Salivary Gland Surgery

The salivary glands are a collection of large and small glands that make and release saliva. They are vital for keeping the mouth and throat moist and help us to digest and swallow food.  Cancer and other non-cancerous conditions, including salivary duct stones, can develop in the salivary glands and require surgery as part of treatment.

About the salivary glands

There are three major pairs of salivary glands and hundreds of minor salivary glands throughout the mouth and throat. The major glands are:

Parotid glands

  • The largest salivary glands (found in front of the ears and behind the jaw) move saliva into the mouth through a tube that opens inside the cheek called the parotid duct.

  • The facial nerve that controls all facial muscles runs through the parotid glands. The parotid glands also contain lymph nodes.

  • Most salivary gland cancers occur here – either in the parotid salivary gland tissue or spread from the skin to the lymph nodes in the parotid glands (as a secondary or metastatic cancer).

Submandibular glands

  • The submandibular glands are found under each side of the jawbone to release saliva into the mouth through a duct under the tongue.

  • Important nerve structures next to these glands allow us to feel and taste using our tongue and move the lower lip.

  • Submandibular gland tumours can be cancerous or non-cancerous.

Sublingual glands

  • The smallest major salivary gland, the sublingual glands are found under the tongue and release saliva through a duct on each side.

  • They sit next to the lingual nerves that give taste and feeling to the tip of your tongue.

  • While rare, tumours in this gland are more likely to be cancerous than tumours in the larger salivary glands.

Salivary gland cancer surgery

Most salivary gland tumours are non-cancerous (benign) tumours, however, they can become malignant over time. While these tumours are usually found in the parotid glands, a smaller number of salivary gland cancers are also found in the submandibular, sublingual and minor salivary glands lining the mouth and throat where they may spread along nerves or to lymph nodes and to other parts of the body.

Dr Wykes is an experienced head and neck surgeon who specialises in the different types of surgery used to remove salivary gland cancers. This includes careful protection of the relevant nerves associated with the salivary glands – including the facial, hypoglossal and lingual nerves – and reconstructive surgery to repair delicate tissues inside the mouth.  

Surgical procedures to remove salivary gland cancer include:

  • Parotidectomy – removing part or all of the parotid gland in front of the ear and any affected surrounding tissues.

  • Submandibular or sublingual gland surgery – removing the glands via the mouth or neck and any affected surrounding tissue and/or bone.

  • Lateral temporal bone surgery – removing bone in the temple and behind the ear when cancer in the parotid glands spreads into the nearby bone. Performed alongside a parotidectomy and neck dissection. This surgery is performed by one of Dr Wykes’ otology colleagues if required.

  • Radical parotidectomy – removing the nerve that controls facial expression when cancer in the parotid glands spreads to surrounding facial nerve.

  • Neck dissection – removing lymph nodes from the neck when cancer has already spread or there is a risk of spreading.

  • Reconstructive surgery – taking tissue from another part of the body (called a free flap repair) to replace any large areas of tissue that need to be removed and to help reconstruct the form and function of the face if the facial nerve is removed.

Salivary duct stones

Salivary duct stones are hardened mineral deposits that form in the salivary glands. They can form in any of the salivary glands but are most often found in the submandibular salivary glands of the jaw. If a stone blocks the salivary duct, the gland can become infected, a condition called sialadenitis.

While it’s unclear why they form, being dehydrated, taking certain medications, smoking and gum disease are contributing factors. They are also more common in men and older people (30-60 years).

Treatment for salivary duct stones

The first line of treatment for salivary duct stones is to stay hydrated and take medication to relieve any pain and swelling. If pain or infection persists, Dr Wykes may recommend a procedure called transoral stone removal, sialendoscopy or salivary gland excision to remove the stone and associated infection.

Under either local and general anaesthetic, Dr Wykes will make a small incision in the mouth and remove a stone, or use small instruments to remove the stone via a telescope.  If the stone is very large or intimately related to the gland, the salivary gland may need to be removed as well.