Salivary gland diseases , Dr.Syed Alam Zeb

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Dr.Syed Alam Zeb

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Salivary gland diseases , Dr.Syed Alam Zeb

  1. 1. SALIVARY GLAND DISEASES Dr.Syed Alam Zeb
  2. 2. <ul><li>There are four main salivary glands: </li></ul><ul><li>two submandibular glands </li></ul><ul><li>two parotid glands </li></ul><ul><li>There also two sublingual glands and >400 minor salivary glands. </li></ul>
  3. 3. SUBLINUAL GLANDS <ul><li>Paired set of salivary glands, lying in the anterior part of the floor of the mouth. </li></ul><ul><li>Each gland has numerous excretory ducts which open either directly in to the oral cavity or indirectly via ducts that drain in to the submandibular duct. </li></ul>
  4. 4. Disorders of Sublingual glands <ul><li>Problems are rare. </li></ul><ul><li>Minor mucous retention cysts may need surgery. </li></ul><ul><li>Plunging ranula is a retention cyst that tunnels deep. </li></ul><ul><li>Nearly all tumours are malignant. </li></ul>
  5. 5. Ranula and plunging Ranula <ul><li>Ranula. This term is only applied to a mucous retention cyst of the sublingual gland. </li></ul><ul><li>Characteristic ‘frog’s belly’ swelling. </li></ul><ul><li>Can resolve spontaneously. </li></ul><ul><li>Surgically the cyst should be excised along with the sublingual gland. </li></ul>
  6. 6. ranula
  7. 7. ranula
  8. 8. <ul><li>Plunging Ranula. Mucous retention cyst that can arise from both the sublingual and submandibular glands. </li></ul><ul><li>Patient presents with a swelling in the submental or submandibular region that is dumbell shaped, soft, fluctuant and painless. </li></ul><ul><li>Diagnosed with US/MRI. </li></ul><ul><li>Treatment is excision. </li></ul>
  9. 9. SUBMANDIBULAR GLAND <ul><li>Paired salivary glands,encapsulated, has superficial and deep parts. Anteriorly related to facial vessels. </li></ul><ul><li>The lingual, hypoglossal and marginal mandibular branch of facial nerve are in closed relation. </li></ul><ul><li>Drained by the wharton’s duct in to the floor of the mouth. </li></ul>
  10. 10. DISORDERS OF SUBMANDIBULAR GLAND <ul><li>DEVELOPMENTAL DISORDERS: congenital absence duct atresia ectopic/ aberrant gland tissue </li></ul><ul><li>INFLAMMATORY DISORDERS Sialadenitis which may be acute, chronic or acute on chronic, caused by either bacteria or virus. </li></ul>
  11. 11. <ul><li>CHRONIC SUBMANDIBULAR SIALADENITIS: This is caused by a stone formation in the duct. There is acute painful swelling, precipitated by eating and resolves spontaneously in 1-2 hrs after meals. On examination the gland is enlarged, firm and tender. Pus may be seen coming out of the duct. </li></ul>
  12. 12. <ul><li>Management : if the stone is in part of the duct anterior to the point where it is crossing the lingual nerve, remove it by a direct incision over the stone and do not stitch the wound in the duct. if the stone is in the posterior part, excise the whole gland and ligate the duct. </li></ul>
  13. 13. <ul><li>Complications of submandibular gland surgery. haematoma wound infection marginal mandibular nerve injury lingual nerve injury hypoglossal nerve injury </li></ul>
  14. 14. <ul><li>Submandibular gland tumours : 50% tumours are malignant. Do FNAC not open biopsy where tumor is suspected. CT and MRI help to know the extent of the disease. Treatment is surgical excision. </li></ul>
  15. 15. PAROTID GLAND <ul><li>The gland is divided in to superficial and deep parts by the facial nerve. </li></ul><ul><li>Structures passing through the parotid gland are important: facial nerve branches of external carotid artery retromandibular vein intraparotid lymph nodes. </li></ul>
  16. 16. <ul><li>Common causes of Parotid swelling : </li></ul><ul><li>Viral infections..mumps. </li></ul><ul><li>Bacterial infections, acute are idiopathic while chronic are due to obstruction. </li></ul><ul><li>Sjogners syndrome </li></ul><ul><li>HIV associated </li></ul><ul><li>Tumours </li></ul>
  17. 17. <ul><li>Sialolithiasis ..stone formation: </li></ul><ul><li>much rarer than submandibular </li></ul><ul><li>usually radiolucent </li></ul><ul><li>sialography is needed to identify them </li></ul><ul><li>removed surgically by exposing the duct and cutting down on to the stone. </li></ul>
  18. 18. <ul><li>Tumours of the parotid gland : </li></ul><ul><li>Classification Adenomas: 1.pleomorphic adenoma is the most common tumour. 2.warthins tumour </li></ul><ul><li>Carcinomas: 1.Adenocarcinoma 2.Sqamous cell Carcinoma 3.Acinic cell ca. </li></ul>
  19. 19. <ul><li>Classification cont: Non-epithelial tumours like haemangioma Lymphomas Secondary tumours Cysts unclassified </li></ul>
  20. 20. <ul><li>Investigations for parotid tumours: </li></ul><ul><li>FNAC CT MRI </li></ul>
  21. 21. <ul><li>Superficial Parotidectomy: this is the most common procedure for parotid gland pathology. </li></ul><ul><li>‘ lazy S’ incision. </li></ul><ul><li>facial nerve is identified the whole superficial parotid gland is removed, not just enucleation of the tumour. </li></ul>
  22. 22. <ul><li>Complications of parotid surgery. </li></ul><ul><li>Haematoma formation. </li></ul><ul><li>Infection. </li></ul><ul><li>Facial nerve damage. </li></ul><ul><li>Numbness of the ear lobe due to division of the greater auricular nerve. </li></ul><ul><li>Frey syndrome. </li></ul>

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