Salivary Gland Tumours and Stones: What Patients Should Know

Salivary gland problems are more common than most people realise - and they range from a nuisance stone that passes on its own to a tumour that needs careful specialist assessment. In this article, Dr Jingyi Cao explains the two main conditions, how they present, and when to seek a specialist opinion.

Salivary stones (sialolithiasis)

Salivary stones form in the ducts of the salivary glands - most often the submandibular gland (under the jaw), which accounts for around 80-90% of cases, with the parotid gland (in the cheek) making up most of the remainder.

They are not rare: sialolithiasis affects roughly 1 in 10,000 to 30,000 people each year, and accounts for up to half of all major salivary gland disease.

The classic symptom: “mealtime syndrome”

Patients typically describe pain and swelling of the gland when eating, because food stimulates saliva production and the stone blocks the duct. On examination, a firm nodule may be felt along the duct, or the gland itself may be swollen. Chronic cases can present with recurring infections or abscesses.

What happens next

A thorough history and examination comes first
Ultrasound is the first-line imaging - quick, inexpensive and accurate for stones
CT can be considered if ultrasound is inconclusive or complications are suspected

Treatment

Uncomplicated stones are often managed conservatively:

Hydration
Encouraging saliva flow (chewing lemon or sour lollies)
Massage and warm compresses
Anti-inflammatory medication (NSAIDs) for pain and swelling
Antibiotics if there is infection

If symptoms persist or recur, referral to a head and neck surgeon is appropriate - some stones require surgical intervention.

Salivary gland tumours

Salivary gland tumours usually present as a painless, slow-growing mass in the parotid or submandibular gland, and are sometimes found incidentally on imaging.

Around 80% arise in the parotid gland, with 10-15% in the submandibular gland. Importantly, the risk of malignancy is higher in the smaller glands: about 20% of parotid tumours are malignant, about 50% of submandibular gland tumours, and up to 80% of tumours in the sublingual or minor salivary glands.

Common tumour types

Pleomorphic adenoma - the most common benign tumour. Even though benign, it is usually removed surgically because of a risk of malignant transformation (around 1.5% at five years, and up to 10% at fifteen years).
Warthin’s tumour - the second most common benign tumour, strongly associated with smoking, more common in men and around age 50. It carries no risk of malignant transformation, and surgery is only needed if the tumour is large, the diagnosis is uncertain, or for cosmetic reasons.
Mucoepidermoid carcinoma - the most common primary malignancy of the salivary glands.
Adenoid cystic carcinoma - a malignancy known for late recurrence, requiring long-term follow-up.

Red flags that should never be missed

Facial nerve palsy (weakness of the face on the affected side)
Rapid growth or a painful swelling
A hard, fixed or irregular mass
Enlarged lymph nodes in the neck
Skin ulceration or tethering of the lump

Management

Treatment depends on the gland, the histology and the stage. It typically involves surgical excision (parotidectomy where needed) with facial nerve preservation where possible, selective neck dissection when indicated, and occasionally adjuvant radiotherapy. Benign tumours have excellent outcomes after complete excision.

The three take-home messages

For salivary stones: think of painful swelling at mealtimes - manage conservatively, but refer if symptoms are recurrent or complicated.
For tumours: any persistent, firm gland lump should be assessed by a head and neck surgeon, especially with red flag symptoms.
Ultrasound is the first-line investigation - further imaging and FNA biopsy are best organised by the specialist, and early referral can make a significant difference to the outcome.

This article is based on Dr Cao’s PodMD episode, Salivary Gland Tumours and Stones. The advice here is of a general nature and is not a substitute for individual medical advice - please discuss your specific situation with your doctor.