SU21.1-2 | Disorders of Salivary Glands — Summary & Reflection

KEY TAKEAWAYS

The major salivary glands are the parotid, submandibular and sublingual, with the facial nerve passing through the parotid to divide it into a superficial and a deep lobe — the single fact that governs parotid surgery. Wharton's (submandibular) duct runs uphill through mucinous saliva, explaining why ~80% of salivary stones are submandibular. Disorders fall into three groups: inflammatory (sialadenitis — bacterial in the dehydrated/post-op, viral mumps in children), obstructive (sialolithiasis, the mealtime swelling) and neoplastic. Tumours follow the rule of 80s (≈80% parotid, ≈80% benign, ≈80% of those pleomorphic adenomas): the pleomorphic adenoma is commonest (benign, pseudopodia through a false capsule → recurs if enucleated); Warthin's tumour is benign, in older male smokers, often bilateral; mucoepidermoid carcinoma is the commonest malignancy; adenoid cystic carcinoma shows perineural spread. Investigate with FNAC + ultrasound/MRI for tumours (never open biopsy of a parotid lump) and imaging/sialendoscopy for stones. Treat sialadenitis conservatively (hydration, hygiene, antibiotics), stones by transoral removal/sialendoscopy or gland excision, and a benign parotid tumour by superficial parotidectomy with facial nerve preservation — never enucleation; malignant tumours need radical surgery, nerve sacrifice only if involved, neck dissection and radiotherapy. A facial nerve palsy with a parotid mass means malignancy until proven otherwise.

REFLECT

Recall the last neck or facial swelling you examined, or imagine clerking the three patients in the hook. Did you — or would you — take a history precise enough to separate a painless slow-growing lump from a mealtime swelling from an acutely inflamed gland, and did you specifically test the facial nerve and palpate the duct bimanually for a stone? Reflect on how much of the diagnosis is settled at the bedside before any scan is ordered. Consider how you would explain to the woman with the parotid lump why she needs a superficial parotidectomy rather than a simple removal of the lump, and how you would consent her honestly for the small but real risk to her facial nerve and for Frey's syndrome — the conversation that turns anatomical knowledge into safe, humane surgery.