What This Guide Covers and Who It Is For
This guide explains salivary gland surgery for patients who may need treatment for stones, chronic infections, or growths in their salivary glands.
Your body has three pairs of major salivary glands. The parotid glands sit in front of your ears. The submandibular glands are under your jaw. The sublingual glands are beneath your tongue. You also have hundreds of tiny minor salivary glands lining your mouth and throat. All of these glands produce saliva, which helps you chew, swallow, and fight bacteria in your mouth. [1]
When a salivary gland becomes blocked, infected, or develops a tumor, surgery may be needed. The type of surgery depends on which gland is affected, the size and location of the problem, and whether the gland can be preserved. An oral surgeon or head and neck surgeon typically performs these procedures.
This guide walks through the most common surgical options, recovery expectations, cost considerations, and signs that you should see a specialist.
Types of Salivary Gland Surgery
Salivary gland surgery falls into several categories based on the problem being treated and the approach used.
Salivary Stones (Sialolithiasis)
A salivary stone, called a sialolith, is a hard, calcium-rich deposit that forms inside a salivary gland duct. Stones block the flow of saliva, causing pain and swelling that typically gets worse during meals. Sialolithiasis accounts for approximately 50% of all major salivary gland disease. The submandibular gland is the most commonly affected gland, involved in roughly 80% to 90% of stone cases. This is partly because the submandibular duct runs upward against gravity, and its saliva is thicker and more mineral-rich than saliva from other glands. [3]
Small stones near the opening of the duct can sometimes be removed in a clinic setting. The surgeon makes a small cut inside the mouth over the duct and eases the stone out. This procedure is called a transoral sialolithotomy. It typically requires only local anesthesia (numbing medicine) and takes about 30 minutes.
Larger or deeper stones may need a different approach. Sialendoscopy uses a miniature camera and instruments inserted into the duct opening to locate and extract the stone. The camera is roughly the width of a pen refill. This minimally invasive technique preserves the gland in many cases and typically results in less swelling and faster healing than open surgery.
When stones are very large, deeply embedded, or recurrent, removing the entire gland may be the safest option. This is discussed in the section on gland excision below.
Gland Excision (Removal of the Entire Gland)
Gland excision means surgically removing an entire salivary gland. This is done when stones keep returning, when the gland is severely damaged by chronic infection, or when a tumor is found.
Submandibular gland excision is one of the more common salivary gland surgeries. The surgeon makes an incision below the jawline, identifies and protects nearby nerves, and removes the gland along with any stones inside it. The remaining salivary glands compensate for the loss, so most patients do not experience long-term dry mouth after removing one gland. [1]
Parotidectomy is the removal of part or all of the parotid gland. The parotid gland is the largest salivary gland, located in front of each ear. The facial nerve, which controls movement of the forehead, eyelids, cheeks, and lips, runs directly through this gland. Surgeons use intraoperative facial nerve monitoring, a device that detects electrical signals in the nerve, to reduce the risk of injury during the procedure. [2]
A superficial parotidectomy removes only the outer portion of the gland. A total parotidectomy removes the entire gland and is typically reserved for larger tumors or malignant (cancerous) growths. In either case, protecting the facial nerve is a central priority of the surgery.
Tumors and Other Growths
Salivary gland tumors can be benign (non-cancerous) or malignant (cancerous). The most common benign tumor is a pleomorphic adenoma, a slow-growing lump that usually appears in the parotid gland. Even benign tumors are typically removed because they can grow over time and, in rare cases, become malignant if left untreated.
Diagnosis usually involves imaging such as CT or MRI and a fine-needle aspiration biopsy. In this biopsy, a thin needle draws a small sample of cells from the lump for examination under a microscope. The biopsy results help the surgeon plan the extent of surgery needed.
Malignant salivary gland tumors may require more extensive surgery, sometimes followed by radiation therapy. An oral and maxillofacial surgeon or a head and neck surgeon typically leads this treatment in coordination with an oncologist. [2]
Chronic Infections and Sialadenitis
Sialadenitis is an infection of a salivary gland. It causes swelling, pain, redness, and sometimes pus draining into the mouth. Acute sialadenitis is most commonly caused by bacterial infection, often due to reduced saliva flow from dehydration, medications, or duct obstruction. [3] Acute infections are usually treated with antibiotics, warm compresses, hydration, and gentle massage of the gland.
Surgery becomes an option when infections keep coming back despite conservative treatment. Repeated infections can scar and permanently damage the gland, reducing its ability to function. In these cases, removing the gland can stop the cycle of infection and pain.
What You Need to Know Before Surgery
Preparation helps reduce complications and supports a smoother recovery. Here is what to expect before your procedure.
Who Needs Salivary Gland Surgery
Surgery is typically recommended when conservative measures fail. Your doctor may suggest surgery if you have a salivary stone too large to pass on its own, recurring infections that antibiotics cannot control, or a mass or tumor in a salivary gland that needs biopsy or removal.
Salivary stones and infections affect adults more often than children. Stones are most common in people between ages 30 and 60. [4] Dehydration, certain medications that reduce saliva flow, and a history of gout may increase the risk of developing stones. [4]
How to Prepare
Your surgeon will review your medical history, current medications, and any allergies. You may need imaging studies such as a CT scan, ultrasound, or MRI before the procedure so the surgeon can see the exact size and position of the stone, tumor, or affected gland.
If the surgery requires general anesthesia, you will be asked to stop eating and drinking for a set number of hours beforehand. Blood-thinning medications such as aspirin, ibuprofen, or warfarin may need to be paused before surgery. Your surgeon will give specific instructions. Arrange for someone to drive you home, since you should not drive after anesthesia.
- Share your full medication list, including supplements and over-the-counter drugs.
- Follow fasting instructions exactly as given.
- Arrange transportation home from the surgical facility.
- Ask your surgeon whether you need to stop blood thinners before the procedure.
- Prepare soft foods at home for the first few days of recovery.
What to Expect During and After Surgery
Most salivary gland surgeries are outpatient procedures, meaning you go home the same day.
During the Procedure
The surgical approach depends on the type of procedure. For a transoral stone removal, you will receive local anesthesia and the surgeon will work inside your mouth. The procedure typically takes 20 to 45 minutes.
Sialendoscopy also begins through the natural duct opening inside the mouth. The surgeon threads a tiny endoscope into the duct, locates the stone on a monitor, and uses small instruments to grasp or fragment it. This procedure may use local anesthesia with sedation or general anesthesia, depending on the complexity.
For gland excision, the surgeon typically makes an incision in the skin. For submandibular gland removal, the incision is below the jawline in a natural skin crease. For parotidectomy, the incision curves in front of and behind the ear. Gland excision usually takes 1 to 3 hours under general anesthesia. Facial nerve monitoring is used during parotid surgery throughout the procedure. [2]
A small drain, a thin tube that collects fluid, may be placed at the surgical site. Drains are typically removed within 1 to 2 days.
Recovery Timeline
Recovery varies by procedure. Less invasive approaches like sialendoscopy typically allow a return to normal activities within a few days. Open gland excision generally requires 1 to 2 weeks of recovery before returning to work and daily routines.
Swelling and mild to moderate pain are normal in the first few days. Your surgeon will prescribe pain medication and may recommend ice packs to reduce swelling. Most patients switch to over-the-counter pain relievers within a few days.
During the first week, eat soft foods and stay well hydrated. Avoid hard, chewy, or very sour foods that stimulate heavy saliva production, as this can cause discomfort at the surgical site. Gentle jaw exercises may be recommended to prevent stiffness.
- Days 1 to 3: Swelling peaks. Rest, ice, and prescribed pain medication.
- Days 4 to 7: Swelling begins to improve. Transition to softer regular foods.
- Days 7 to 14: Most patients return to work and light activities. Avoid heavy exercise.
- Weeks 3 to 6: Full healing of the surgical site in most cases. Follow-up visit to check progress.
Possible Risks and Complications
All surgery carries some risk. Salivary gland surgery risks include infection, bleeding, scarring, and numbness or tingling near the incision site. These complications are typically manageable and resolve with time.
The most significant risk specific to parotid surgery is facial nerve injury. Temporary weakness of facial muscles occurs in some patients and usually improves over weeks to months. Permanent facial nerve damage is uncommon when experienced surgeons use nerve monitoring. [2]
Frey syndrome is another possible complication after parotid surgery. It causes sweating on the cheek during eating because nerve fibers regenerate and connect to sweat glands instead of salivary gland tissue. This condition is typically mild but can be treated with medication or Botox injections if bothersome. [3]
After submandibular gland removal, there is a small risk of injury to nerves that control tongue movement or sensation in the lower lip. Your surgeon will discuss the specific risks of your procedure before you consent to surgery.
Cost Factors and Insurance
Salivary gland surgery costs depend on the type of procedure, the facility, anesthesia, and your geographic location.
A transoral stone removal using local anesthesia in an office setting is typically on the lower end of the cost spectrum, often ranging from $1,500 to $3,000. Sialendoscopy generally falls in the range of $3,000 to $6,000. Open gland excision, especially parotidectomy under general anesthesia in a hospital or surgical center, can range from $5,000 to $10,000 or more. These figures are estimates. Costs vary by location, provider, and case complexity.
Medical insurance, rather than dental insurance, typically covers salivary gland surgery because it involves treatment of a medical condition. Coverage depends on your specific plan, diagnosis, and whether the procedure is considered medically necessary. Pre-authorization may be required. Contact your insurance provider before surgery to confirm benefits, co-pays, and deductibles.
If you are uninsured or underinsured, ask the surgical office about payment plans or financial assistance programs. Some facilities offer reduced rates for self-pay patients.
- Transoral stone removal: typically $1,500 to $3,000
- Sialendoscopy: typically $3,000 to $6,000
- Gland excision (submandibular or parotid): typically $5,000 to $10,000 or more
- Costs vary by location, provider, and case complexity.
- Medical insurance often covers these procedures when deemed medically necessary.
When to See a Specialist
Certain symptoms signal the need for evaluation by an oral surgeon or head and neck specialist rather than a general dentist.
See a specialist if you notice a persistent lump or swelling in your cheek, under your jaw, or under your tongue that lasts more than two weeks. Pain or swelling that flares during meals and then slowly subsides is a classic sign of a salivary stone blocking a duct. Repeated episodes of gland infection despite antibiotic treatment also warrant a specialist referral. [3]
A lump that grows steadily, feels firm or fixed in place, or is accompanied by facial numbness or difficulty opening your mouth should be evaluated promptly. These features can indicate a tumor that needs biopsy and possible surgical removal.
Your general dentist may be the first to notice salivary gland changes during a routine exam. They can refer you to an oral surgeon who has training in diagnosing and treating conditions of the salivary glands. An ear, nose, and throat (ENT) surgeon is another specialist who performs salivary gland procedures.
- Swelling under the jaw or in front of the ear lasting more than two weeks
- Pain or swelling that worsens during eating
- Recurring salivary gland infections
- A firm or growing lump in the cheek, jaw, or floor of the mouth
- Facial numbness, weakness, or difficulty opening your mouth
Find a Salivary Gland Surgery Specialist
If you are experiencing salivary gland pain, swelling, or a lump that concerns you, a specialist can provide a thorough evaluation and discuss your treatment options. Use our directory to find a qualified oral surgeon near you who has experience with salivary gland procedures, stone removal, and gland excision.
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