Aug 21, 2018
No one knows why stones and tumors sometimes form in salivary glands. Most are not cancerous, but if they aren’t treated promptly, they can be big trouble. Dr. Matthew Pierce discusses the risk factors and how advances in technology make treatment easier than ever.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: Thank you for joining us today. We’re talking with Dr. Matthew Pierce, an otolaryngologist and head and neck surgeon at MedStar Washington Hospital Center. Welcome, Dr. Pierce.
Dr. Pierce: Thank you.
Host: Today, we’re talking about salivary gland disease, which is a grouping of conditions that affect oral health. The salivary glands produce saliva, which helps digest food and protect the teeth from decay. Salivary gland diseases can cause discomfort and can lead to serious health concerns that affect the mouth and lips. Dr. Pierce, what are some of the more common salivary gland diseases you treat?
Dr. Pierce: So, I treat a multiple array of salivary gland diseases, everywhere from benign diseases to cancers of the salivary glands. Um, some common ones that I treat are stones of the salivary gland using a multiple array of techniques, including sialoendoscopy, which is small scopes in the salivary glands. In addition to stones, I also treat patients who have had chronic infections or inflammation of the salivary glands, as well as tumors of the salivary glands, including the parotid gland and the submandibular gland. And those can both be cancerous or benign tumors of the salivary glands.
Host: How many salivary glands does the average person have?
Dr. Pierce: So, everybody has four major salivary glands. They have the parotid glands on either side of the cheek as well as submandibular glands below the mandible, below the jawbone, as well as multiple minor salivary glands throughout the mouth - in the palate, underneath the tongue, and in the cheek mucosa itself.
Host: So, you have scopes that are small enough to fit within those glands?
Dr. Pierce: We have scopes that can fit into the major salivary glands, in the ducts that drain the major salivary glands. The scopes are very small and they can go in through those glands and we can look for strictures, or narrowing, of the ducts as well as...we can look for stones and potentially even remove some small stones from those ducts.
Host: What would cause a stone to form in the salivary glands?
Dr. Pierce: So, we don’t really know the exact way that these stones are formed. We do know that patients that are dehydrated, that don’t drink enough fluids, are more prone to it, as well as patients that have an increased amount of exogenous calcium or taking calcium for other reasons sometimes can lead to stones, but not for everybody. So, the shorter answer is that we don’t really know what causes these in certain people.
Host: So, if someone has a salivary gland disease, what symptoms would prompt them to come to the doctor?
Dr. Pierce: The major symptom that most people notice is swelling in the area. So, swelling in the cheek or swelling just beneath the jawbone, and that could be in the form of a lump, it could be in the form of an infection, or it could also be associated with pain. Stones often present with recurring swelling and pain that then resolves and then comes back. This can be diagnosed through physical exam as well as certain x-rays and imaging techniques.
Host: So, you mentioned a couple of reasons why doctors think somebody might develop a salivary gland disease. What are some of the things that patients can do to perhaps reduce their risk for this happening to them?
Dr. Pierce: Well, as I mentioned, uh, one of the best things that you can do is staying well hydrated. But, other than that, there’s not much that one can do to prevent stone formation, or tumor formation, either. There are some rare tumors of the salivary glands that can be associated with smoking, but in general, most of the tumors of the salivary glands are not associated with smoking or any other…other type of lifestyle changes or anything like that.
Host: So, we’re talking about a very small gland. How large...how large are the tumors that you find within the salivary glands?
Dr. Pierce: The average size of tumors that I take out of the salivary glands are usually about the size of a marble. Sometimes, they can be as large as a golf ball size, but they’re not usually very big. Sometimes, they can get very large and cause discomfort, but the majority of tumors of the salivary glands actually don’t cause many symptoms. Um, and they’re actually quite small and often they’re found incidentally when getting imaging for other illnesses or other issues.
Host: So, compared to the size of a normal or a healthy salivary gland, how big would the marble-sized tumor be compared to that regular gland?
Dr. Pierce: So, the average-sized gland--obviously, it varies from person to person, but it could be as much as double in size. Or, you know, you may just feel a small little nodule in your cheek or just underneath your jawbone. They typically don’t increase the size of the gland itself. Again, as I mentioned, maybe you might feel a little nodule inside your cheek or your neck there.
Host: What are some of the risks to an individual if they don’t get this treated or if it goes undetected?
Dr. Pierce: Uh, the vast majority of tumors in the salivary glands are benign, meaning they are not cancer. However, there are certain ones that if you don’t treat, they continue to enlarge and even can turn into cancer if you don’t treat them and…and take care of them in a timely fashion. So, there are risks to not doing anything. There’s also the risk of, uh, stones or other tumors causing obstruction, causing recurrent infections and inflammation, and causing swelling of the actual gland.
Host: So, all of that would affect, you know, what…what body functions?
Dr. Pierce: So, it doesn’t really obstruct blood flow. It doesn’t really...it wouldn’t really affect any body functions. Even if you do have an obstruction of one gland, usually it does not cause enough decrease in flow. You have enough accessory glands to where it’s not gonna really cause dry mouth unless you have some other type of disease causing decreased salivary flow in your other glands as well.
Host: Could you talk a little bit about your patient population? Are you usually seeing this in younger folks, older folks?
Dr. Pierce: The majority of salivary gland diseases are...are seen in older people in their 40s, 50s, 60s, and above. And the reason for that is it takes a while for these tumors to grow as well as the stones to form. This is something that happens over the course of many years, um, for salivary gland stones. And, uh, certain tumors are seen mostly in the elderly. However, it varies depending on what type of tumor it actually is. But we usually see these in the adult population.
Host: How do you work with other members of your team or other colleagues are MedStar Washington Hospital Center to care for patients with these diseases?
Dr. Pierce: So, we work very closely together, especially with the endocrinology team. A lot of patients who have received radioactive iodine may be more prone to developing strictures and salivary gland diseases. And so, we work very closely with them to find these patients that may be suffering from post-radiation salivary dysfunction. We also work closely with the radiation oncologists in finding these patients and help treating these patients. Uh, certain patients that have cancers of the salivary glands often require further treatments in addition to surgery, and this may be radiation and/or chemotherapy, and so we work closely with our colleagues there as well.
Host: If a person undergoes radiation for any type of cancer, you know, in the chest or the neck or the head area, is the dry mouth or are those salivary issues pretty common?
Dr. Pierce: So, patients that receive radiation to the head and neck area often do have problems producing saliva and they often have dry mouth afterwards. It’s a common side effect of radiation treatment. Radiation in other areas does not cause that same type of dry mouth. It’s pretty unique to patients who have had neck cancer and receiving radiation to that specific area. And the reason for that is because the radiation dose is actually concentrated in the area that has the cancer, and, unfortunately, the salivary glands are in that area. And so, in order to get rid of the cancer completely, a lot of times the salivary glands are affected. And this does not happen in all patients that undergo radiation, but a good portion of them it does.
Host: Is there any, uh, medication therapy that you would give these patients to control the size of the tumor?
Dr. Pierce: Um, initially, there is not a medication to treat cancers or tumors of the salivary glands. These are typically treated with surgery up front. For patients who have dry mouth, there are certain mouthwashes and medications that we can give to these patients to help saliva production. In patients that have salivary gland stones or strictures, again there’s not really an oral medication that we can prescribe that’s going to help with these conditions. These are typically surgically treated in the right patient population.
Host: Why should a patient choose MedStar Washington Hospital Center over maybe another physician in the community?
Dr. Pierce: MedStar Washington Hospital Center is a tertiary referral center and we have a very unique capacity to collaborate with our colleagues in other specialties. And we treat everything from the most simple to the most complex salivary gland diseases. And, by coming to one center where you get very comprehensive type of care, you avoid delays in care as well as you get the most state of the art treatment for, um, whatever salivary gland disease you may have.
Host: Could you talk about any patient success stories that you might have from your population?
Dr. Pierce: Um, I’ve had quite a few good success stories, uh, both salivary gland stones or patients who have had recurrent inflammation of the salivary glands, uh, using this endoscopic technique. I had a patient that had a tumor of his parotid gland and he elected to undergo surgery to remove this, and he underwent a successful surgery. He was sent home on the first day after surgery. Um, and he is extremely happy with his result and fortunately, it was not a cancer and he is done with treatment.
Host: What is the technique that you use to do these scoping procedures in patients? Are they under anesthesia? How does that work?
Dr. Pierce: The sialoendoscopy, which is the scope for salivary gland diseases such as stones, is typically done with the patient asleep. There are some physicians that will do this with the patient awake. And a lot of times it depends on the patient preference. It’s a relatively straightforward and low-risk procedure, but usually the patient requires some type of sedation for comfort.
Host: And is it typical that they would have that similar result, where they can go home the next day?
Dr. Pierce: The patients that have the scope, uh, for either a salivary gland stricture or salivary gland stone usually go home the same day. Uh, the patients that require excision of a salivary gland usually stay one night in the hospital.
Host: Do they have any recovery time for stitches or anything like that?
Dr. Pierce: For removal of the salivary glands, they require an incision in either the neck or right in front of the ear. The incision is usually well hidden and the scars are kept to a minimum in the patients that require excision of the gland or excision of a tumor. Uh, the patients that have stones or the patients that have the, uh, sialoendoscopy procedure do not require stitches.
Host: Thanks for joining us today.
Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.