Salivary Gland Obstruction: Progress in Clinical Treatment
Guest: Dr. Boyd Gillespie - Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: Dr. Boyd Gillespie is Associate Professor of Ear, Nose, and Throat, or Otolaryngology, here at the Medical University of South Carolina. Dr. Gillespie, I understand you’ve been doing some very interesting new clinical work in the area of salivary obstruction. Can you start off, please, by explaining just how it is that the salivary glands become blocked?
Dr. Boyd Gillespie: We have six major salivary glands in our head and neck region: two in our cheeks, and two under our jaw line, on either side. There are several ways that these glands can become obstructed. Scar tissue can form within the glands after an infection, such as mumps, a viral illness of the glands. Autoimmune diseases can actually attack these glands and cause them to become blocked. Certain drugs can cause blockage of these glands. The most common reason is probably salivary stones, which are small pieces of calcium stone, similar to bladder stones, or renal stones.
Dr. Linda Austin: What are the symptoms, then, if you have an obstruction, or a blockage, in your salivary glands?
Dr. Boyd Gillespie: The symptoms are recurrent swelling of the gland, occurring predominantly prior to eating, or when exposed to food. So, anything that would make you salivate, or produce saliva, can cause the gland to swell up. Because the gland is unable to empty that saliva into the mouth, it gets blocked up in the glands. So, the major symptoms are pain, swelling, recurrent infections, sometimes, and, often, the drainage of a very thick foul-tasting saliva into the mouth.
It’s a bad problem, luckily, though, it’s a benign disease. But most patients who have it have been suffering from it for years, and there have been limited things available to treat it. The traditional treatment for this is to drink a lot of water to try to keep your saliva thin and watery, massage the gland, helping the gland empty naturally, and sucking on sour candies. However, nowadays, we’re fortunate to have some newer techniques to treat this.
Dr. Linda Austin: And, tell us about those techniques.
Dr. Boyd Gillespie: Approximately ten years ago, in Europe, some innovative surgeons developed small scopes that can pass into the natural opening of these glands. These glands empty into our mouth. The two in our cheeks empty through small holes in our cheeks. The other glands empty beneath the tongue through small openings. With these special scopes, we’re able to dilate those openings. We place the scopes into the natural drainage pathway of the glands, identify what’s causing the obstruction, and then treat it.
In patients with stones, we can actually go in and use a small grabber basket device to grab the stones and remove them. With people with scar tissue, we can remove the scar tissue and dilate the glands. Some people who have autoimmune diseases or certain drugs causing inflammation of the glands, we’re able to diagnose that and do steroid infusions directly into the gland, cleanse the gland, and reduce the inflammation.
Previously, all that was available to those patients were conservative measures, such as hydration and massage, or removal of the gland, if they got bad enough. The use of these techniques has allowed us to not have to operate on as many patients; we’ve had to remove far fewer glands.
Dr. Linda Austin: So, very exciting. Now, how common is this problem?
Dr. Boyd Gillespie: It affects about one percent of the population during the course of one’s lifetime. So, about 1 in 100 people will have this condition.
Dr. Linda Austin: So it’s pretty common, actually.
Dr. Boyd Gillespie: It’s pretty common. And there are a lot of people out there that have it because we really haven’t had a way to treat it effectively. So, once people get it, they tend to have it for a long period of time.
Dr. Linda Austin: So, you must be doing a lot of these procedures then, I would think.
Dr. Boyd Gillespie: Quite a few. We’re in the course of trying to train more American surgeons in these techniques. The technology was developed in Germany and Switzerland. I’ve gone over there to train in the techniques and have brought it back here where I’ve started to train other surgeons. Unfortunately, right now, it’s not widely practiced among surgeons in the United States. There are about four or five centers now that are able to offer this. But, hopefully, in the next five or ten years, we’ll have many more trained surgeons in the U.S.
Dr. Linda Austin: Very exciting. Well, congratulations on this great new clinical development here at MUSC.
Dr. Boyd Gillespie: Thank you.
Dr. Linda Austin: Thanks for talking with us today.
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