Salivary Glands
The body has several salivary glands. The main ones are parotid glands in front of the ears, submandibular glands just under the jaw, and subligual glands under the tongue. In addition, there are numerous other small salivary glands located throughout the mouth.
Saliva is important in digestion of food, it lubricates the mouth to help us talk and swallow, and it has antibacterial properties that prevent tooth decay.
The salivary glands are not to be confused with lymph nodes (lymph glands). Salivary glands produce saliva or spit, whereas lymph nodes are there to fight infection as part of the immune system.
What problems occur with salivary glands in children?
Diseases affecting the salivary glands are uncommon in children, but when they do occur they are usually caused by infection. Infection of the salivary glands is also referred to as sialadenitis. Recurrent sialadentits may be caused by stone(s) in the salivary duct (the passageway that allows the saliva produced in the gland to drain into the mouth). There is also a condition called Juvenile Recurrent Parotitis, which causes recurrent pain and swelling in the parotid gland.
A common cause of salivary gland swelling used to be mumps. With vaccination, this became much less common. However, some parents are reluctant to vaccinate their children, so we are again seeing more mumps now as a result.
Pain in the salivary glands and surrounding areas can also be caused by infections related to the common cold, or be the result of tooth decay.
Lumps in the salivary glands due to other causes are rare in children, and the vast majority of these are not worrisome. Mostly they are benign (not cancer).
What are the symptoms of a salivary gland infection?
Bacterial infections usually cause rapid swelling, the parotid being the most commonly affected. Your child may complain of pain, fever, reduced ability to eat and feeling generally unwell.
If the swelling is due to a stone in one of the salivary glands, this typically cause the whole gland to intermittently swell up during eating and drinking and then go back down again. This is because when we eat and drink production of saliva increases, but if there is a stone in the duct or gland itself then the saliva can’t drain properly and hence the gland swells up. Stones most commonly affect the submandibular gland, but can also affect the parotid gland.
Juvenile recurrent parotitis
Juvenile recurrent parotitis is a condition characterised by recurrent episodes of pain and swelling in the parotid salivary gland, in front of the ear. We don't know exactly what causes it. The recurrent episodes can be a real nuisance, but thankfully in most children they resolve during teenage years.
During an episode, your child can be given painkillers, and antibiotics can be used. Also try to encourage them to suck lemon wedges as this produces saliva and this flushes out any irritants that sit within the saliva gland. Placing a warm towel over the swelling can also help.
There is no easy way of preventing the episodes. Certainly removal of the glands wouldn't be considered, because surgery to the parotid glands can have significant side effects including weakness of the nerve that moves the face. We know that as the child gets older the episodes settle down, so just waiting for that to happen is often the best option for most children. But we do recognise that the recurrent nature of the pain and swelling is a real nuisance.
Treatment of salivary gland infection
If your child has an infection of a salivary gland, we advise to keep your child well hydrated and encourage them to drink plenty of fluids, take regular painkillers, and antibiotics may be prescribed if felt to be bacterial in origin. Massaging the gland and eating sour sweets (yes sweets!) helps salivary flow and therefore flush out the infection. Rarely, admission to hospital for stronger, intravenous antibiotics and hydration via a drip may be necessary.
If the gland keeps swelling up after eating, the ENT doctor may arrange an X-ray and / or ultrasound test of the gland to look for stones or any narrowing of the salivary gland ducts. Blood tests may also be arranged to look for other causes of inflammation that cause a gland to recurrently swell up. Other tests such as a CT or MRI scan may be organised for lumps in a salivary gland, but as already mentioned these are rarely anything to worry about.
Section contributor:
Rachael Lawrence MBBS BSc MRCS
ENT Registrar