Management of Benign Salivary Gland Conditions.

In this section, we discuss the management of benign salivary gland disease. Pathologies vary from sialolithiasis, salivary duct stenosis, sialadenitis, infectious glandular disease, autoimmune glandular disease, and radioactive iodine-induced disease. We discuss both novel techniques in the diagnosis and management of these diseases, including ultrasound, sialendoscopy, minor salivary gland biopsy, and botulinum toxin injection, which allow for both the alleviation of symptoms and gland preservation.

Tratamento cirúrgico de sialólito no ducto da parótida: relato de caso / Surgical treatment of sialolite in the duct of the parotid: case report / Tratamiento quirúrgico de sialolito en el conducto del parótido: reporte de caso

Introdução: Os sialólitos são lesões mineralizadas nas glândulas salivares que causam obstrução total ou parcial do ducto, acometendo comumente a glândula submandibular. Sua abordagem varia de pouco invasiva à cirúrgicas, a depender do número, localização e dimensões dos cálculos. Objetivo: Esse estudo teve como objetivo relatar um caso clínico raro de sialólito no ducto da glândula parótida tratado através da remoção cirúrgica. Relato De Caso: Paciente compareceu ao ambulatório com história de dor e edema em face com 2 meses de evolução, referindo piora da sintomatologia após alimentação. Ao exame físico apresentou edema endurecido em região pré-auricular esquerda e ausência de drenagem no ducto da parótida ipsilateral. Foi realizado uma radiografia de tecidos moles com filme periapical, que revelou imagem radiopaca circunscrita sugestiva de um sialólito no ducto da glândula parótida esquerda. Assim, foi realizada excisão cirúrgica do cálculo seguida do reestabelecimento da patência ductal através da instalação de cateter venoso. Paciente evoluiu bem e segue em acompanhamento sem recidiva dos sinais e sintomas. Considerações Finais: O presente estudo revela que o diagnóstico precoce da sialolitíase e a escolha do plano de tratamento adequado estão associados a um bom prognóstico, e o reestabelecimento da patência ductal, quando danificado, é imprescindível para o sucesso do tratamento(AU)

Introduction: Sialoliths are mineralized lesions in the salivary glands that cause total or partial obstruction of the duct, commonly affecting the submandibular gland. It ranges from less invasive to surgical approach, depending on the number, location and dimension of the calculi. Objective: This study aimed to report a rare clinical case of a sialolith in the parotid gland's duct treated by surgical removal. Case Report: The patient attended the outpatient clinic with a history of pain and edema in the face with 2 months of evolution, reporting worsening symptoms after feeding. On physical examination, he had hardened edema in the left preauricular region and no drainage in the ipsilateral parotid duct. Soft tissue radiography with a periapical film was performed, which revealed a circumscribed radiopaque image suggestive of a sialolith in the left parotid gland's duct. Thus, the calculus's surgical excision was performed, followed by the reestablishment of the ductal patency through the installation of a venous catheter. The patient evolved well and is being followed up without recurrence of signs and symptoms. Final Considerations: The present study reveals that the early diagnosis of sialolithiasis and the choice of the appropriate treatment plan are associated with a good prognosis, and the reestablishment of ductal patency, when damaged, is essential for the success of the treatment(AU)

Introducción: Os sialolitos son lesiones mineralizadas en las glándulas salivales que causan obstrucción total o parcial del conducto, afectando comúnmente a la glándula submandibular. Su abordaje varía desde poco invasivo hasta quirúrgico, dependiendo del número, ubicación y dimensiones de los cálculos. Objetivo: Este estudio tuvo como objetivo reportar un caso clínico raro de sialolito en el conducto de la glándula parótida tratado mediante extirpación quirúrgica. Reporte de Caso: Paciente acudió a consulta externa con antecedente de dolor y edema en el rostro de 2 meses de evolución, refiriendo empeoramiento de la sintomatología tras la alimentación. A la exploración física presentaba edema endurecido en región preauricular izquierda y ausencia de drenaje en conducto parotídeo ipsilateral. Se realizó una radiografía de partes blandas con placa periapical, que reveló una imagen radiopaca circunscrita sugestiva de un sialolito en el conducto de la glándula parótida izquierda. Así, se realizó la escisión quirúrgica del cálculo seguida del restablecimiento de la permeabilidad ductal mediante la instalación de un catéter venoso. El paciente evolucionó bien y se le está dando seguimiento sin recurrencia de signos y síntomas. Consideraciones Finales: El presente estudio revela que el diagnóstico precoz de la sialolitiasis y la elección del plan de tratamiento adecuado se asocian a un buen pronóstico, y el restablecimiento de la permeabilidad ductal, en caso de daño, es fundamental para el éxito del tratamiento(AU)

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences.

BACKGROUND AND OBJECTIVES: To report the first experiences with a newly available Ho:YAG laser system for the treatment of salivary stones. STUDY DESIGN/MATERIALS AND METHODS: A retrospective study in a tertiary referral center was conducted. Patients diagnosed with sialolithiasis were treated in Erlangen using the Calculase III™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany). Preset parameters had a frequency of 4 Hz and energy of 0.8-1.2 J, resulting in 3.2-4.8 W. Following total fragmentation, one to two serial sialendoscopies were performed to achieve complete fragment clearance. RESULTS: A total of 55 stones in 49 patients were treated; 17 stones in 15 submandibular glands and 38 in 34 parotids. In total, 61 laser lithotripsies (range 1-3 per stone) were performed using various modes (long, short, and burst) and with preset parameters of 4 Hz and energy of 0.8-1.2 J, resulting in effective power of 3.2-4.8 W. Complete fragmentation was achieved in all the accessible stones. Sialendoscopes, fibers, or the mode used had no significant influence on success rates. A multimodal therapy concept was employed to treat stones in 12.24% of the cases; 95.92% of the patients were ultimately stone-free, and all became symptom-free. All glands were preserved. CONCLUSIONS: The new Calculase III™ Ho:YAG laser was effective in the treatment of sialolithiasis with no increased risk of complications in the patients or damage to the sialendoscopes. Clinical factors such as the type of gland involved, or the location and size of stones had a greater impact on success rates than the technical or preset parameters. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Intraductal lithotripsy in sialolithiasis with two different Ho:YAG lasers: presetting parameters, effectiveness, success rates.

OBJECTIVE: To compare two different Ho:YAG laser systems in relation to the preset parameters and their effectiveness for intraductal fragmentation of the salivary stones. PATIENTS AND METHODS: We made a retrospective study in two tertiary referral centers (Department of ENT, Head and Neck Surgery, University of Erlangen-Nuremberg, Germany and the MacKay Memorial Hospital, Taipei, Taiwan). Patients with a diagnosis of sialolithiasis were treated in Erlangen and Taipei. The Erlangen patients were treated using the Calculase II™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany) at 4 Hz, 1.2 J (4.8 W) and the MacKay patients were treated using the VersaPulse® PowerSuite™ Ho:YAG laser (Lumenis Ltd., Yokneam, Israel) at 6 Hz, 0.5 J (3 W). RESULTS: A total of 12 patients with 12 stones were treated in Erlangen and 54 with 75 stones in Taipei. The submandibular stones were present in 50% and 86.7% of cases, respectively. The complete fragmentation was achieved in all of the treated stones in both groups; 100% and 92.6% of the patients were stone-free, 100% and 94.4% of the patients became symptom-free, respectively. 33% of the Erlangen patients had multimodal treatments. The glands were preserved in all cases in both centers. CONCLUSIONS: The Ho:YAG laser proved to be effective in the treatment of sialolithiasis. Stone size, location, and involved gland were important additional parameters. Our experience and the literature results show that the laser presetting with a frequency of 3-6 Hz, an energy level of 0.5-1.2 J, and effective power of between 3 and 4.8 W is sufficient to achieve maximum success without any increased risk for complications.

Soft Tissue Disorders of the Mouth.

Soft tissue disorders of the mouth encompass a wide expanse of pathophysiology. This article focuses on the identification, etiology, management, and complications of common infectious processes (candidiasis, dental caries, and herpes labialis), inflammatory lesions (sialolithiasis, oral lichen planus, and aphthous ulcer), and benign entities (bony tori and mucocele).

[Endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton's duct].

Objective: To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton's duct. Methods: From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton's duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs. Results: The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months' follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function. Conclusions: Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.

Treatment of salivary stones by intraductal pneumatic lithotripsy: A preliminary presentation of the StoneBreaker with sterile bag covering.

INTRODUCTION: Sialendoscopy has changed the management of obstructive sialadenitis. Nowadays, minimally invasive techniques evolve to preserve salivary gland function. Intraductal lithotripsy allows stones fragmentation and retrieval without opening the salivary duct. We report our experience with the StoneBreaker (SB), a new lithotripter with improvement using a sterile bag that permits reuse of the SB without passing to sterilization. TECHNICAL NOTE: The non-sterilized SB was used into a sterile camera sleeve in 5 patients, 3 submandibular lithiases and 2 parotid lithiases. Technique and outcomes were described with a review of the literature. An explanatory video of the procedure was performed. DISCUSSION: Complete fragmentation was achieved and all fragments were extracted without any ductal damage. Utilization of the sterile sleeve did not change the SB efficiency and the procedure duration. The use of a sterile bag allowed several consecutive procedures with a single non-sterilized handpiece. However, the gas cartridge change may be more delicate when more than 80 impacts are needed. Patients remained symptoms and stones free one month after surgery.

Salivary gland endoscopy in children: A systematic review / Endoscopia de glândulas salivares em crianças: revisão sistemática

Summary Objective: To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the indications, endoscopic findings, and effectiveness of the procedure. Method: The electronic databases searched were Pubmed, Scielo, and Cochrane. The search was conducted by two researchers independently, following inclusion and exclusion criteria. A third author analyzed sources of conflict. In the first stage they were discarded by reading the articles title that had no relation to the purpose of the study and then evaluated the abstracts of each study. In these two initial phases 37 articles were excluded. Articles not excluded by the selection criteria have been retrieved and assessed in full. Seven articles had their data extracted and were compared. Results: The literature search parameters listed allowed the recovery of 44 articles. After applying the exclusion criteria, seven studies were included in this review representing 207 patients undergoing with ages ranging from 1 to 16 years. All studies except one underwent SE under general anesthesia. The juvenile recurrent parotitis was the main clinical diagnosis related with SE procedures (N=152). The number of inflammatory attacks per patient per year was the parameter for indication of SE. The efficacy of the procedure was considered high by all authors ranging between 83 and 93% in larger series evaluated. Conclusion: Sialendoscopy is a safe and effective procedure for the diagnosis and treatment of recurrent inflammatory diseases of salivary glands in children.

Resumo Objetivo: revisar os estudos sobre endoscopia das glândulas salivares em crianças tendo como foco principal as indicações, os achados endoscópicos e a eficácia do procedimento. Método: foram avaliadas as bases de dados eletrônicas Pubmed, Scielo e Cochrane. A busca foi realizada por dois pesquisadores de forma independente, seguindo critérios de inclusão e exclusão. Um terceiro autor analisou pontos de conflito. Em uma primeira etapa, foram descartados pela leitura do título artigos que não tivessem relação com o objetivo do estudo e a seguir foram avaliados os resumos de cada estudo. Nessas duas fases iniciais, foram excluídos 37 artigos. Os artigos não excluídos pelos critérios de seleção foram levantados e avaliados integralmente. Sete artigos tiveram os dados extraídos e comparados. Resultados: a busca na literatura de acordo com os parâmetros elencados permitiu a recuperação de 44 artigos. Após a aplicação dos critérios de exclusão, sete estudos foram incluídos na revisão, representando um N de 207 pacientes submetidos à sialoendoscopia (SE) com idades variando de 1 a 16 anos. Todos os estudos, exceto um, realizaram a SE sob anestesia geral. A parotidite recorrente da infância foi a hipótese diagnóstica clínica que levou à indicação de SE no maior número de pacientes, um total de 152 procedimentos. O critério de indicação dos procedimentos foi o número de crises inflamatórias por paciente por ano. A eficácia do procedimento foi considerada alta por todos os autores, variando entre 83 e 93% nas maiores séries avaliadas. Conclusão: a sialoendoscopia é um procedimento eficaz e seguro para diagnóstico e tratamento de afecções inflamatórias recorrentes de glândulas salivares em crianças.

Pediatric sialendoscopy in Asians: A preliminary report.

BACKGROUND/PURPOSE: The sialendoscopic approach in treating pediatric salivary gland disorders has been reported with great success through the years. Whereas this success has been widely reported in Caucasian populations, relatively little has been reported regarding the use of this procedure in pediatric patients in Asian countries. The purpose of this study is to report our preliminary experience in pediatric sialendoscopy. METHODS: The data from 20 patients (<18years old), who underwent sialendoscopy for obstructive sialoadenitis in the Department of Otorhinolaryngology of Mackay Memorial Hospital between October 2013 and November 2015, were reviewed. RESULTS: Twelve of our 20 patients (60%) were diagnosed with sialolithiasis and 8 of our 20 patients (40%) presented with non-lithiasis obstructive sialoadenitis. Ductal stenosis was found in 13 patients, and 18 patients had debris/mucous plug formation. The overall success rate was 95% (19/20) in our series, and 85% (17/20) of the patients had achieved a complete remission after a single sialendoscopy procedure. CONCLUSIONS: Sialendoscopy is an ideal treatment in the management of obstructive sialoadenitis in Asian pediatric patients. If necessary, Holmium:YAG laser lithotripsy and sialostent placement could be applied, and both procedures are well tolerated in pediatric patients.

Laser lithotripsy of salivary stones: Correlation with physical and radiological parameters.

BACKGROUND AND OBJECTIVES: Sialolithiasis is a common disease of the major salivary glands. Owing to the variety of conservative and minimally invasive techniques, it is now possible to treat most cases of sialolithiasis without removal of the affected salivary gland. One treatment option is the endoscopic removal of the calculi. In cases of larger concretions, intraductal disintegration using laser-induced shock waves can be appropriate to allow endoscopic removal. In the present study, we investigated whether physical and radiological parameters of salivary stones can effectively predict the applicability of laser lithotripsy. Furthermore, we determined to what extent the applied laser energy resulted in tissue damage. STUDY DESIGN/MATERIALS AND METHODS: In addition to basic parameters like size and density, we analysed 47 salivary stones using fluorescence spectroscopy, infrared spectroscopy, Raman spectroscopy, and dual-energy computed tomography. Subsequent fragmentation of all stones was performed with a Ho:YAG laser in a near-contact manner. Fragmentation rates were calculated and correlated with the previously measured physical and radiological parameters. Finally, to test for tissue damage, we performed HE-histology of salivary duct mucosa treated with the same laser energy used for stone fragmentation. RESULTS: Blue light excitation induced either green or red fluorescence emission. Dual-energy CT resulted in evidence of calcium-containing material. Infrared spectroscopy and Raman spectroscopy, both identified carbonate apatite as the main component of salivary stones. Disintegration into pieces smaller than 2 mm was possible in all cases. Fragmentation rates depended on the energy per pulse applied but not on any of the analysed physical and radiological parameters. In contrast to lithotripsy with 500 mJ per pulse, which was associated with no tissue damage, lithotripsy with 1,000 mJ per pulse resulted in damage of salivary duct mucosa. This suggests that the optimal laser energy for stone fragmentation is between 500 and 1,000 mJ per pulse. CONCLUSION: Laser lithotripsy using Ho:YAG laser is a highly efficient treatment, at least in vitro. All salivary stones could be disintegrated irrespective of their physical and radiological composition.

Rigid swelling of sublingual caruncle area due to the salivary gland duct obstruction by a sialolith

Sialolithiasis is the presence of calculus within the ductal system of a salivary gland. Among the diagnostic methods are inspection, palpation, checking the amount of saliva secreted and the identification of a sialolith. The authors present the case of a 37-year-old female patient with edema of the submandibular area and a bulging sublingual caruncle due to a calculus that obstructed the salivary gland ostium.

Salivary gland disorders.

Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges. Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis. Inflammation is commonly caused by an obstruction such as a stone or duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. Diagnosis is made by imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging) and biopsy (initially with fine-needle aspiration). Overall, most salivary gland tumors are benign and can be treated with surgical excision.

Outcomes of Holmium Laser-Assisted Lithotripsy with Sialendoscopy in Treatment of Sialolithiasis.

OBJECTIVES: The purpose of the current study was to compare outcomes and complication rates of sialolithiasis treated with intracorporeal holmium laser lithotripsy in conjunction with salivary endoscopy with those treated with simple basket retrieval or a combined endoscopic/open procedure. STUDY DESIGN: Case-comparison study. SETTING: Tertiary hospital. METHODS: Review of prospectively collected data of patients who underwent treatment for sialolithiasis by the senior author during 2011 to 2013. Patient demographics, operative techniques, surgical findings, clinical outcomes, and complications were recorded. Additional information regarding symptoms and satisfaction with treatment was obtained via standardized telephone questionnaire at the time of the data analysis. RESULTS: Thirty-one patients were treated for sialolithiasis. Sialoliths averaged 5.9 mm in size (range, 2-20 mm) and were comparable between both groups. Sixty-eight percent were in the submandibular gland (n = 21), with the remaining 32% in the parotid gland (n = 10). Fifty-two percent of patients (n = 16) were treated endoscopically with intracorporeal holmium laser lithotripsy, while the remaining 48% (n = 15) were treated with salivary endoscopy techniques other than laser lithotripsy. Successful stone removal without additional maneuvers occurred in 81% of the laser cases and 93% of the nonlaser group. Patients in the laser group reported an average improvement of symptoms of 95% compared with 90% of the nonlaser group when adjusted for outliers. Complications in all patients included ductal stenosis (n = 2) and salivary fistula (n = 1). CONCLUSION: The results of our series show favorable results with the use of intracorporeal holmium laser lithotripsy for the endoscopic management of sialolithiasis with minimal adverse events.

Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands.

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.

Lithotripsy for salivary stones with prospective US assessment on our first 25 consecutive patients.

OBJECTIVES: To evaluate the predictive value of sonographic fragmentation in the successful treatment of sialolithiasis. The main objective was to streamline the management by treating the patients with three sessions of ultrasonic lithotripsy, and to compare the success rate and complications with data from the literature. A second objective was to analyse the predictive value of data from the post procedure and follow-up sonography related to therapeutic success with regard to size, site and location of stones. MATERIAL AND METHODS: Prospective follow-up of 25 patients (mean age of 43 ± 17.2 years old 11-68; 13 women, 10 men) over a period of 31 months (October 2009-April 2012) with one or more salivary calculi (19 parotid, submandibular 6) treated with extracorporeal lithotripsy (electromagnetic MINILITH SL 1, Storz Medical, Switzerland). No anaesthesia or analgesia was used. Each session of lithotripsy lasted on average 30 min. Minor complications were collected on an anonymised sheet. RESULTS: Complete success (absence of clinical symptoms 3 months after the end of treatment (or the last session) and residual stones <2 mm) was observed in 36% of patients, partial success (persistence of symptoms least 3 months (lower intensity and lower frequency) or size of residual stones>2 mm) in 48% and failure (persistence of same or increased symptoms at 3 months or no change in size of the calculi) in 17% of patients. Sonographic fragmentation of the stone (p = 0.004), total energy delivered (p = 0.008) and the total number of shock waves (n = 0.045) are predictive factors of complete success. Size, salivary topography, ductal topography, mobilization of the stones, occurrence of minor side effects and total duration of treatment had no predictive value of complete success (p > 0.05). There was no significant difference between the first 5 and the last 20 patients (p = 0.367). In agreement with the literature data, the efficacy of treatment was greater for parotid than submandibular calculi. CONCLUSION: Extracorporeal lithotripsy is an alternative to conventional surgery with no major complications. Sonographic fragmentation of calculi, total energy and total number of shock waves are predictive factors of successful treatment.

Salivary gland emergencies.

Salivary gland disorders are uncommon in the emergency department setting. Given the vast differential that spans infectious, autoimmune, neoplastic, and metabolic processes, they can pose a diagnostic challenge even to skilled clinicians. There is a paucity of evidence-based data regarding the management of these disorders with frequent incongruence between specific sources. Although by no means exhaustive or absolute, this article reconciles existing literature and serves as a concise and informative guide to salivary gland disorders encountered by the emergency care practitioner.