Differential Diagnosis of Salivary Gland Lesions

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Oral Diagnosis II
Forth Year

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Differential Diagnosis of Salivary Gland Lesions

  1. 1.  Developmental anomalies - Aberrant Salivary glands - Aplasia & Hypoplasia - Accessory ducts - Diverticuli
  2. 2.  Aberrant/Ectopic Salivary Glands: Develops at a site where it is not normally found. Usually in the cervical region near Parotid gland / body of mandible.  Aplasia: Rare.  Hypoplasia: Defect in Saliv. glands themselves or by atrophy secondary to a neurologic defect.  Accessory ducts: Mostly seen superior and anterior to stenson’s duct orifice.  Diverticuli : Small pouches of the salivary gland ductal system, and their presence leads to repeated episodes of parotitis. Diagnosis - Sialogram
  3. 3.  Sialoliths – Calcified organic matter either in the salivary gland/ducts.  80 – 90 % occur in Submandibular gland /duct due to: - Wharton’s duct contains sharp curves, likely to trap mucin plugs/cellular debris. - Calcium levels are higher in saliva from submandibular glands. - Dependent position of submandibular gland increases the chance of stones.
  4. 4. Clinical Features: Painful intermitted swelling in the area of major Salivary glands. Worsens during eating & resolves after meals. Pain originates due to pooling of saliva behind the stone. Leads to infection and eventual fibrosis and atrophy. Diagnosis: Sialography. Ultra sound. CT Scan.
  5. 5. Sialolithiasis Swelling in the gland area due to Sialolith Sialolith - radiograph
  6. 6.  Clinical term used to describe swelling caused by the pooling of saliva at the site of a severed or obstructed minor salivary gland duct.  Common in the Lower lip.  2 types: - Mucous extravasation type - Mucous retention type Mucous extravasation type: Common type. Caused by laceration of minor salivary gland duct by trauma. Thin walled bluish lesions that rupture easily. Usually in lower lip, where trauma is common. Mucous retention type: Less common. Due to obstruction of minor salivary gland duct, which causes a back up of saliva. This continual pressure dilates the duct and forms a cyst like lesion. Common in palate and floor of the mouth.
  7. 7. Mucocele Mucocele of the lower lip (arrows )
  8. 8.  Ranula :  Special type of mucocele , occurs on the floor of the mouth from trauma of a sublingual/submandibular gland duct.  Resemblance to the belly of a frog .  Seen superficial / deep to the mylohyoid muscle.
  9. 9.  Inflammatory lesion of unknown etiology. - Trauma causing ischemia of the minor salivary glands. - Males – 5th & 6th decades of life. - Seen as an ulcer on the palate.
  10. 10. Necrotizing Sialometaplasia
  11. 11.  Sialadenitis: Painful swelling of the affected glands. As a result of Bact’l / Viral infections; allergic infections. Parotid gland is mostly affected.
  12. 12.  Mumps (Epidemic Parotitis): - Paramyxo virus. - Both parotid glands may be simultaneously involved. - Involved glands continue to enlarge for 2-3 days and return to normal size in 7 days. - Enlarged glands are tender and pain is experienced when eating sour foods. - Associated edema of the skin over the glands and inflammation around Stensen’s / Wharton’s duct.
  13. 13. Mumps
  14. 14.  Herpes virus infection.  Common in patients whose cellular immunity is compromised by cancer chemotherapy, immunosuppressive drugs.
  15. 15.  Acute / Chronic.  Parotid – frequently affected. Acute bacterial sialadenitis (Acute suppurative parotitis) - Usually in adults. - Usually unilateral. Sudden onset of pain, which worsens when the mouth is opened. - Tender, enlarged gland. - Diagnosis is confirmed when purulent material is expressed from Stensen’s duct orifice by pressure over the gland.
  16. 16.  Enlargement related to allergic reactions to drugs or other allergens.  Self limiting disease.
  17. 17.  A systemic granulomatous disease.  Uveoparotid fever – a special form of disease, characterized by inflammation of the uveal tract of the eye, parotid swelling and facial palsy.  3rd or 4th decade of life.  Bilateral, firm painless enlargement.  Decreased/ absent salivation of the affected gland.  Treatment - Symptomatic
  18. 18.  Non neoplastic, non inflammatory enlargement of the salivary glands. - Usually bilateral. - Seen as recurrent, painless enlargement of the glands. - Parotid usually affected. - Cause unknown. May be due to - - Hormonal - Alcoholic - Malnutrition
  19. 19.  An autoimmune disorder of exocrine glands.  May be assoc: with other conn: tissue disease, lymphoproliferative disorders. - Primary type – affects exocrine glands only esp- lacrimal & saliv glands. - Secondary type - affects exocrine glands with assoc: conn: tissue disorders.
  20. 20.  C/F: - Dryness of eyes, pharynx, nose. - Xerostomia (B/L Parotid involvement ) - Candidiasis, Dental caries - Symptoms & signs of assoc: collagen disease (eg: rheum. arthritis )
  21. 21.  Treatment: To reduce sec: effects of reduced exocrine secretion – use saliva substitutes, etc. Dental considerations: - Lack of saliva   dental caries - Daily home use of topical fluoride and freq: oral hygiene visits. - Antifungal agents for candidiasis. - Precaution against infection before oral surgical procedures.
  22. 22. Benign & malignant. Usually involve parotid gland. Majority are benign – mixed tumors (Pleomorphic adenoma ) Appear as a mass with an associated ulceration probably. Neurologic involvement  discomfort and in parotid tumors  facial paralysis due to facial nerve involvement.

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