Salivary Gland Surgery: Lumps, Salivary Stones and Ranula
Salivary gland disorders most commonly present as a lump in front of the ear, swelling under the jaw that comes and goes during meals, or a soft swelling under the tongue or chin. At Charlottenlund Private Hospital, the salivary glands are examined using ultrasound and fine-needle biopsy, and salivary stones, lumps and ranulas are treated with endoscopic surgery or conventional surgery. This page is part of the neck lump section, where other causes of swelling are described.
Where are the salivary glands located, and what do they do?
Humans have three pairs of major salivary glands. They all empty into the oral cavity but produce different types of saliva. The largest is the parotid gland, glandula parotis, which is located in front of and below the ear. It produces thin, watery saliva – the type you notice when your mouth waters – which passes through the cheek and enters the mouth near the back upper molars.
The submandibular gland, glandula submandibularis, is located beneath the angle of the jaw. It produces a mixture of thicker and thinner saliva and empties into the front of the floor of the mouth beneath the tongue.
At the very front beneath the tongue lies the sublingual gland, glandula sublingualis, which produces a very thick secretion and empties through the same duct area as the submandibular gland.
The parotid gland was previously well known in connection with mumps, but according to Ugeskrift for Læger, the number of reported cases fell from 26,252 in 1986 to 7 in 2023 following the introduction of the MMR vaccine.
Parotid gland
- Glandula parotis
- In front of and below the ear
- Most commonly: benign lump
Submandibular gland
- Glandula submandibularis
- Beneath the angle of the jaw
- Most commonly: salivary stones
Sublingual gland
- Glandula sublingualis
- At the front beneath the tongue
- Most commonly: ranula
What salivary gland conditions may require surgery?
Three conditions account for the vast majority of surgeries. In the parotid gland, the cause is usually a benign lump, and the part of the gland containing the lump is removed. In the submandibular gland, the cause is usually a salivary stone, which causes recurring swelling and inflammation. In the sublingual gland, the cause is a ranula or plunging ranula. As a rule, lumps in a salivary gland are removed because a fine-needle biopsy cannot always determine the cell type with certainty. If a malignant lump is suspected or the facial nerve is affected, further investigations take place through the hospital cancer pathway.
What are salivary stones, and how are they removed?
Salivary stones form in the gland’s duct, much like tartar forms on teeth, and some people are more prone to them than others. According to a 2025 review article in Ugeskrift for Læger, salivary stones are the most common cause of salivary gland obstruction; they are most common in people aged 60–70 and most often affect the submandibular gland because its duct is long and the saliva is thick. The typical sign is a tender swelling under the jaw that appears during meals and then subsides—known as salivary colic. Small stones may pass on their own, and some can be removed through the gland’s duct. If stones recur, cause repeated inflammation or cannot be removed through the duct, the submandibular gland may be removed surgically.
What are a ranula and a plunging ranula?
A ranula is a saliva-filled cyst in the floor of the mouth beneath the tongue that originates from the sublingual gland. A plunging ranula is a rare variant in which thick saliva cannot drain properly and instead spreads down through the muscles of the floor of the mouth, resulting in a soft swelling beneath the chin or in front of the submandibular gland.
The condition is harmless but can cause discomfort and may be cosmetically bothersome. According to Ugeskrift for Læger, treatment is surgical and consists of removing the sublingual gland through the mouth.
A swelling in the neck may also be a neck cyst, which can be assessed during the ultrasound examination.
How is a lump or swelling in a salivary gland examined?
The examination consists of a consultation, an ear, nose and throat examination, during which the glands and their ducts are palpated, and an ultrasound scan. If there is a lump, a fine-needle biopsy is performed, in which cells are collected using a thin needle and examined by a pathologist.
At Charlottenlund Private Hospital, the ultrasound examination and fine-needle biopsy are performed by the specialist during the preliminary examination. Salivary stones can often be seen on ultrasound, but according to Ugeskrift for Læger, very small stones measuring less than 2–4 mm can be difficult to detect. In these cases, sialendoscopy can be used both to establish the diagnosis and to provide treatment.
CT and MRI scans are not performed at the hospital – patients are referred elsewhere if these are required.
How is the operation performed?
The procedure depends on the gland involved and the underlying cause. Removal of a stone from the duct and sialendoscopy are performed through the mouth under local or general anaesthesia, without an incision in the skin.
For a lump in the parotid gland, the affected part of the gland is removed through an incision in front of and below the ear. The facial nerve, which runs through the gland, is identified and carefully followed during the procedure, and nerve monitoring is used.
The submandibular gland is removed through an incision in a skin crease beneath the jaw, while the sublingual gland is removed through the mouth. Removed tissue is always sent for microscopic examination.
The operations are performed under local or general anaesthesia depending on the procedure and usually do not require an overnight stay.
What can you expect after the operation?
After endoscopic surgery or removal of a salivary stone, there may be mild tenderness and swelling in the floor of the mouth for a few days. After removal of a gland, there will usually be some tenderness around the surgical wound.
The remaining salivary glands continue to produce saliva. According to Ugeskrift for Læger, removal of an entire salivary gland carries a risk of affecting nearby nerves and reducing saliva production. The surgeon will explain the specific risks during the preliminary examination.
Increasing swelling, redness or fever after surgery should be assessed by a doctor.
When should you see a doctor?
Swelling beneath the jaw or in front of the ear that repeatedly comes and goes – particularly during meals – should be assessed by an ear, nose and throat specialist. The same applies to a lump in a salivary gland that does not disappear, or a soft swelling beneath the tongue or chin.
According to Ugeskrift for Læger, acute salivary gland inflammation with pain, swelling and possibly fever is generally treated initially by your GP, while recurrent episodes should be assessed by a specialist.
If the face becomes asymmetrical or weak together with swelling of a salivary gland, you should seek medical attention immediately.
Persistent dry mouth without swelling may have other causes, including connective tissue disease, which can be investigated by a rheumatologist.
Signs that should be investigated
- Swelling under the jaw during meals
- Lump in front of or below the ear
- Growing lump
- Soft swelling under the tongue or chin
- Recurring inflammation in the same gland
- Crooked or weak face—seek medical attention immediately
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway consists of a preliminary examination, treatment and follow-up. During the preliminary examination, the specialist reviews your medical history, examines the glands, performs an ultrasound scan and, if necessary, takes a fine-needle biopsy.
It is then decided whether a stone should be removed, sialendoscopy should be performed or surgery is required. If the gland is acutely inflamed, the inflammation is treated first by your GP.
The procedures are performed in the surgical department in Charlottenlund, and the results of the microscopic examination are reviewed at the follow-up appointment. The specialists are presented on the staff page.
Referral
Most patients at Charlottenlund Private Hospital are treated through private health insurance. Insurance companies typically require a referral from your GP and prior approval.
Self-paying patients do not require a referral, and prices are available in the price list.
Frequently asked questions
How many salivary glands do you have?
Three pairs of major salivary glands: the parotid glands (glandula parotis), the submandibular glands (glandula submandibularis) and the sublingual glands (glandula sublingualis). There are also many small glands in the lining of the mouth.
What is salivary colic?
A tender swelling of a salivary gland that appears during meals and then subsides. The cause is usually a salivary stone blocking the flow of saliva.
Can salivary stones be removed without removing the gland?
When stones recur, cause repeated inflammation or cannot be removed through the gland’s duct. The operation is performed under general anaesthesia.
What is a plunging ranula?
A rare saliva-filled cyst that originates in the sublingual gland and causes a soft swelling under the chin. It is harmless and is treated by removing the sublingual gland.
Do you need to stay overnight?
The procedures are performed under local or general anaesthesia and usually do not require an overnight stay.