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Scott Webb: Most of us don't think about our salivary glands unless we're having an issue like dry mouth. But diagnosis and treatment of conditions like salivary stones are things that my guest thinks about quite a bit. I'm joined today by Dr. Matthew Mifsud. He's an assistant professor and head and neck surgical oncologist, and he is here today to discuss salivary glands and the latest surgical options for patients.

Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content, and a valuable learning tool for world-class healthcare. I'm Scott Webb. And doctor, thanks so much for your time today. We're going to talk about salivary glands and surgery, minimally invasive surgery, of course, which we all love. Those are the buzzwords in medicine. So, as we get rolling here, why should we care about the salivary glands? Are they really that important?

Dr. Matthew Mifsud: Well, I mean, if you think about it, you need saliva to eat, right? So eating is probably one of the most important things we do as human beings, right? So I mean, anything that supports that is essential. And then, more than that, saliva is important for things like keeping your teeth healthy, keeping your mouth feeling good. So it is really important. Those patients that develop issues with these glands, it really affects their quality of life. So I would say, yeah, I mean, it's pretty darn important.

Scott Webb: Yeah. And of course you have to think about salivary glands because it's kind of what you do, but the rest of us don't really think about it unless we have something going on, let's say like dry mouth, which we've all experienced and heard of. But are there some other conditions that arise from our salivary glands?

Dr. Matthew Mifsud: Yeah, I mean there's a number of different things that can affect these. And dry mouth is obviously a big one and sometimes dry mouth is just because you have a dry mouth or sometimes it is because there's something wrong. But the way I think about it, there's some things that are inflammatory, some conditions that affect other parts of the body that affect these glands as well.

One of the most common ones, something called Sjogren syndrome, which we can talk about as we go. And then, you can get some tumors and things that grow in these glands that need some precise treatment. You can also get these stones. They look a lot like kidney stone that will actually develop in these glands and can cause you some pain and some problems.

Another big thing for me isn't so much a disease, but my cancer patients, when they get radiation, unfortunately, one of the side effects of radiation is it does burn out those salary glands. So they do suffer a lot from the damage and dysfunction that they develop because of this.

Scott Webb: Yeah, I see what you mean. And somebody like me who basically talks for a living, obviously dry mouth wouldn't be good, whatever the cause is. So good to know it that sounds like diagnosis and lots of treatment options. So let's talk about that. How does sialendoscopy or salivary endoscopy really work?

Dr. Matthew Mifsud: Yeah. So salivary endoscopy I think came to this country maybe almost 20 years ago, 18, but really it's been more common in the last five to 10 years. And it's kind of what it sounds. You have these really tiny scopes that we're able to get few millimeters in with. They were able to get into the little openings inside of your mouth where the saliva comes from. And there's two openings kind of underneath your tongue, and there's two on the cheeks. And the idea is that you take these little cameras with some sterile saline or water that you're kind of flushing things out with. And it opens up these duct systems, a lot like plumbing, right? And you're taking a look, trying to find problems, trying to see if there's anything you need to fix or remove or pull. So it's a lot like you would imagine your plumber would do, taking a look with a camera to look for a clogged pipes. It's the same basic idea.

Scott Webb: I love when experts bring it down to our level. You know, you think of yourselves as, "Yeah, I'm kind of like a plumber," right? And that's something we can all sort of identify and kind of picture what you're saying.

Dr. Matthew Mifsud: When I'm doing these procedures, it feels a lot like that. And, you know, other things I do a little bit less, but for these, it kind of has that feeling.

Scott Webb: Yeah. That's awesome. So you mentioned salivary stones before, so let's talk some more about that. Tell me about salivary stones. How do they impact patients and how do you treat them?

Dr. Matthew Mifsud: Yeah. So the tricky thing about salivary stones is no one knows why they happen. The first question patients always ask me is, "How did I get this?" And unfortunately, I always have to tell them, "Well, no one really knows for sure." But they basically look like little rocks that develop in these glands and most often underneath the tongue, you know, kind of along the floor of the mouth. And the problem with these is they cause an obstruction. They basically cause a blockage. And when there's a blockage of that gland. Usually, the ones underneath the jaw area will swell up. They become painful. They can become infected. They really hurt. Sometimes people even have to come into the emergency room if they have that much of a bad infection.

Kind of a more milder version of that is every time somebody eats, as they salivate and that gland gets simulated, they'll get pain and it makes it hard for them to eat. So that's how they usually will develop.

Scott Webb: Are there some other minimally invasive procedures that you perform? We've talked about the sialendoscopy, but is there some other minimally invasive-- As I mentioned in my intro, you know, it's kind of like the buzzwords in medicine. We all want, you know, faster recovery and smaller scars and all that. So are there some other procedures as well?

Dr. Matthew Mifsud: Yeah. And the way I kind of take these is sort of step-wise. So the first thing are what we can do with the cameras and that's in some ways the most minimally invasive way, because there's not really a cut. But there's a lot of things we can do by making relatively small incisions inside of the mouth. And we do that sometimes if there's a really significant scarred area where we can make a little incision and kind of reroute the duct system and make that work. Or sometimes when there's a pretty large stone, you might not be able to get out with a little basket or something with a little camera, but we can make a pretty tiny incision in the back, near the tongue and remove that stone. And in the past, if you had a stone like that, really the only option you had was to take the whole gland out, and that's a much more involved surgery. It's not a huge surgery, but it's not a small one. You need to make an incision in the neck, usually you need to take this gland out. It can cause some cosmetic issues. And also, there's some nerves that you could potentially damage doing that. So kind of avoiding having to do that is a big deal. And now, with these sort of smaller surgeries, we can send the patients home the same day, maybe with some antibiotics, some massage of that area, and that's all they really need.

Scott Webb: Yeah, it's amazing when I talk to the experts just how far things have come. You know, you say like, what used to be or maybe what's still done, but we find more and more that the gold standards that are emerging now are the minimally invasive, go home the same day, you know, just faster recovery, smaller scars, all those good things. It's been really educational today, doctor. As we wrap up, what are your sort of final thoughts and takeaways when we think about salivary glands and the surgical options? What would you like folks to know?

Dr. Matthew Mifsud: I think the key with anything, and I think this area in particular, the problems that happen this area are not terribly common. So when you have something, you need to be in a situation where there's a lot of different tools, right? And what I think what's nice about the practice we sort of developed here is, you know, we can do anything that's needed. So we start with these very straightforward or simple procedures, the endoscopy procedures and the open procedures in the mouth and things like that. We also have some adjuncts to that. We occasionally actually use botox, you know, like they use for cosmetics, but to treat the glands, to prevent them from excess salivation, things of that nature. And so, we have those tools. But when there's something that's more serious, like a tumor or a cancer or something like that, we have those tools as well where we can actually go in and do the bigger operations if we need to. So having that kind of full service aspect is really good because we can take you from the most simple to the most complicated procedure and really make sure we really can tailor your plan. And then, if it's something where I need somebody else's help from, or I need different kind of doctor or an immune specialist or something, we can bring those in and add that to that surgical aspect. So I think it's really important to kind of be able to provide all those different things to your patient in kind of one place as opposed to I can do a little bit of this, or a little bit of that and can't really do anything they might need.

Scott Webb: Yeah. So just sort of adding things up here today, a bit like a plumber at times, full service, one-stop shopping. You're speaking my language, doctor. I appreciate it. So thanks so much for your time. You stay well.

Dr. Matthew Mifsud: You as well.

Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa General Hospital, please visit cme.tgh.org.