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This letter originally appeared in Dr. Hoffman's column on allHealth.com. |
Q: I would like to know if it possible to have a salivary gland tumor. My daughter has a growth (approximately the size of a golf ball) that comes and goes on her right side of the mandible. It usually lasts three weeks and the growth usually comes approximately every three months. During this time she experience extreme fatigue and tenderness of the area. We have been to several doctors to no avail.
Q: My husband has enlarged glands right under the jaw-line. He went to he doctor and was given a CBC/diff. and was told that all blood work was fine. He also tested negative for mono. He is very tired, and the glands hurt and also his ears hurt. What could cause the glands to swell so big? The doctors say it could be a virus. What are your thoughts?
A: These may seem like different problems, but they are in fact very similar problems. The most probable explanation is that the daughter and the husband both suffer from sialoadenitis, an inflammation of the salivary glands.
The parotid glands are the largest salivary glands. There are two parotid glands, one in front of each ear; each extends down to the lower jaw (mandible). There is even parotid tissue beneath and behind the ear lobe.
There are two submandibular glands, one below each jaw-line, midway between the chin and the ear lobe. Normally, each submandibular gland is about the size of the patient’s thumb. If inflamed, the gland can easily swell to three or four times its original size.
Finally, there are two small sublingual glands (located beneath the tongue) and about 10,000 microscopic "minor" salivary glands, scattered throughout the nasal cavity, oral cavity, and throat.
Sialoadenitis can be due to a viral infection; mumps, for example, is a viral infection that typically involves swelling of the parotid glands. More commonly, sialoadenitis is due to a bacterial infection, and the most common bacterium to do this is a nasty bugger called Staphylococcus. Occasionally, sialoadenitis is not due to infection at all; in a disease known as Sjogren’s syndrome, the body’s immune system mistakenly attacks the salivary glands and lacrimal (tear-producing) glands.
The swelling can be sudden and painful, and the gland can become extraordinarily large. This rarely represents a tumor, since tumors do not instantly appear and certainly do not come and go from one month to the next. (However, on rare occasion a SMALL tumor located near one of the main drainage ducts of a salivary gland can compress the duct, impairing the flow of saliva. This can predispose the patient to recurrent bouts of sialoadenitis.) More common predisposing factors are salivary gland stones (the medical term for this is sialolithiasis) and narrowing (stricture) of the salivary gland ducts.
I have previously addressed the treatment of sialoadenitis in this column, and I have also discussed Sjogren’s syndrome. Here, I would like to comment on the diagnosis of sialoadenitis.
In the second letter, the author’s husband had a blood test (CBC with differential, known commonly as a "blood count") which appeared normal, so his doctor assumed that his patient did not have a bacterial infection. This doctor was primarily interested in the white blood cell count (WBC). White blood cells fight bacterial and viral infection. There are many different types of white blood cells; lymphocytes tend to predominate during viral infections, while PMNs (you don’t want to know what that stands for!) predominate during bacterial infections. The WBC count tells the doctor whether there are more circulating WBCs than usual, and the differential tells him which type of WBC is most prevalent.
I, personally, would not rely entirely upon this test to decide whether or not this fellow has a bacterial infection. I would carefully examine the patient. Is the skin over the gland red, or swollen? Is he experiencing fatigue, fevers, chills, or sweats? When I simultaneously massage the swollen gland and look into his oral cavity, do I see clear saliva, no saliva, or pus coming out of the salivary duct? Answers to these questions would help me decide whether or not he has a bacterial infection, which in turn would determine whether I would treat him with antibiotics.
We have been to several doctors to no avail. Unfortunately, some doctors never even think about salivary gland inflammation and infection, mistakenly assuming that the patient has swollen lymph nodes. The doctor may fail to recognize a bacterial infection and not treat the patient with antibiotics. Worse yet, the doctor may treat the patient with an antibiotic that does not have activity against Staphylococcus, such as amoxicillin. This exposes the patient to all of the risks of antibiotic use, without any of the benefit.
Both the first author’s daughter and the second author’s husband would greatly benefit from a visit to an ear, nose and throat specialist. ENT docs are THE experts when it comes to the diagnosis and treatment of salivary gland problems.
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More information available on other diseases of the ears, nose and throat! |
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Click here if you have questions, comments or criticisms for Dr. Hoffman. |
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