Salivary Gland Tumors
There are three main pairs of salivary glands. The first and largest are the parotid glands in front and just below the ears. The second largest are the submandibular glands at the back of the mouth under the side of the jaw. The third pair is the sublingual glands. They are found in the floor of the mouth under the tongue. There are several other minor salivary glands scattered below the lining of the mouth and throat.
The salivary glands secrete saliva into the mouth through ducts. Saliva moistens food, makes it easier for us to chew food and swallow, and aids in breaking down food for digestion. Saliva also washes away bacteria and food particles and keeps the mouth moist.
Salivary tumors are rare, especially in children. The tumors can be benign or malignant and most commonly are located in the parotid glands. Signs of a possible tumor include: development of a painless lump or growth, swelling or gradual increase in the size of a gland, or, in rare cases, facial paralysis.
Diagnosing and Treating Salivary Tumors
Sometimes salivary tumors are detected during a routine dental exam. A fine needle may be used to withdraw some cells for laboratory examination. From this information, doctors will determine if the tumor is benign or malignant and what steps need to be taken for treatment.
If a tumor is malignant, surgeons need to remove the tumor and a small margin of healthy tissue. Patients may lose part of the jaw, and several teeth. As with many types of oral cancer, the surgery can be extremely extensive and disfiguring. Traditionally, doctors make the incision through the skin over the face and cut down to the bone to get at the tumor and surrounding tissue.
Some doctors are using a less visible approach called midface degloving. Instead of working from the outside of the face, an incision is made inside – along the upper lip and gum line. Next, the skin is lifted from the face to expose the facial skeleton. Doctors remove the tissue and replace the overlying skin. Since all the incisions are made inside the mouth, there are no visible scars or bruising.
When a tumor is located on the roof of the mouth, the patient is left with a large hole in the hard palate, creating both cosmetic and functional problems. With no separation between the mouth and nasal passages, air, food, and liquids can pass from the mouth and out the nose. Speech and swallowing become difficult.
Doctors also have a way to deal with this problem. Prior to surgery, impressions are taken of the patient's mouth. These impressions are used to create a special appliance, called an obturator prosthesis that fills in the gap at the roof of the mouth. A temporary obturator is inserted just after surgery while the patient is still asleep. When he/she wakes, the hole is covered. The obturator also protects the surgical site and helps the surrounding tissue to heal. The patient is able to talk and take oral fluids soon after surgery. As the area heals, the device is adjusted to ensure a tight seal and prevent leakage of air, fluids, and food into the nasal cavity. Once doctors have determined healing is complete, a permanent device is constructed. The obturator can also be designed to replace teeth and gums that need to be removed during surgery.
Salivary Gland Tumors