivary Gland Tumors

Salivary Gland

Malignancy Rate

Parotid

20%

Submandiublar

50%

Sublingual/Minor

65%

Both benign (non-cancerous) and cancerous tumors may develop in the salivary glands. The majority of salivary gland tumors begin in the parotid glands (80 percent), with approximately 10 percent occurring in the submandibular, and the remainder forming in the sublingual glands and the minor glands. Approximately 80 percent of tumors found in the parotid glands are benign, whereas 50 percent of submandibular tumors and only 35 percent of sublingual and minor glands are benign. Our ear, nose, and throat specialist, serving all of Southern California, can perform a biopsy to determine whether a growth is cancerous or not.


Fig. 18 - Fine Needle Aspiration

Benign

Pleomorphic Adenoma

Warthin's

Malignant

Mucoepidermoid

Acinic Cell

Adenoid Cystic

Squamous Cell

Carcinoma Ex-Pleomorphic

Metastasis from Other Cancers

Although they will not spread to other parts of the body, benign tumors of the salivary glands may affect surrounding nerves, and make surgery more difficult as they grow around the nerve. It is also possible for benign tumors to become cancerous. Thus, removal of the tumor and close monitoring are necessary in order to prevent a more serious situation. Treatment of cancerous tumors also almost always involves surgical removal.

When surgical removal of a salivary gland by a qualified ear, nose, and throat specialist becomes necessary, Beverly Hills-area patients trust Dr. Babak Larian, a highly respected ear, nose, and throat specialist in Southern California who performs parotidectomy and submandibular gland resection surgeries for the benefit of his patients:

Risk Factors

Exposure to radiation is the most well-known cause of salivary gland cancer. This includes environmental exposure and radiation therapy for cancer of the head or neck. Individuals who are consistently exposed to industrial solvents, pesticides, or sawdust may have an increased risk of developing a type of salivary gland malignancy that affects the nose and sinuses.

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Symptoms

In advanced cases, pain and facial paralysis may be indicators of a parotid tumor. The most common symptom of salivary gland cancer, however, is a painless mass.

Diagnosis

When a salivary gland tumor is discovered, a fine needle biopsy is often indicated to determine whether it is benign or cancerous. To ascertain the extent of the tumor, an MRI scan of the face and neck may be indicated.

Treatments

When surgical removal of a salivary gland by a qualified ear, nose, and throat specialist becomes necessary, Beverly Hills-area patients trust Dr. Babak Larian, a highly respected ear, nose, and throat specialist in Southern California who performs parotidectomy and submandibular gland resection surgeries:

Minimal Scar Parotidectomy

The surgical procedure used to remove a parotid gland is known as a micro parotidectomy. Although advanced technology is used by our ear, nose, and throat specialist to monitor facial nerve function during surgery, when possible, surgeons can perform a superficial parotidectomy. Because a superficial parotidectomy only removes the superficial lobe of the gland (the part superficial to the facial nerve), it involves less risk to the surrounding facial nerve branches. The EMG facial nerve monitoring device is used in every case to help during the surgery. Every safety measure and precaution is taken before, during and after surgery to assure the facial nerve functions perfectly. Thus the incidence of permanent facial nerve paralysis when removing benign parotid tumors is extremely (less than 0.1%)

Fig. 19A - Facial Nerve & Facial Muscles Fig. 19B - Facial Nerve Monitor

A Superficial Parotidectomy is an outpatient procedure and most patients go home the same day. A two-team approach is used in every case in cooperation with a facial plastics and reconstructive surgeon. A face-lift incision that is well hidden in the hairline or a shorter incision just next to the ear is used in most cases.

Once the parotidectomy is completed, the reconstruction is immediately performed. There are several reconstruction options, but most commonly we use a portion of the neck muscle called the sternocloidomastoid muscle (SCM). This muscle is rotated into the area of the defect and spread widely to cover the facial nerve (thus protecting and separating it from the overlying skin, as to avoid complications), and to also prevent any depression on the side of the face. Rarely other grafts are used. Adjustments to the excess skin, created by stretching caused by the tumor, is also made at the same time. The facial plastics surgeon uses intricate technique to close the incision to assure minimal to no scarring is left. This collaborative effort with the plastics and reconstructive surgeon assures ideal results with a face that looks perfectly even.

Fig. 21A -SCM Flap Fig. 21B - SCM Flap Rotated onto the Face

In cases when parotidectomy is performed for a cancer, the location of the tumor dictates how much of the parotid is removed and the risk to the facial nerve. Again every effort is made to save the facial nerve, but if the tumor involves the nerve, at times the nerve will have to be removed in order to have removed the cancer.

 
Parotid pamphlet  

 

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Submandibular Gland Resection

To remove a submandibular gland that is affected with a tumor, or is chronically infected, a submandibular gland resection is performed. During this procedure, a one and a half-inch-long incision is created beneath the lower jaw. The gland is separated from the surrounding tissue and carefully extracted through the incision. Our ear, nose, and throat specialist in Beverly Hills uses advanced techniques to ensure that the nerves that run through this area remain unharmed during the procedure.


Fig. 22 - Submandibular Incision

Facial Paralysis

In the event that a facial nerve is cut for purposes of removing the cancer during a parotidectomy or submandibular gland resection, Dr. Larian is often able to perform reconstructive facial reanimation immediately to restore movement to the facial musculature.

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Contact Our Ear, Nose, and Throat Specialist in Los Angeles / Beverly Hills

If you think you may have a salivary gland disorder, contact our ear, nose, and throat specialist in Southern California. Serving Beverly Hills, Los Angeles, and the surrounding areas, Dr. Babak Larian provides high quality head and neck surgery and non-surgical care.

Request your consultation with Dr. Larian today.
Call us at 310.776.6913 to schedule an appointment or

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