Your SlideShare is downloading. ×
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

2,031

Published on

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

No Downloads
Views
Total Views
2,031
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
149
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

×