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Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
Salivary glands disorders i
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Salivary glands disorders i

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Oral & Maxillofacial Surgery …

Oral & Maxillofacial Surgery
Fifth Year

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  • 1. Salivary Glands Disorders DR. Wael Talaat Assistant Professor of Oral & Maxillofacial Surgery 1
  • 2. Objectives    To know the anatomy of major salivary glands To properly diagnose the different salivary glands disorders To be familiar with the different treatment modalities 2
  • 3. Major glands/Secretions  Major SG are paired structures and include the parotid, submandibular and sublingual  Parotid: serous Submandibular: mucous & serous Sublingual: mucous   3
  • 4. Salivary Function    Aids in mastication, deglutination Salivary lysozyme, IgA and other antibacterial substances protect against caries and oral cavity infections Saliva also aids in speech 4
  • 5. 5
  • 6. Anatomy: Parotid Gland The largest salivary gland  Lies wedge-shaped between the mandible and sternomastoid muscle and over both  Relations: • Above: external auditory meats and temporomandibular joint • Below: post belly digastric • Anteriorly: mandible and masseter • Medially: styloid process and its muscles  6
  • 7. Relations of the Parotid 7
  • 8. Anatomy:Parotid Gland  CN VII branches roughly divide the PG into superficial and deep lobes while coursing anteriorly from the stylomastoid foramen to the muscles of facial expression. 8
  • 9. Anatomy: Parotid Duct    Small ducts coalesce at the anterosuperior aspect of the PG to form Stensen’s duct. Runs anteriorly from the gland and lies superficial to the masseter muscle At the anterior edge of the masseter muscle, Stensen’s duct turns sharply medial and passes through the buccinator muscle, buccal mucosa and into the oral cavity opposite the maxillary second molar. 9
  • 10. 10
  • 11. Anatomy: Submandibular gland   Located in the submandibular triangle of the neck, inferior & lateral to mylohyoid muscle. The posterior-superior portion of the gland curves up around the posterior border of the mylohyoid and gives rise to Wharton’s duct. 11
  • 12. 12
  • 13. Anatomy: Submandibular Duct   Wharton’s duct passes forward along the superior surface of the mylohyoid adjacent to the lingual nerve. The nerve winds around the duct, first being lateral, then inferior, and finally medial. 13
  • 14. Anatomy: Submandibular duct    2-4mm in diameter & about 5cm in length. It opens into the floor of the mouth thru a punctum. The punctum is a constricted portion of the duct to limit retrograde flow of bacteria-oral fluids. 14
  • 15. 15
  • 16. Anatomy: Sublingual glands Lie on the superior surface of the mylohyoid muscle and are separated from the oral cavity by a thin layer of mucosa. 16
  • 17. Anatomy: Sublingual glands   The ducts of the sublingual glands are called Bartholin’s ducts. In most cases, Bartholin’s ducts consists of 820 smaller ducts of Rivinus. These ducts are short and small in diameter. 17
  • 18. Anatomy: Sublingual glands  The ducts of Rivinis either open…  individually into the FOM near the punctum of Wharton’s duct  on a crest of sublingual mucosa called the plica sublingualis  open directly into Wharton’s duct 18
  • 19. Major Salivary Glands Bartholin`s ducts (sublingual : The : they Stensen`s duct (Parotid duct ) ducts )duct are 8-20 into the oral cavity adjacent in the opens in number and open directlyduct ) :floor Wharton`s duct (Submandibular to maxillary The of or mouth molar Or indirectly firstthe second (plica sublingualis)the lingual duct opens near the junction of through the submandibular duct frenum and the floor of the mouth 19
  • 20. Minor Salivary Glands Minor S.G are referred to as the labial , buccal , palatine , tonsillar (Weber`s glands) , retromolar (Carmalt`s glands) , and lingual glands which are divided into three groups : inferior apical (glands of Blandin Nuhn ) , taste buds (Von Ebner`s gland) and the posterior lubricating glands . 20
  • 21. Physiology     Physiologic control of the SG is almost entirely by the autonomic nervous system; parasympathetic effects predominate. If parasympathetic innervation is interrupted, glandular atrophy occurs. Normal saliva is 99.5% water Normal daily production is 1-1.5L 21
  • 22. DIAGNOSTIC MODALITIS 1 ) History and clinical examination It is very important in diagnosis of S.G disorders , the clinician will be able to categorize the problem as reactive , obstructive , inflammatory ,infectious , neoplastic , developmental or traumatic. 22
  • 23. DIAGNOSTIC MODALITIS 2) Salivary gland radiography  Plain film radiography  Sialography  C.T scan , M.R.I and Ultrasound 23
  • 24. 24
  • 25. 25
  • 26. Sialography 26
  • 27. Sialography 27
  • 28. DIAGNOSTIC MODALITIS 3) Sialochemistry Examination of the electrolyte composition of the saliva (sodium & potassium) may indicate a variety of S.G disorders For example : Elevated Na+ with decreased P+ may indicate an inflammatory sialadenitis 28
  • 29. DIAGNOSTIC MODALITIS 4) Fine needle aspiration biopsy Fine needle aspiration biopsy is well documented in differentiation between benign & malignant S.G neoplasms 29
  • 30. 30
  • 31. DIAGNOSTIC MODALITIS 5) Salivary gland biopsy Either incisional or excisional can be used to diagnose a tumor of one of the major S.G 31
  • 32. Obstructive Salivary Gland Disorders Sialolithiasis  Mucous retention/extravasation  32
  • 33. Obstructive SG Disorders: Sialolithiasis   Sialolithiasis results in a mechanical obstuction of the salivary duct Is the major cause of unilateral diffuse parotid or submandibular gland swelling 33
  • 34. Sialolithiasis Incidence Sialolithiasis remains the most frequent reason for submandibular gland resection 34
  • 35. Sialolithiasis   The exact pathogenesis of sialolithiasis remains unknown. Thought to form via…. an initial organic nidus that progressively grows by deposition of layers of inorganic and organic substances.  May eventually obstruct flow of saliva from the gland to the oral cavity. 35
  • 36. Sialolithiasis Acute ductal obstruction may occur at meal time when saliva producing is at its maximum, the resultant swelling is sudden and can be painful. 36
  • 37. Gradual reduction of the swelling can result but it recurs repeatedly when flow is stimulated. This process may continue until complete obstruction and/or infection occurs. 37
  • 38. Etiology    Hypercalcemia Xerostomic meds Tobacco smoking Smoking has an increased cytotoxic effect on saliva, decreases PMNL phagocytic ability and reduces salivary proteins 38
  • 39. Etiology Gout is the only systemic disease known to cause salivary calculi and these are composed of uric acid. 39
  • 40. Stone Composition  Organic; often predominate in the center Glycoproteins  Mucopolysaccarides  Bacteria  Cellular debris   Inorganic; often in the periphery  Calcium carbonates & calcium phosphates in the form of hydroxyapatite 40
  • 41. Parotid vs. Submandibular Gland ….  Most authorities agree obstructive phenomemnon such as mucous plugs and sialoliths are most commonly found in the SMG 41
  • 42. Reasons sialolithiasis may occur more often in the SMG      Saliva more alkaline Higher concentration of calcium and phosphate in the saliva Higher mucus content Longer duct Anti-gravity flow 42
  • 43. Clinical presentation    Painful swelling (60%) Painless swelling (30%) Pain only (12%) Sometimes described as recurrent salivary colic and spasmodic pain upon eating  43
  • 44. Clinical History         History of swellings / change over time? Trismus? Pain? Variation with meals? Dry mouth? Dry eyes? Recent exposure to sick contacts (mumps)? Radiation history? Current medications? 44
  • 45. Diagnostics: Plain occlusal film   Effective for intraductal stones, while…. intraglandular, radiolucent or small stones may be missed. 45
  • 46. Diagnostic approaches 1- CT Scan 2- Ultrasound 3- Sialography 4- Diagnostic Sialendoscopy 46
  • 47. Sialolithiasis Treatment   None: antibiotics and anti-inflammatories, hoping for spontaneous stone passage. Stone excision: Interventional sialendoscopy  Simple removal (20% recurrence)   Gland excision 47
  • 48. Gland excision indicated Very posterior stones Intra-glandular stones Significantly symptomatic patients 48
  • 49. 49
  • 50. Mucocele  Can be classified as a cystic salivary gland lesion and as an obstructive salivary gland disorder. 50
  • 51. Mucocele   Mucus is the exclusive secretory product of the accessory minor salivary glands and the most prominent product of the sublingual gland. The mechanism for mucus cavity development is extravasation or retention 51
  • 52. Mucocele  Mucoceles, exclusive of the irritation fibroma, are most common of the benign soft tissue masses in the oral cavity.  Muco: mucus , coele: cavity. When in the oral floor, they are called ranula. 52
  • 53. Mucocele Extravasation is the leakage of fluid from the ducts or acini into the surrounding tissue. Extra: outside, vasa: vessel Retention: narrowed ductal opening that cannot adequately accommodate the exit of saliva produced, leading to ductal dilation and surface swelling. Less common phenomenon 53
  • 54.   Which of the two is a pseudo cyst ?? Would the mucocele of the lower lip be an extravasation or retention cyst ?? 54
  • 55. Mucocele Consist of a circumscribed cavity in the connective tissue and submucosa producing an obvious elevation in the mucosa  55
  • 56. Mucocele  The majority of the mucoceles result from an extravasation of fluid into the surrounding tissue after traumatic break in the continuity of their ducts.  Lacks a true epithelial lining. 56
  • 57. Ranula   Is a term used for mucoceles that occur in the floor of the mouth. The name is derived form the word rana, because the swelling may resemble the translucent underbelly of the frog. 57
  • 58. Ranula  Although the source is usually the sublingual gland, may also arise from the submandibular duct  or possibly the minor salivary glands in the floor of the mouth.  58
  • 59. Ranula    Presents as a blue dome shaped swelling in the floor of mouth (FOM). They tend to be larger than mucoceles & can fill the FOM & elevate tongue. Located lateral to the midline, helping to distinguish it from a midline dermoid cyst. 59
  • 60. 60
  • 61. Cervical Ranula   Occurs when spilled mucin dissects through the mylohyoid muscle and produces swelling in the neck. Concomitant FOM swelling may or may not be visible. 61
  • 62. Treatment of Mucoceles in Lip or Buccal mucosa   Excision with strict removal of any projecting peripheral salivary glands Avoid injury to other glands during primary wound closure 62
  • 63. Ranula Treatment   Marsupialization has fallen into disfavor due to the excessive recurrence rate of 60-90% Sublingual gland removal via intraoral approach 63
  • 64. Thank You 64

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