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Swellings of the salivary glands can be signs of inflammation, obstruction by stones or strictures, tumors and other causes
Anatomy of the salivary glands of the head: parotid gland (pg), submandibular gland (gsm), sublingual gland (gsl)
Computertomography image of a calcified tumor of the left submandibular gland (arrow)
Introducing an endoscope for salivary ducts (sialendoscope) with the help of a so-called port. Simple diagnostic measures can be even carried out without any anesthesia.
Endoscopic view of a stone in the duct system of the parotid gland (Stensen's duct) behind a branching.
A basket is introduced through the working channel of the endoscope to grasp and remove the stone.
Tip of a sialendoscope with an inlying basket that has captured a stone.
Tips of sialendoscopes with a miniforceps (top), laser fiber (middle) and drill (bottom) for the fragmentation of salivary gland stones.
Endoskocopic view of a laser light impulse being applied to a salivary gland stone (laser lithotripsy)
Endoscopic view of a salivary gland stone which was fragmented by laser lithotripsy.
Fragments of stones which were broken and removed by forceps under sonographic control (sonoguide forceps)
Fragmentation of salivary gland stones through acoustic shock waves (extracorporeal shock wave lithotripsy). This method is usually applied in local anesthesia without the need of any cutting.
Small stone fragments which left the salivary ducts after extracorporeal shock wave lithotripsy.
Endoscopic view of a stricture of a salivary duct.
Also balloons can be sled through the working channels of sialendoscopes. They can be used to dilate strictures.
A drain is mounted on a sialendoscope so that it can be placed in the duct system under endoscopic control to prevent the development of new strictures after dilatation.
In case that you should be a physician interested in the techniques described here: We have organized and taught on several practical and theoretical instruction course during national and international conferences. If you should be interested in these please either contact us or search on the websites of scientific medical associations.
...to our site on the diagnosis and treatment of diseases of the salivary glands with special focus on obstructive diseases (salivary gland stones and strictures). We hope that this sites provides interesting information for you and we would be happy to receive suggestions for improvements or other feedback.
M.D. / Prof. Dr. med.
salivary gland treatment centre in
the Department for Otorhinolaryngology / ENT, Head and Neck Surgery of the University Hospital of Marburg (Chairman: Prof. Dr. B.A. Stuck) , Germany
The information on this site can not
replace medical advice or treatment (see also disclaimer).
We restricted the topics on this site for reasons of clarity:
There exist also other techniques than those described here. Additionally, there is a multitude of other conditions, disorders and diseases which can affect the salivary glands (e.g. Sjögrens syndrome or recurrent juvenile parotitis) which is not covered by this site for the same reason.
What are the typical signs of stones and strictures (obstructive disease), and of tumors?
The typical signs of obstructive disease are swellings during meal-time. The regions mainly affected are the cheek (parotid gland) or the area below the chin (submandibular gland). Additional pain can be a sign of infection (sialadenitis). Tumors (benign and malign neoplasms) are often associated with chronic swellings which are frequently painless. The nerve for the movement of the face has a close contact to the salivary glands. If the motion of the face should be affected you should visit a physician soon.
What examinations can be done for diagnosis?
Clinical examination and a ultrasound examination of the head and neck with a high-end machine are often sufficient for a diagnosis to diagnose tumors, stones and inflammatory disease. Sometimes it might be useful to perform an endoscopy of the salivary duct system (sialendoscopy, sialoscopy). Further methods are magnetic resonance imaging (mri) or sialography, computer tomography (ct scan) and very seldom szintigraphy. In case that the findings are suspicious of a tumor it can be helpful to perform punctions for fine needle aspiration cytology or even core bore biopsies.
Tumors are typically treated by total or partial removal of the gland from the outside. Main priorities after total removal of the tumor are the preservation of the facial nerve and aesthetic aspects. Magnifying optic systems like loops or microscopes and electrophysiologic monitoring methods are often used to avoid damage to the nerve.
In case of small stones it might be worthwile to stimulate saliva production and wait for a while as some stones will leave the duct system spontaneously. Otherwise a multitude of different minimal-invasive options has emerged in the last two decades and this development seems to continue.
In former times the gland had to be remove in all cases. An alternative is the surgical removal through the mouth in many cases. This is sometimes possible with classical surgical instruments. In a number of cases it is now also possible to reach the stones with small endoscopes through the natural orifices of the ducts. These so-called sialendoscopes have outer diameters of about 0.6 to 2.0 mm. They have working channels to insert instruments for stone retrievel like baskets, graspers and miniforceps. If the stone should be to large an attempt of fragmentation with instruments like lasers or drills can lead to success. Instead of using endoscopic control it is sometimes also possible to use forceps guided by ultrasound for fragmentation.
A further option is the use of acoustic shock waves. This technique is called extracorporeal shock wave lithotripsy (ESWL). The focus of the shock wave is centered into the stones. Small fragments can be washed out by the natural flow of saliva. Sometimes several sessions are necessary. The combination of different techniques is often useful and increases the chances of success (so-called multimodal therapy).
Strictures can also be treated under endoscopic or ultrasonographic control with instruments like balloons, drills, forceps and drains. Like for stones the combination of different techniques is often useful.
For further questions or if you are interested in an appointment at our out-patient clinics for salivary diseases please address:
Dr. Urban Geisthoff M.D./ Prof. Dr. med.
(further information regarding his qualifications is published under
Salivary gland centre, ORL/ENT department,
(Chairman: Prof. Dr. B.A. Stuck)
University Hospital Marburg
Prof. U. Geisthoff
Ms. Susanne Zapf (lead of the International Office)
Tel.: + 49 (0) 6421 58 66808
Fax: + 49 (0) 6421 58 96111
Secretaries (Ms. Hinkelmann, Ms. Luppolo, Ms. Bender, Ms. Oetzel)
Tel.: + 49 (0) 6421 58 66603
Fax: + 49 (0) 6421 58 66367
Please note that the regulatories for German physicians limit the amount of information by telecommunication nets (including telephone, email, internet etc.).
Further information on the topic and on us can also be found under the position "Travel / links" .
What is a salivary gland centre?
The term "salivary gland centre" is neither protected nor well defined. Therefore this is an additional information about a specialization according to our own judgement. We think that it is probably adequate to use it for our facility as we
- have broad experience on this topic for a long time now.
- can offer the whole spectrum of different diagnostic an therapeutic options in cooperation with the other departments of our hospital.
- are equipped with all instruments necessary for treatment. These sets of instruments were chosen from different suppliers so that we can cover various different situation in an optimal way.
- are doing research in the field. We contributed to the development of special instruments and new techniques. We were able to present these on conferences and publish these in the literature.
- instructed other physicians on this topic during medical courses during scientific conference in Germany and abroad.
- are treating not only patients from the region but also from other countries.
- take part in the development of medical guidelines.
- offer a special outpatient clinics for salivary gland diseases.
- have just a passion here.
Of course there are a lot of other qualified colleagues. To find these you can ask your general practitioner, other physicians treating you, the chambers of physicians ("Aerztekammern"), scientific medical associations.
We would like to list a selection of some of those which we know. Please do understand that this list for sure not complete, and that our recommendation can never be a guarantee but is for information only and without responsibility.
- Prof. Dr. H. Iro and coworkers in Erlangen, Germany
- Prof. Dr. O. Guntinas-Lichius and coworkers in Jena, Germany
- Prof. Dr. J. Zenk and coworkerst in Augsburg, Germany
- Dr. Ph. Katz and coworkers in Paris, France
- Prof. Dr. M. McGurk and coworkers in London, UK
- Dr. F. Marchal and coworkers in Geneve, Switzerland
- Prof. Dr. O. Nahlieli and coworkers in Ashkelon, Israel
- Prof. Dr. M. Fritsch and coworkers in Indianapolis, USA
Of course you are also invited to visit our
- salivary gland treatment centre in Marburg (please find contact data of Dr. Geisthoff above).
We do not take responsibility for the content of linked external web sites.