Salivary Gland Surgery Basics: What Every Dentist Knows

Saliva comes from three pairs of major glands — the parotid (in front of the ear), the submandibular (under the jaw) and the sublingual (under the tongue) — plus hundreds of tiny minor glands. Together they make about 1 to 1.5 litres daily, starting digestion, protecting teeth and enabling speech and swallowing.

Surgery becomes necessary when stones block a duct, benign tumours (most often pleomorphic adenoma) or cancers grow in a gland, or chronic infection destroys it. It is delicate work because the facial nerve runs straight through the parotid, while the lingual and hypoglossal nerves pass close to the submandibular gland.

Key Concepts

• Parotid gland: the largest salivary gland; the facial nerve divides inside it into five branches.
• Submandibular gland: under the jaw; its duct (Wharton's) opens under the tongue — the commonest stone site.
• Sialolithiasis: a duct stone causing pain and swelling that worsen at mealtimes ("mealtime syndrome").
• Pleomorphic adenoma: the commonest benign salivary tumour — usually a slow, painless parotid lump.
• Superficial parotidectomy: removing the parotid's outer lobe while preserving the facial nerve — standard for benign tumours.
• Frey's syndrome: cheek sweating while eating after parotid surgery, from misdirected nerve regrowth.

How It Works

1. Diagnose the lump. Ultrasound plus fine-needle aspiration (FNAC) distinguishes stone, benign tumour and cancer; MRI maps tumours near nerves.
2. Try gland-preserving options first. Small stones may pass with hydration and massage; larger ones come out through the duct, sometimes via sialendoscopy.
3. Find the nerve first. In parotid surgery the facial nerve trunk is identified before gland tissue is removed around it, with a nerve monitor checking branches.
4. Remove the right amount. Benign tumour: superficial parotidectomy with a cuff of normal tissue. Cancer: total parotidectomy, plus neck dissection if nodes are involved.
5. Protect nearby nerves. Submandibular removal spares the marginal mandibular, lingual and hypoglossal nerves through a crease-hidden neck incision.
6. Recover. A drain stays 1-2 days; facial movement is checked on waking, with physiotherapy if any branch is weak.

Worked Example

A 45-year-old man has a 3 cm painless lump in front of his right ear for 2 years; FNAC suggests pleomorphic adenoma. His daily saliva is about 1,200 ml, with the parotids contributing roughly 25% — 300 ml from both sides, 150 ml from the operated side. Superficial parotidectomy takes about 2.5 hours; all five facial nerve branches are preserved and the tumour comes out with a 1 cm cuff of normal gland. The drain is removed on day 2 after under 30 ml in 24 hours. At 6 weeks his smile is symmetric, and the remaining glands cover the lost 150 ml/day — he notices no dryness.

Common Misconceptions

• "Removing a salivary gland causes permanent dry mouth." Remaining glands compensate; most patients notice little difference.
• "Every parotid lump is cancer." About 80% of parotid tumours are benign — but all need proper testing.
• "Stones always need gland removal." Most are handled through the duct or sialendoscopy; removal is the last resort.

Real-World Applications

• ENT and maxillofacial clinics evaluating the classic "lump in front of the ear."
• Sialendoscopy suites: gland-saving stone removal.
• Oncology: parotid cancers needing surgery plus neck dissection and radiotherapy.

Salivary gland surgery balances removing disease against preserving nerves — the facial nerve in the parotid, the lingual and hypoglossal nerves near the submandibular gland. With accurate diagnosis, gland-sparing options first and meticulous dissection, most patients keep both their smile and their saliva.