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Dr. Hernan Goldsztein is now a full partner with Pacific ENT Medical Group, Inc.

Dr. Hernan Goldsztein was selected as a Top Doctor in Otolaryngology by his peers in 2017 and 2018 as featured in San Diego Magazine.

Dr. Moses Salgado and Dr. Hernan Goldsztein were featured as “Champions for Health” in San Diego Physician Magazine because of their volunteer work with patients in Project Access San Diego

Pacific ENT of San Diego County's Carlsbad * Treating Sinusitis * Sinus Surgery * Sleep *  Snoring * Sleep Apnea * Allergies * Ear Hearing & Balance * Voice * Head & Neck Surgical Care Allergist ENT Sinus Doctors of San Diego County California

Salivary Gland Disease

There are three pairs of major salivary glands, the parotid, submandibular, and sublingual. There are also hundreds of minor salivary glands lining the mouth. The function of salivary glands is to produce saliva to help with lubrication and taste of food, as well as the initial phases of digestion. Saliva also washes away bacteria, and is important for the health of teeth.

Salivary glands may become painful and swollen due to infection or inflammation. Infections may be caused by viruses, such as mumps, HIV or other viruses such as coxsackievirus-A, or echovirus. Bacteria such as staphylococcus aureus and anaerobes may cause infections as well. Granulomatous diseases such as sarcoidosis or tuberculosis also occur. Non-infectious inflammatory disorders may include Sjogren's syndrome and sarcoidosis.

Swelling may be caused a sialolith or stone that lodges in the drainage duct of the gland. Swelling is usually worse at mealtime, especially when eating sweet or sour foods.

Treatment will depend on the cause of the inflammation. Increased fluid intake and moist heat, massage and use of sialogogues (sour lozenges) and in some instances, antibiotics are often helpful. Removal of the stone by opening of the drainage duct, or in some cases, removal of the salivary gland, will help those with sialoliths.

The parotid glands may also become painlessly enlarged because of underlying problems such as diabetes, malnutrition, alcoholism and bulimia.

Trauma may cause blockage of the drainage of the salivary glands resulting in mucoceles or ranulas. Mucus retention cysts (mucoceles) are relatively common on the lower lip because of trauma related to the adjacent teeth. Mucoceles are usually removed in the office under a local anesthetic.

Tumors may be benign or malignant (cancerous). The majority of tumors (70-80%) occur in the parotid gland, 10% in the submandibular gland, less than 1% in the sublingual gland and 10-20% in the minor salivary glands. Most tumors in the parotid gland are benign (80-90%). Malignant tumors increase with the other salivary glands, 50% of the submandibular gland, 75% in the sublingual gland.
The most common benign tumor is a pleomorphic adenoma or "mixed" tumor. They typically are slow growing, painless and lobular (bumpy). They may become large over time and there is a 2-10% rate of cancerous transformation in long-standing lesions. To ensure complete removal and prevent recurrence, they are treated with wide local excision. This may require removal of a portion or the entire salivary gland.

The next most common benign tumor is a Warthin tumor. This occurs most commonly in older men, may be present on both sides and is usually located behind the lower jaw bone. They are also treated with wide local excision of the tumor.

Cancerous salivary tumors may present with a painless lump. Symptoms of weight loss, facial weakness or numbness are more likely with cancerous lesions. The most common types of cancer include mucoepidermoid carcionoma, adenoid cystic, acinic cell, and adenocarcinoma. Cancer of the lymph nodes (lymphoma) may also occur in the salivary glands, especially the parotid gland.

Treatment depends on the type and extent of the cancerous growth. Surgery, to remove the gland, is often recommended. Radiation therapy is also recommended for certain tumors.

Upon diagnosis of a growth in a salivary gland, a biopsy with a small needle, under local anesthesia, is often recommended to determine what kind tumor is present. An imaging study, such as an MRI or CT scan may also be ordered. Further treatment is then recommended based on the results of those studies.


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