Your SlideShare is downloading. ×
0
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
16 diseases of salivary glands
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

16 diseases of salivary glands

2,188

Published on

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,188
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
161
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Diseases of salivary glands Instructor – Dr. Jesus George 1
  • 2. Introduction  The salivary glands classified as major& minorglands  Major glands are paired glands they are  Parotid glands  Submandibular glands  Sublingual glands  The numerous minor salivary glands , widely distributed in the oral cavity  Salivary gland secretion contain water, electrolytes , urea , ammonia , glucose , fats &proteins 2
  • 3. Parotid gland  Largest salivary gland  Pyramidal in shape  Two lobes superficial , & deep connected by an isthmus at posterior part of gland  Apex is toward angle of mandible  Base at the external acoustic meatus  Anteriorly gland extends up to buccal pad of fat  Posteriorly encircles posterior border of mandible  Parotid gland secretion is serous in nature 3
  • 4. Parotid duct (Stenson's duct )  Stenson`s duct emerges at anterior part of gland  Stenson`s duct opening is seen as a papilla in the buccal mucosa opposite maxillary second molar 4
  • 5. Submandibulargland  The gland is located submandibular space  Extending inferiorly up to digastric muscle  Superiorly mylohyoid muscle  Posteriorly up to angle of mandible  Anteriorly mid portion of body of the mandible  Submandibular gland secretion is mixed 5
  • 6. Submandibularduct (Wharton's duct)  The duct starts from deep part of gland  Turns sharply at the posterior border of mylohyoid muscle anteriorly & superiorly , crosses hyoglossus muscle 6
  • 7. Sublingual gland  This gland is located in sublingual space it is present in association with sublingual fold below tongue , & divided into anterior & posterior part  Sublingual gland secretes both serous & mucous  Bartholin’ s duct  The ducts of anterior part may join to form a large main duct called Bartholin’ s duct 7
  • 8. Minorsalivary glands  More than 800 minor salivary glands may be present in oral cavity  Secrete mucous secretions 8
  • 9. Functions of saliva  Digestive function  Protective function  Cleansing  Lubrication  Antibacterial action 9
  • 10. Classification of salivary gland diseases  Salivary gland dysfunction  Xerostomia  Sialorrhea  Developmental  Aplasia - absenceof thegland  Atresia - absenceof theduct  Aberrancy- ectopic gland 10
  • 11. Cont.  Enlargement of the gland  Inflammatory  Viral ; mumps  Bacterial  Non– inflammatory  Autoimmune; Sjogren’s syndrome  Alcoholic cirrhosis  Diabetes mellitus  Sialolithiasis 11
  • 12. CONT.  Cysts  Retentioncysts  Extravasationcyst  Ranula  Tumours of salivary glands  Benign tumours  Pleomorphic adenoma  Warthin’s tumour 12
  • 13. CONT.  Malignant tumours  Mucoepidermoid carcinoma  Acinic cell carcinoma  Adenoid cystic carcinoma  Necrotizing sialometaplasia 13
  • 14. Xerostomia  Xerostomia is a subjective sensation of a dry mouth  It affects women more than men , are commonly in older people  Antihistamines , decongestants , antidepressants , antipsychotics, antihypertensives, & anticholinergics are known to cause xerostomia  Other cause of xerostomia -- salivary gland aplasia, aging , excessive smoking , mouth breathing , local radiation therapy , Sjogren’s syndrome & HIV infection 14
  • 15. Cont.  Clinical features  Dry mouth with foamy , thick , & ropy saliva  Gloves stick to the mucosa  Difficulty in mastication & swallowing  More chance for candidiasis & caries  Treatment  Removal of the cause  Maintenance oral hygiene  Use of sialagogues 15
  • 16. Cont.  Systemic pylocarpine 5- 10 mg 3-4 times daily  Frequent dental visits  Topical fluoride application 16
  • 17. Sialorrhoea  Sialorrhoea is excessive salivation  Minor sialorrhea can be seen due to local irritation like aphthous ulcers or ill- fitting dentures  Profuse salivation is seen in rabies, heavy metal poisoning, gastro esophageal reflux disease or after certain medication like lithium & cholinergic agonists  Mentally retarded children also excessive salivation – not by excessive production of saliva  Treatment  Removal of the cause 17
  • 18. Cont.  Anticholinergic medication  Submandibular gland resection  Parotid duct ligation. 18
  • 19. Sialadenitis  Inflammation of the salivary glands is known as sialadenitis  Causes  Viral infections  Bacterial infections  Allergic reactions  Systemic diseases 19
  • 20. Mumps  It is also called as epidemic parotitis.  It is caused by paramyxo virus and affects major salivary glands, especially the parotid salivary gland.  Clinical Features:  The mumps virus can be transmitted through urine, saliva or respiratory droplets.  Incubation period-16 to 18 days. 20
  • 21. Cont.  Patients are contagious 1 day before & 14 days after the resolution  Usually subclinical  If symptomatic prodromal symptoms of Low- grade fever, Headache, malaise & Myalgia  Discomfort & swelling over the lower ½ of external ear down to posterior & inferior border of mandible  Either one or both the parotid gland are enlarged and become tender. 21
  • 22. Cont.  Enlargement & pain are maximum in 2-3 days  Chewing movements or saliva stimulating foods increases pain  Enlargement begins on one side & then extends to other side  There many also be and edema & erythema involving the ductal orifice.  If sublingual gland is involved – bilateral enlargement of floor of mouth 22
  • 23. Cont.  Complications  Pancreatitis  Orchitis  Oophoritis  Meningio encephalitis  Diagnosis:  Urine, saliva & cerebrospinal fluid for culture. 23
  • 24. Cont.  Treatment:  Analgesics and antipyretics  Bed rest  Avoidance of sour foods  Prior vaccination 24
  • 25. Bacterial infection  Bacterial infection can inflammation of major salivary glands  Bacterial sialadenitis affects parotid gland more commonly  Submandibular glands are rarely affected 25
  • 26. Acute bacterial sialadenitis  Organisms - staph ;aureus , strep ; pyogenes, strep; viridans etc  Some drugs like tranquilizers; antiparkinson drug ; diuretics; & antihistamines drugs etc decrease salivary flow with increased chance of infection of salivary glands  Clinical features  Sudden onset of pain at angle of the jaw which is unilateral 26
  • 27. Cont.  Affected gland is enlarged & tender & extremely painful  Inflammatory swelling is very tense & does not show much fluctuation  Skin is warm & red  Associated fever & trismus may be there  Purulent discharge from the affected duct orifice  Histopathologic features  Accumulation of neutrophils is observed with in ductal system & acini 27
  • 28. Cont.  Treatment  Antibiotics  Hydrating the pt  Stimulate the salivation by chewing sialagogues  Improve oral hygiene by debridement & irrigation  Surgical drainage if abscess is there 28
  • 29. Chronic bacterial siladenitis  It may be idiopathic or with factors like  Duct obstruction ,  Congenital stenosis,  Sjogren ’s syndrome  The microorganisms may be strep; viridans, e- coli  Clinical features  Unilateral periodic pain & swelling at the angle of jaw usually during mealtime  Gland may undergo atrophy , which results in decreased salivary flow 29
  • 30. Cont.  Histopathologic features  Patchy infiltration of salivary parenchyma by lympocytes & plasma cells  Atrophy of acini & ductal dialatation & sometimes fibrosis  Sialography – ductal dialatation proximal to area of obstruction  Treatment  Antibiotics 30
  • 31. Cont.  Intra ductal infusion of erythromycin or tetracycline  Excision of the gland 31
  • 32. 32
  • 33. Sjogren syndrome  Characterized by dry eyes , xerostomia & rheumatoid arthritis  Clinical features  Occurs predominantly in women  Dry eyes & dry mouth  Pain & burning sensation  Red & tender mucosa with Ulceration  Difficulty in swallowing  Altered taste sensation  Denture sore mouth 33
  • 34. Cont.  Angular cheilitis  There may have diffuse firm enlargement of major salivary glands usually bilateral  Sialography- demonstrates cavitary defects are filled with radiopaque contrast media producing ‘ branchless fruit laden tree’ or “cherry blossom appearance”  Histopathologic features  Lymphocytic infiltration with destruction of acinar cells 34
  • 35. Cont.  Treatment  Xerostomia - artificial saliva,sugarless gums,pilocarpine  Flouride application to prevent caries 35
  • 36. 36
  • 37. Sialadenosis  It is non- inflammatory , non - neoplastic swelling of the salivary gland  Sialadenosis can occur in the following conditions;  Hormonal disorders(pregnancy, hypothyroidism)  Diabetes mellitus  Alcoholic cirrhosis  Malnutrition  Caused by dysregulation of autonomic innervation of salivary acini causing aberrent intracellular secretory cycle leading to excessive secretion of secretory granules 37
  • 38. Cont.  Clinical features  Enlargement is usually painless  Usually bilateral  More common in women  Commonly affects parotid  Histopathologic features  Hypertrophy of acinar cells  Nuclei are displaced to the base  Cytoplasm is engorged with zymogen granules 38
  • 39. Cont.  In DM & alcoholism – acinar atrophy & fatty infiltration  Treatment  Control underlying cause  Pilocarpine 39
  • 40. Sialolithiasis  Sialolithiasis is the formation of sialolith ( salivary calculi, salivary stone ) in the salivary duct or gland resulting in the obstruction of the salivary flow  Sialolith  Sialolith is a calcified mass with laminated layers of inorganic material from crystallization of salivary solutes  The sialolith is yellowish white in colour ;  Single or multiple, may be round & ovoid or elongated having size of 2cm or more diameter 40
  • 41. Cont.  The minerals are various forms of calcium phosphate like hydroxyapatite, octacalcium phosphate etc  Calcium & phosphorus ions are deposited on the organic nidus, may be desquamated epithelial cell, bacteria, foreign particle or product of bacterial decomposition  It may be related to sialadenitis or ductal obstruction  Clinical features  Commonly seen in middle -age persons 41
  • 42. 42
  • 43. Cont.  More common in submandibular salivary ductal system  Pain & swelling during & after eating food  Stone can be palpated if it is in the peripheral aspect of the duct  Minor salivary stones are seen as asymptomayic hard nodule commonly in upper lip  Histopathologic features  Sialoliths appear as round , & oval calcified mass exhibits concentric laminations surround a nidus of amorphous debris43
  • 44. Cont.  Investigations  Radiographs –PA view , lateral oblique or occlusal view – shows radiopaque mass  Sialography  Treatment  Smaller sialoliths, are located peripherally near ductal opening may be removed by manipulation called milking the gland  Larger sialoliths are surgically removed 44
  • 45. Cont.  Stones which are not impacted , may be extracted through the intubation of the duct with fine soft plastic catheter& application of the suction to the tube  Piezoelectric shock wave lithotripsy  Multiple stones or stone in gland require removal of the gland  Transoral sialolithotomyof thesubmandibular duct  Local anaesthesia  Position of the stone is located by x-rays & palpation 45
  • 46. Cont.  Suture is placed behind the stone  Tongue is lifted & held with help of a gauze  Incision is made in the mucosa parallel to the duct  Duct is located by blunt dissection  Longitudinal incision is made over the stone  Stone removed using small forceps, in case the stone is large, it is crushed with help of the forceps  Cannula may be passed to aspirate the pieces of stone, mucin etc  Sutures are placed at the level of the mucosa 46
  • 47. Mucocele  Lower lip is commonly affected  Other common sites are buccal mucosa, ventral tongue, floor of mouth  It can be superficial or deep  Superficial – elevated well circumscribed vesicle with bluish hue  Deep – nodule with no change in color  Cystic contents – thick mucous material  Usually covered by mucous membrane  There may have periodic rupture of the swelling releasing the contents47
  • 48. 48
  • 49. Cont.  After rupture it may leave shallow painful ulcers  Some lesions resolve by itself  Histopathologic features  Area of spilled mucin surrounded by granulation tissue  Adjacent minor salivary glands contain c/c inflammatory infiltrate  Treated by excision along with adjacent minor salivary glands to prevent recurrence 49
  • 50. Salivary duct cyst  Mucus retention cyst or sialocyst  Epithelium lined cavity that arises from salivary gland tissue  True cyst  May be caused by ductal dilatation or secondary to ductal obstruction  It can be seen in major or minor salivary glands  Cysts of major glands are common in parotid gland  Intraoral cyst are common in buccal mucosa, floor of mouth & lips 50
  • 51. Cont.  They are soft, fluctuant, asymptomatic swelling & may appear bluish depending on the depth  Histopathologically – cyst may be lined by cuboidal, columnar or squamous epithelium surrounding the mucoid secretion in lumen  Treated by local excision for minor salivary gland ducts  For major salivary glands total or partial removal of gland can be done  Sialgogues can stimulate salivation & prevent accumulation of mucus 51
  • 52. 52
  • 53. Ranula  Extravasation cyst usually arises from ducts of sublingual gland  Bluish, dome shaped, fluctuant swelling in floor of mouth  May enlarge raise the tongue  Usually seen lateral to midline  May extend to the neck behind the posterior border of mylohyoid (plunging ranula)  Histopathologically similar to mucocele  Treated by marsupialization or removal of the feeding sublingual gland53
  • 54. 54
  • 55. Pleomorphic adenoma  It can affect both major & minor salivary gland  It commonly affects the parotid gland  Clinical features  More commonly in females  Small painless nodule at the angle of mandible or beneath the ear lobe  Well circumscribed , encapsulated , firm in consistency & may show area of cystic degeneration  Difficulties in mastication & talking  Initially tumor is movable but later becomes55
  • 56. Cont.  If deep lobe is affected , a swelling in the lateral pharyngeal wall or soft palate  Minor salivary gland involvement is common in palate & lip as smooth surfaced dome shaped swelling  Histopathologic features  Well - circumscribed , encapsulated tumor  Tumor is composed of a mixture of glandular epithelium & myoepithlial cells with in a mesenchyme like background may be myxoid or chondromatous or hyalinized56
  • 57. 57
  • 58. Cont.  Treatment - surgical excision 58
  • 59. Warthin tumor  Papillary cystadenoma lymphamatosum  Affects the parotid glands  Males are affected more  Clinical features  Firm or fluctuant, non- tender , circumscrided mass in the region of angle or ramus of the mandible or beneath ear lobe  Common in the tail of the gland  Both side parotid gland affected 59
  • 60. 60
  • 61. Cont.  Histopathologic features  Tumour composed of mixture of ductal epithelium & lymphoid tissue  Treatment  Surgical excision 61
  • 62. Mucoepidermoid carcinoma  The low grade tumour behaves almost like a benign tumour with very good prognosis  High grade tumour behaves very aggressively  It occurs with equal distribution between males& females  Clinical features  More common in parotid gland  It may grow slowly or rapidly  Painless swelling  Ulceration 62
  • 63. Cont.  Facial paralysis  Minor salivary gland tumors are common in palate & may have bluish hue  Local destruction & metastasis to regional lymph nodes & distant metastasis to the lung  Histopathologic features  Mucus producing cells & squamous cells  High grade tumors have cellular atypia  63
  • 64. 64
  • 65. Cont.  Treatment  Surgical excision  For minor salivary glands excision with surrounding normal tissues  For tumors with metastasis radical resection with radiation 65
  • 66. Acinic cell carcinoma  A low grade malignancy  Clinical features  Commonly occurs in parotid gland  Common in females  Usually asymptomatic  Commonly affects serous acini  In minor salivary glands it is common in buccal mucosa, lip & palate  It may be a slow growing swelling  Sometimes pain, tenderness may be there 66
  • 67. 67
  • 68. Cont.  Histopathologic features  Acinar cell has abundant granular basophilic cytoplasm & round, darkly stained eccentric nucleus  Treatment  Tumour confined to the superficial lobe is treated by lobectomy  Tumour involving deep lobe - parotidectomy  Radiotherapy for severe cases 68
  • 69. Adenoid cystic carcinoma  It is also called cylindroma  Clinical features  Slow growing swelling  Commonly occurs in palatal minor salivary glands  Commonly occurs in middle aged individuals  Constant , low grade, dull aching pain  Facial nerve paralysis in parotid tumours  Histopathologic features  Islands of basaloid epithelial cells that contain multiple cylindric , cyst like spaces 69
  • 70. 70
  • 71. Cont.  Perinueral invasion  Treatment  Surgical excision 71
  • 72. Necrotizing sialometaplasia  It is a locally destructive inflammatory lesion affecting minor salivary glands  Cause is ischemia of salivary tissues  Clinical features  Commonly occurs in men  Minor salivary glands of the palate, lip or retromolar pad affected  The lesion occurs as a swelling with paresthesia then it sloughs leaving large ulcer or ulcerated nodule  Edge of lesion presents with an inflammatory72
  • 73. 73
  • 74. Cont.  Histopathologic features  Acinar necrosis  Squamous metaplasia of salivary ducts  Treatment  Debridement by hydrogen peroxide or saline  Application of gentian violet  The lesion is self - limiting one & heals in 6 to 8 weeks 74
  • 75. Sialography  It is a specialized radiographic procedure performed for detection of disorders of major salivary glands  Mercury is used as contrast agent  It involves cannulation & filling with a radiopaque or contrast agent to make them visible on a radiograph  Indications  Detection of calculi or foreign bodies 75
  • 76. Cont.  Determination of the extent of destruction of salivary gland tissue secondary to obstruction such as calculi or foreign bodies  Detection of fistulae , diverticuli & strictures  Detection & diagnosis of recurrent swelling & Inflammatory processes  Demonstration of tumour ; its size location & origin  Selection of the site for biopsy 76
  • 77. Cont.  Contraindications  Pt with allergy or hypersensitivity to contrast media  Acute inflammation of the salivary glands  Pt scheduled for thyroid function test  Technique  Identification of the location of duct orifices  Exploration of the duct with lacrimal probe  Cannulation of the ducts  Introduction of the radiographic dye 77
  • 78. Cont.  Radiographic projections  Lateral oblique projection  Lateral projection  Occlusal projection  Antero- posterior projection  OPG projection 78
  • 79. Surgical management  Superficial parotidectomy  Complete excision of parotid gland  Biopsy orexcision of submandibulargland 79
  • 80. Superficial parotidectomy  Indications  Tumour ; common is pleomorphic adenoma  Massive enlargement secondary to  Sjogren’s syndrome  Calculus in the hilum of gland - calculus is removed without removal of the gland  Chronic infection 80
  • 81. Cont.  Approaches  Preauricular  Submandibular  Combination of the two  Preauricularincision  Incision is taken in the skin  Platysma & superficial fascia dissected  Duct is identified at anterior border of gland 81
  • 82. Cont.  Duct is followed backward through substance of gland until calculus identified & recovered  Fascial sheath encasing the gland is closed completely  Wound is closed in layers  Pressure dressing given 82
  • 83. Complete excision of parotid gland  In this procedure facial nerve preservation is difficult so this should be explained to the pt  Y-shaped incision is planned, starting from the superior attachment of the pinna downward & anteriorly toward angle of the mandible & anteriorly , forward till hyoid bone  The second arm of incision is made posterior to the pinna  Ear lobe is retracted upward & skin flap is developed on the cheek side of the incision 83
  • 84. Cont.  Superficial lobe is freed from its attachments  Stenson’s duct is located , ligated & cut  Deep lobe is approached  Ligation of external carotid artery & posterior facial vein is carried out  Facial nerve is then carefully elevated from the deep portion  Deep portion is gently dissected out of the retromandibular space  Wound is closed in layers 84
  • 85. Excision of submandibular gland  An incision , 4to5 cm in length , is taken in the skin in the submandibular region  Incision is placed in, or parallel to the skin creases , about 2cm below submandibular border  Wound is deepened through platysma & deep fascia  Branches of facial nerve in the field are identified , mobilized & retracted  Facial vein is identified & ligated 85
  • 86. Cont.  Lower pole of the gland is exposed, grasped with tissue holding forceps  Facial artery is ligated & divided  Gland is separated from lower border of mandible  Lingual nerve is dissected  Ligature is passed anterior to ductal pathosis  Second ligature is passed posterior to the first one , but still anterior to the ductal pathosis& duct is sectioned between the ligatures 86
  • 87. Cont.  Deep part of the gland is excised  Wound sutured in layers 87
  • 88. Complications of surgery of salivary glands  Damage to lingual nerve  Damage to Wharton's duct  Damage to Auriculotemporal nerve  Facial nerve paralysis 88

×