Salivary gland  diseases , Dr.Syed Alam Zeb
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Salivary gland diseases , Dr.Syed Alam Zeb

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Dr.Syed Alam Zeb

Dr.Syed Alam Zeb

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Salivary gland  diseases , Dr.Syed Alam Zeb Salivary gland diseases , Dr.Syed Alam Zeb Presentation Transcript

  • SALIVARY GLAND DISEASES Dr.Syed Alam Zeb
    • There are four main salivary glands:
    • two submandibular glands
    • two parotid glands
    • There also two sublingual glands and >400 minor salivary glands.
  • SUBLINUAL GLANDS
    • Paired set of salivary glands, lying in the anterior part of the floor of the mouth.
    • 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.
  • Disorders of Sublingual glands
    • Problems are rare.
    • Minor mucous retention cysts may need surgery.
    • Plunging ranula is a retention cyst that tunnels deep.
    • Nearly all tumours are malignant.
  • Ranula and plunging Ranula
    • Ranula. This term is only applied to a mucous retention cyst of the sublingual gland.
    • Characteristic ‘frog’s belly’ swelling.
    • Can resolve spontaneously.
    • Surgically the cyst should be excised along with the sublingual gland.
  • ranula
  • ranula
    • Plunging Ranula. Mucous retention cyst that can arise from both the sublingual and submandibular glands.
    • Patient presents with a swelling in the submental or submandibular region that is dumbell shaped, soft, fluctuant and painless.
    • Diagnosed with US/MRI.
    • Treatment is excision.
  • SUBMANDIBULAR GLAND
    • Paired salivary glands,encapsulated, has superficial and deep parts. Anteriorly related to facial vessels.
    • The lingual, hypoglossal and marginal mandibular branch of facial nerve are in closed relation.
    • Drained by the wharton’s duct in to the floor of the mouth.
  • DISORDERS OF SUBMANDIBULAR GLAND
    • DEVELOPMENTAL DISORDERS: congenital absence duct atresia ectopic/ aberrant gland tissue
    • INFLAMMATORY DISORDERS Sialadenitis which may be acute, chronic or acute on chronic, caused by either bacteria or virus.
    • 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.
    • 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.
    • Complications of submandibular gland surgery. haematoma wound infection marginal mandibular nerve injury lingual nerve injury hypoglossal nerve injury
    • 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.
  • PAROTID GLAND
    • The gland is divided in to superficial and deep parts by the facial nerve.
    • Structures passing through the parotid gland are important: facial nerve branches of external carotid artery retromandibular vein intraparotid lymph nodes.
    • Common causes of Parotid swelling :
    • Viral infections..mumps.
    • Bacterial infections, acute are idiopathic while chronic are due to obstruction.
    • Sjogners syndrome
    • HIV associated
    • Tumours
    • Sialolithiasis ..stone formation:
    • much rarer than submandibular
    • usually radiolucent
    • sialography is needed to identify them
    • removed surgically by exposing the duct and cutting down on to the stone.
    • Tumours of the parotid gland :
    • Classification Adenomas: 1.pleomorphic adenoma is the most common tumour. 2.warthins tumour
    • Carcinomas: 1.Adenocarcinoma 2.Sqamous cell Carcinoma 3.Acinic cell ca.
    • Classification cont: Non-epithelial tumours like haemangioma Lymphomas Secondary tumours Cysts unclassified
    • Investigations for parotid tumours:
    • FNAC CT MRI
    • Superficial Parotidectomy: this is the most common procedure for parotid gland pathology.
    • ‘ lazy S’ incision.
    • facial nerve is identified the whole superficial parotid gland is removed, not just enucleation of the tumour.
    • Complications of parotid surgery.
    • Haematoma formation.
    • Infection.
    • Facial nerve damage.
    • Numbness of the ear lobe due to division of the greater auricular nerve.
    • Frey syndrome.