Saliva

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  • Saliva

    1. 1. DR BASAVARAJT BHAGAWATI, SBBDC GZBD
    2. 2. Salivary gland D’S CLASSIFICATION: DEVELOPMENTAL INFLAMMATARY CYSTIC AUTOIMMUNE NEOPLASTIC
    3. 3. CLASSIFICATION  Developmental  1.Hypoplasia/aplasia  Aberrent s. gland[ectopic]  Accessary s. gland  Diverticuli  Inflammatary diseases  Viral:mumps, CMV HIV  Bacterial: Acute B. Sialadenitis Chronic B. Sialadenitis
    4. 4. S.G. DISEASES  CYSTIC  MUCOCELE  RANULA  AUTOIMMUNE  MUKULICZ D’S  SJOGREN’S SYNDROME  NEOPLASTIC  BENIGNTUMOURS  MALIGNANT TUMOURS
    5. 5. Omdr-2011
    6. 6. SG-3  Symptom –xerostomia  Pt c/o  dryness of oral mucosal surfaces/ reduced oral fluids  Difficulty in chewing,swallowing and speaking  Burning mouth/ mucosa-aggrevates on eating spicy and coarse food  Pain in the mucosal surfaces
    7. 7. Sg-3  Medical history:present/past  h/o  Radiotherapy to head & neck tumours  Medications-tricyclic atidepressents,sedative,antihistamines  dryness in the eyes,throat and vagina
    8. 8. clinical examination  Cracked lips,corrugated -buccal mucosa  Lipstick sign:presence of shed epithelial cells on labial sufaces of max. Anteriors teeth  Tongue blade sign:hold the tongue blade against the buccal mucosa and mucosa is adhered to tongue blade as the blade is lifted away  Enlargement of salivary glands
    9. 9. Saliva collection  Stimulated saliva sample  Unstimulated saliva samples
    10. 10. methods  Draining methods  spitting method  Suction method  absorbent
    11. 11. methods  Suction method  Saliva is collected by using suction tip or saliva ejectors for defined time period  Absorbent method:uses pre weighed gauge sponge for a set of time period  Saliva secreation can be stimulated by applying 2% citric acid on the tip of the tongue
    12. 12. Methods-indidual/specific sg  Parotid gland saliva collected by placing carlosons-crittenden collectors over the ductal orifices submandibular and sublingual gland saliva collected by alginate held collector called segregator
    13. 13. Saliva samples-  Stimulated – saliva:less than 1ml/min – abnormally low  Unstimulated –saliva:less than 0.1ml/ min abnormally low
    14. 14. salivry glnd imaging  Plain film radiography  Sialography  Ultrasonagraphy  Radionuclide imaging/scintigraphy  C T  M R I
    15. 15. SALIVARY FLOW OVER A 24 HOUR PERIOD
    16. 16. MUMPS  Viral infection of salivary gland caused by paramyxo virus  Infects SG s, Gonads, CNS  PAROTID commonly affected
    17. 17. MUMPS [c/f]  Age:2nd deacde peak incidece  CL. Presentation;  Prodromal symptoms like fever,malaise anorexia and tenderness at the angle of the jaw.  Parotid swelling may be the first indication in many cases  swollen parotid may extend from ear to lower part of the mandibular ramus displacing ear upwards&outwards
    18. 18. MUMPS[C/F]  Bilateral parotitis is common but one gland swells 1-2 days after the other  Edema of the skin over the gland and red,inflamed ductal orifice  DIAGNOSIS:History/Cl. Exmn. Negative h/o mumps in the past&vaccine  Investigation: 1.Antibody titres:4fold increased.2. Serum amylase levels increased
    19. 19. Mumps Treatment:supportive analgesics&antipyretic Preventive vaccine: MMR Systemicsteriods: Orchitis  COMPLICATIONS  MENINGITIS  ENCEPHALITIS  ORCHITIS  PANCRETITS  MYOCARDITIS
    20. 20. Ac Bacterial S’itis  Clinical features: Age:adults mean-70yrs Parotid gland commonly affected,unilateral Syptoms:sudden on set of pain at the angle of the jaw& which increases on eating Other sympoms ;Fever  Clinical exmn reveals a tender enlarged gland & overlaying skin warm &red  Diagnosis is confirmed by collection of purulent material from the ductal orifice
    21. 21. Acute Bacterial sailadenitis  Acute infection of salivary gland bacteria  Bacterial strains:staphylococcus Aureus and streptococcus viradans  Predisposing Factors: 1. Dehydration that reduces salivary flow
    22. 22. Acute Bacterial sailadenitis Investigations  Culture of purulent material collected from duct.[gram stain]  Blood: leukocytosis  Treatment:antibiotics [Parentaral] amoxycillin+cloxacillin [250mg+250mg] Metronidazole [400mg] Fluid balance Oral hygine Surgical drianage
    23. 23. Chronic sialadenitis  Chronic infection of SG’s  Bacterial strains  step.viridans  E coli,proteus  C/f :children &young adults affected.  Parotids commonly affected  Syptoms:pain at the angle  Purulent discharge from ductal orfice  Antibiotics resolve the infection but recurrence is noted  Recurrences lead to fibrosis of gland
    24. 24. Treatment  ANTIBIOTICS [after culture /gram’stian]  Fluid balance  Other modalities:INTRADUCTAL ANTIBIOTICS –Erythromycin/ tetracyclines
    25. 25. Mucocele  Mucocele is a swelling caused by pooling of saliva at the site of injured or obstructed minor salivary gland duct  Mucocele are classified as  1.Mucous retention M.  2.Extravasation M.
    26. 26. Mucocele  Mucous retntion M.is caused by obstruction of minor salivary gland duct Extravasation mucocele occurs because of laceration of of minor salivary gland duct
    27. 27. Mucocele[C/F]  Clinical appearance depends on location of the lesion.  R.M. is common on the palate/floor mouth  EV.M. is seen on lips where trauma is common  Super ficial lesions are vesicles containig mucin  Bluish in colour and on rupturing they release mucin  Size vary from 3- 4mm to 1cm in diameter  Deep lesions well defined and covered by normal mucosa
    28. 28. Ranula  Ranula is Mucocele which occurs on the floor mouth because of trauma to the sublingual gland duct.  Slow growing lesion causing difficulty in mastication.  Types : Super ficial Deep
    29. 29. Ranula  Superficial Ranula- superficial to mylohyoid muscle  Deep ranula:deep to mylohyoid muscle [plunging R.] Treatment Deep R./Recurrent R. Surgical excision Other modalities Large lesions: Marsupalization Intralesional steriods
    30. 30. Sialoliths [s.calculi] Sialolith are calcified and organic matter that form within the secreatory system of the of major salivary gland Composition Hydroxyappetite crystal Octocalcium phosphate Traces of Mg,, Cl, K,Carbon&ammonium
    31. 31. sialoliths  Etiology /p. factors [Debatable] 1. Inflammation 2. Drugs [anticholenergic medications,antihistamines] 3. Defects in calcium and phospharous metabolism
    32. 32. SIALOLITH  Sialoliths are common in the submandibular gland duct, because……..  Anatomical course of wharton’s duct has sharp curves which may trap mucin/calculus  High mucin level of the gland may trap foreign bodies &debris  Calcium content is higher in the saliva of sub.mand. Gland  Flow rate of the saliva is slower than parotid  Dependent position of the gland increases chances of stasis of saliva
    33. 33. SIALOLITH  Clinical features: Intermittent swelling in the region of major salivary gland that enlarges during eating and resolves later  Pain because of the back up saliva behind the stone  Stasis of saliva may lead to infection /fibrosis /atropy of the gland  Sinus /fistula and ulceration in chronic cases  They may be palpable if they are at periphery of the duct  They are circumscribed &firm to hard masses
    34. 34. SIALOLITH[Investigations] OCCLUSAL RADIOGRAPH: SUB.MAND. GLAND /SUBLINGUAL PA View/OPG: PAROTIDS Modern imaging SIALOGRAPHY,CT SCAN,ULTRASOUND
    35. 35. SIALOGRAPHY  It is a radiographic technique where in a radiographic contrast agent is infused into the ductal system of major salivary gland and imaged with plain films,fluroscopy or CT Scan.
    36. 36. SIALOGRAPHY  INDICATIONS:  Sialoliths  Chronic infection  Tumours of SG gland  Autoimmune d’s; sjogren’s syndrome  For extrinsic/intrinsic masses in gland  CONTRA INDICATIONS:  Acute infections  Allergy to contrast agents
    37. 37. SIALOGRAPHY  INDICATIONS:  Sialoliths  Chronic infection  Tumours of SG gland  Autoimmune d’s; sjogren’s syndrome  For extrinsic/intrinsic masses in gland  CONTRA INDICATIONS:  Acute infections  Allergy to contrast agents
    38. 38. SIALOGRAPHY  CONTRAST AGENTS:  WATER SOLUBLE   LIPID SOLUBLE  Water soluble: Advantages: a]Good flow rate b] Less painful DIS advantages;absorbed by duct :poor contrast Lipid soluble;ADV.good contrast. Not absorbed by duct DISadvantages:painful infusions:poor flow rate
    39. 39. SIALOGRAPHY procedure  1.Ductal orifice located and dilated by lacrimal probe  2.Cannula is passed into ductal orifice  3.Syringe is inserted into the cannula andd slowly solution is infused  PAROTID:0.75-1.5ml  SUB.MAND:0.5-1ml  4.Infusions done with fluroscopic mionitoring 5.Images are taken 3.phases Ductal phase Glandular phase Secreatary phse
    40. 40. THANK U
    41. 41. Ptyalism  Hypersalivation (also called ptyalism[1] and sialorrhea[2] ) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.[3 Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.  Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a
    42. 42. Conditions-ptyalism Rabies  Gastroesophageal reflux disease ,  Pregnancy  Pancreatitis  Liver disease  Serotonin syndrome  Mouth ulcers  Oral Infections  Medications that can cause overproduction of saliva include:[3]  clozapine  pilocarpine  Ketamine  TOXINS:  mercury  copper
    43. 43. DECREASED –CLEARANCE-SALIVA Infections : tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps. jaw fracture/TMJ dislocation Radiation Therapy
    44. 44. Neurological disorders:  myasthenia gravis, Parkinson's disease, Multiple System Atrophy, , bilateral facial nerve palsy and hypoglossal nerve palsy.
    45. 45. Management . Removal of cause Antihistamine or atropine sulphate
    46. 46. Self-contained saliva test kit for use at the point of care that will target markers for periodontal diseases, caries, infectious diseases, pancreatic cancer, diabetes, salivary gland diseases, renal diseases, steroids and inflammatory

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