Salivary Gland Tumors

Salivary gland tumors are abnormal growths or masses in the salivary glands. They can interfere with the glands’ functions and appear as a bulge in the neck area.

The vast majority of salivary gland tumors are benign, meaning they are noncancerous. Most usually appear as a slow-growing, painless lump at the back of the jaw, just below the earlobe. They can also be found toward the middle of the neck, under the chin.

Malignant, or cancerous, salivary gland tumors are rare. They can be more or less aggressive (rapidly growing). The only known risk factors for salivary gland cancers are Sjogren's syndrome and exposure to radiation.

They can appear in any of the three major salivary gland pairs, but are most common in the parotid glands, which are located in the upper part of both cheeks, near the ears. The duct of each parotid gland empties onto the inside of the cheek, near the top back teeth.

They can also grow in the submandibular glands, which are located under the jaw and empty behind the lower front teeth. A tumor in this gland will appear more toward the middle of the neck, just under the jaw. Infrequently, they are found in the sublingual glands, which sit beneath the tongue.

Other common salivary gland disorders are ranulas and salivary duct stones.

Salivary gland tumors usually start as a small bump or lump in the neck. They are not painful and don’t interfere with saliva production, swallowing or breathing when they are small.

They grow slowly, and the area of swelling in the neck will appear enlarged. If allowed to grow, they can cause numbness or muscle weakness in part of the face, difficulty swallowing, trouble opening the mouth widely, and pain.

A pediatric otolaryngologist, a physician who specializes in the ears, nose and throat (ENT), will examine the child. Depending on the location and type of problem, the doctor may press on (palpitate) the child’s neck or look inside their mouth, pushing on the floor of the oral cavity.

If a salivary gland tumor is suspected, imaging tests will be ordered. These may include:

• a CT scan, which uses a combination of X-rays to take detailed pictures of the inside of the body
• an MRI, which uses strong magnets and radio frequency waves to produce images of the body
• an ultrasound of the neck, which uses sound waves to create images inside of the body

Rarely, the doctor will order a salivary gland biopsy or fine needle aspiration, which takes out a bit of tissue from the tumor, to determine whether the tumor is benign or malignant. This is infrequently done in children since the mass will need to be removed in all cases. Certain benign tumors can become malignant if left to grow.

Nearly all salivary gland tumors will need to be removed. The surgery usually requires a one-night stay in the hospital. The size and location of the tumor will determine if the surgeon will remove a portion of the affected salivary gland or if the entire gland must be removed.

Children being treated for a salivary gland tumor will see a pediatric otolaryngologist (ENT). At Children’s Hospital of Philadelphia, pediatric ENT surgeons on our Head and Neck Disorders team will care for children with salivary gland tumors.

The approach to removal of the tumor will depend on its location.

• Parotidectomy is the name of the surgery used to remove a tumor in the parotid glands. The facial nerve passes through the body of the parotid gland. Protecting this nerve, which controls the ability to close the eyes, raise the eyebrows and smile, and other nearby structures is why this operation requires particular care and expertise from the surgical team. Depending on the location of the tumor either part or all of the gland may have to be removed.
• Removing a tumor in the submandibular glands is called a submandibular gland excision. The surgeon will make a cut (an incision) under the jawline to remove the gland and some of the surrounding tissue. The extent of the surgery will depend on the size and type of the tumor. Precision is important because of the three nerves in the area: the marginal mandibular nerve, which helps smiling; the lingual nerve, which allows sensation in the tongue; and the hypoglossal nerve, which allows movement in the part of the tongue that helps with speech and swallowing.
• Surgery to remove tumors in a sublingual gland is called sublingual gland excision and most often involves removal of the entire gland along with the mass. The surgeon will make an incision inside the mouth to remove the gland and tumor. The surgical area is repaired by either closing the gap with stitches or grafting the skin. Because the lingual nerve, which controls feeling and taste on the side of the tongue, is nearby, a skilled surgeon, like those in CHOP’s Head and Neck Disorders Program, is required. After surgery, the tongue might be numb on the affected side. This is usually temporary and lasts from a few weeks to a couple of months.

All tumors are sent to Pathology after surgery to determine if they are benign or cancerous.

Pleomorphic adenomas are the most common benign salivary gland tumor and are most frequently found in the parotid gland. However, they can also grow in the submandibular gland and minor salivary glands, but less often than in the parotid gland.

Warthin’s tumor is the second most common benign tumor of the parotid gland.

Children with benign tumors have few after effects following surgery. If the gland is removed totally, the other salivary glands produce enough saliva so there are no problems chewing or swallowing food. The ENT doctor may request follow-up appointments to make sure the tumor hasn’t grown back.

Children with cancerous tumors will be referred to a pediatric oncologist in the Cancer Center at Children’s Hospital of Philadelphia for treatment.