Salivary Gland Disorders and Cancers

Fortunately, the vast majority of salivary diseases are benign, inflammatory, or infectious. At Mount Sinai, we pride ourselves in minimally invasive approaches for head and neck diseases, and salivary diseases are no exception. Most obstructive processes of salivary glands can be addressed through specialized salivary endoscopy, or through intraoral approaches, avoiding any skin incisions. When salivary malignancies are encountered, we also have a dedicated team of cancer surgeons, reconstructive/cosmetic surgeons, radiation oncologists, and medical oncologists, who can formulate a personalized treatment plan for any particular tumor. Clinical trials are available for recurrent tumors or those resistant to traditional therapy.

About Salivary Gland Disorders and Cancers: Salivary Stones, Sialendoscopy and Cancer

Salivary glands produce saliva, which begins the process of breaking down food (digestion). Saliva also helps prevent mouth and throat infections through the antibodies and other substances it contains.

The salivary glands are classified as either major or minor. The three pairs of major salivary glands are listed below.

  • Parotid glands, the largest salivary glands, are found in the cheeks, coming down to overlap the jawline and the area just below the earlobes. Roughly 70 percent of salivary gland tumors start here. Most of these tumors are benign (non-cancerous), but the parotid gland is still where most malignant (cancerous) salivary gland tumors start.
  • Submandibular glands are smaller and found under the jaw. They secrete saliva under the tongue. About 10 to 20 percent of tumors start in these glands and approximately half of these tumors are benign.
  • Sublingual glands, which are the smallest, are found under the floor of your mouth and below either side of your tongue. Tumors arising in these glands are rare.
  • The minor salivary glands are too small to be seen without a microscope. Several hundred of them are located beneath the lining of your lips, tongue, and hard and soft palate, as well as inside your cheeks, nose, sinuses, and larynx (voice box). Tumors in these glands are uncommon but are more often malignant than benign.

Salivary Stones and other Benign Diseases

Recurrent or persistent swelling in the cheek or underneath the jawline may indicate an obstruction in one of the major salivary glands.  A variety of diseases can cause obstruction within the salivary ductal system, including infection, inflammatory diseases, and stones.  The cause of many obstructive diseases, as well as the origin of salivary stones, is not well understood.  Fortunately, the majority of the time, obstructive processes can be addressed through minimally invasive approaches. 

Sialendoscopy for Salivary Obstruction

Salivary endoscopy, or sialendoscopy, is a technique that uses very small-caliber endoscopes to visualize, irrigate, and dilate the ductal system.  Many small salivary stones may be removed using tiny instruments through the working channel of the endoscope. Larger stones may sometimes require a combined approach with an endoscope and an intraoral or a or a minimally invasive skin incision. Sialendoscopy has also been found to benefit many patients with systemic inflammatory processes or diseases that have impacted the major salivary glands.

Benign Salivary Tumors

The most common tumors occurring in major salivary glands are benign; the more common ones include pleomorphic adenoma, Warthin’s tumor (papillary cystadenoma lymphomatosum), monomorphic adenoma, and oncocytoma. Because of the malignant transformation potential of many benign tumors, as well as the limitations of needle biopsy for certain lesions, surgery is often advised for salivary gland tumors. At Mount Sinai, we are committed to safe and complete surgical excision of tumors, with a secondary emphasis on minimally invasive, cosmetically favorable techniques. When necessary, our team is able to perform restorative procedures for surgical defects.

Salivary Gland Cancer

Several types of salivary gland cancers link to the types of salivary gland cancers page exist, and are grouped into low, intermediate, and high grade. Treatment plans are individualized depending largely on the grade of the tumor. Surgery is almost exclusively recommended as a first, and often only, step towards cure of salivary cancer. The parotid and submandibular glands are the most common major salivary glands affected. Surgery for these glands involves external incisions, hidden in natural creases of the skin, through which the affected gland, and sometimes nearby lymph nodes at risk, can be removed. Rarely, surgery may necessitate sacrifice of nerves running through the gland, at which time simultaneous nerve reconstruction, and possible additional restorative surgery, may be recommended. Our robust team of medical and radiation oncologists are available for those more advanced cases that require additional therapy after surgery.