Is it possible to have a salivary-gland tumor? My daughter has a golf-ball-sized growth that comes and goes on the side of her jaw. It usually lasts three weeks. During this time she experiences tenderness of the area and extreme fatigue. We have been to several doctors to no avail. P.I. My husband has enlarged glands under the jawline. He went to his doctor and was told that all blood work was fine. He is very tired, and the glands and also his ears hurt. What could cause the glands to swell so big?

Jean

These may seem like different problems, but they are in fact very similar. The daughter and the husband both suffer from sialadenitis, 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. There is even parotid tissue beneath and behind the ear lobe.

There are two submandibular glands, one below each jawline, 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, mouth and throat.

Sialadenitis can be caused by viral infections. Mumps, for example, is a viral infection that typically involves swelling of the parotid glands. More commonly, sialadenitis is the result of a bacterial infection, and the most common culprit 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 sialadenitis.) More common predisposing factors are salivary-gland stones (the medical term for this is "sialolithiasis") and narrowing ("stricture") of the salivary-gland ducts.

In the second question, the author's husband had a blood test that appeared normal, so his doctor assumed that his patient did not have a bacterial infection. 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, looking for the following: Is the skin over the gland red or swollen? Is the person experiencing fatigue, fevers, chills or sweats? When I simultaneously massage the swollen gland and look into his mouth, 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," writes the mother. 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 thus not treat the patient with antibiotics. Worse yet, the doctor may treat the patient with an antibiotic that does not have activity against Staphylococcus. This exposes the patient to all of the risks of antibiotic use without any of the benefit.

Both patients would greatly benefit from a visit to an ear, nose and throat specialist (ENT). ENT docs are THE experts when it comes to the diagnosis and treatment of salivary-gland problems. For information on treatment, see my previous column on blocked salivary glands.