The Medical Consumer's Advocate

Painful swelling of the salivary glands

 

Q: Eating certain types of foods (sweet usually) causes an immediate swelling under my jaw on my right side. It is not painful really but uncomfortable. Can you give me some possible ideas of what these symptoms might mean? Could I have some kind of infection in the salivary glands or some problem connected with the taste buds?

 

A: Don’t blame your taste buds; it’s that ornery salivary gland that’s to blame.

Saliva is produced by four very large glands (the parotid and submandibular glands, one on each side), two not-so-large glands (the sublingual glands), and a few thousand microscopic "minor salivary glands" that are scattered throughout the oral cavity, nasal cavity and throat. The submandibular glands are located beneath your lower jaw (the mandible– hence the name, "sub-mandibular"). Your problem is due to poor flow of saliva from the right submandibular gland.

Why do you notice it only when you eat certain foods? The taste of food (even the sight or smell of food) causes tiny muscles distributed throughout the salivary glands to contract, squeezing saliva from each gland. Some foods are better than others in this regard; sour candies (a sweet-and-sour double whammy) are REALLY effective at stimulating salivary flow.

Why is it uncomfortable? Be thankful; most people with this problem find it to be truly painful. Your gland is trying mightily to expel its payload of saliva, but it is fighting against an obstruction; the result is a swollen, tender gland.

What is the obstruction? Here’s a bit of salivary gland anatomy: think of the salivary gland as an enormous leafy tree. The leaves in this analogy are the cells that produce saliva; the twigs and stems are the various ducts that channel saliva toward the "trunk," which is the main duct draining saliva into the mouth. In most cases, the obstruction is due to one of three things: (1) a stone lodged within the main duct (not unlike the kidneys or bladder, salts can precipitate in the salivary glands, forming small stones); (2) scarring of the main duct, due to trauma or previous infection (the medical term for scarring which narrows a duct is stricture); (3) infection or other inflammation of the gland itself, which causes extrinsic pressure on the duct, pinching it off. Less commonly, a tumor can form near the duct, also causing an extrinsic "pinch."

This problem is usually treated either by a primary care physician or an ear, nose and throat surgeon. Initially, I treat such problems with a combination of simple recommendations:

1. Stay well-hydrated (the current recommendation– for all of us– is a whopping 10 eight ounce glasses per day of nonalcoholic, noncaffeinated beverages).

2. Chew a sour sugar-free gum once or twice between meals to stimulate a persistent flow of saliva from the gland.

3. Firmly massage the gland frequently throughout the day. This will also promote a persistent flow of saliva.

4. When the gland is swollen and tender, apply warm compresses.

In addition to these recommendations, if I think the patient has an infection, I will also treat them with antibiotics. This is a determination I make from my patient’s physical examination; you should leave this to your physician to decide, and NOT attempt to self-treat with antibiotics.

If this conservative regimen fails to alleviate my patient’s symptoms, I will then obtain X-rays of the gland to look for a stone. (If the symptoms have been present for months or years, I will often order X-rays immediately and not wait to see the results of conservative measures.) Sometimes, a stone will not show up on a plain X-ray but will show up on a CT scan. If a stone is present, it is usually best to remove it in the operating room. Choice of local or general anesthesia depends largely on what the patient can tolerate. It is not a terribly painful operation.

If there is a stricture of the duct, it is sometimes possible to dilate the stricture by passing successively larger blunt metal probes into the duct.

If the recurrent swelling does not respond to conservative measures and is not due to some easily-corrected problem (as described above), on occasion it is necessary to surgically remove the gland. This is accomplished under general anesthesia, through an incision on the neck.

I strongly suggest that you discuss this with your physician, since your problem will probably not go away all by itself, and may require more aggressive therapy.

 

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