These slides cover the major non-granulomatous inflammations of Salivary gland.

1. INFLAMMATORY DISORDERS OF
SALIVARY GLAND
Anurag E K

2. Salivary Glands
Parotid glands: Pair of glands with serous secretion that account for 20-25% of total
secretion. Drains through Stenson’s duct at the buccal mucosa.
Submandibular glands: Major contributor to the normal secretion of saliva- 70%. Drains by
Wharton’s duct.
Sublingual and minor salivary glands: Present beneath the sublingual folds and drain
through multiple ducts.
Functions:
• Helps keep oral mucosa lubricated.
• During mastication, helps form bolus of food.
• Enzymes, mainly amylase, for carbohydrate digestion.
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3. DISORDERS OF SALIVARY GLAND
 Congenital
 Inflammatory
 Obstructive
 Traumatic
 Neoplasms
 Degenerative Conditions

4. Mumps
Etiology: Acute viral parotitis – Paramyxovirus
• m/c/c of acute non-suppurative sialadenitis
• Mostly affects children(<15 yrs.)
• Transmission through airborne droplets from salivary and nasal
secretions.
• Enters through URT and localizes in glandular tissue.
• IP: 2-3 weeks
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5. Mumps
Clinical features:
• Viral prodrome – low grade fever, headache, myalgia, anorexia,
arthralgia and malaise.
• Localized pain, exacerbated by chewing.
• Gland swelling is tense and firm (b/l parotid swelling in 75% cases).
• Otalgia, Trismus and Dysphagia
Complications: Orchitis, Aseptic meningitis, Pancreatitis, Nephritis and
SNHL.
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6. Mumps
Investigations:
• Serology: Complement fixing soluble Ab against viral core.
• Leukopenia
• Elevated serum salivary amylase.
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7. Mumps
Treatment:
• Supportive measures – Bed rest, oral hygiene, Hydration, Dietary
modifications to minimize secretions.
• Paracetamol or Ibuprofen for fever and pain.
Prevention:
• SC vaccine ( live attenuated Jerry-Lynn strain) given as MMR at 12-15
months and 2nd dose at 4-6 years.
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8. Acute Suppurative Sialadenitis
-m/c involved: parotid gland
Risk Factors:
• Age ( 50-60 yrs.)
• Debilitating conditions- Malignant lesions and pre-existing infections.
• Post-operative period
• Local factors- stenosis and sialolithiasis
• Systemic diseases- DM, hypothyroidism, Renal failure, Sjogren's syndrome
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9. Acute Suppurative Sialadenitis
Etiology:
• Community acquired
• S. pyogenes
• S. pneumoniae and
• H. influenzae
• Penicillin-resistant S. aureus in hospitalized patients.
• Anaerobic
• Peptostreptococcus
• Bacteroides sp.
• Fusobacterium
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10. Acute Suppurative Sialadenitis
Clinical Features:
• Rapid onset of pain and swelling, fever, chills and malaise.
• Dehydration with dry mucosa.
• Suppurative discharge on bimanual palpation.
D/D:
• Lymphoma, Bezold’s abscess, Cervical adenitis, Dental abscesses.
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12. Acute Suppurative Sialadenitis
Investigations:
• Leucocytosis with neutrophilia
• Cultures – purulent discharge, percutaneous needle aspiration.
• CT or USG indicated to look for abscess, if patient does not respond to
medical treatment.
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13. Acute Suppurative Sialadenitis
Treatment:
• Oral hygiene
• Fluid & Electrolyte replacement
• Reversal of salivary stasis
• Sialagogues such as lemon drops, orange juice
• Analgesics and local heat application
• Antimicrobial therapy
o Augmented penicillin
o 1st gen Cephalosporin
o Vancomycin
o Metronidazole
• Surgical drainage of loculated abscess.
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14. Parotid Abscess
- Advanced cases of suppurative parotitis.
Complications:
• Suppuration of potential spaces of face, neck and mediastinum.
• Rupture through the floor of EAC or spontaneous drainage through the
cheek.
• Rarely, Osteomyelitis, Thrombophlebitis of Jugular vein, Septicaemia,
Respiratory obstruction and death.
- Treated by Incision and Drainage.
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16. Neonatal Suppurative Parotitis
- Common in preterm and male neonates.
- m/c S. aureus, others – E. coli, Pseudomonas, GBS
- Fever, Anorexia, Irritability and Failure to gain weight.
- b/l swelling, which is tender, firm or fluctuant.
- I&D if no improvement with parenteral antibiotics.
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17. Recurrent Parotitis of Childhood
- Periodic episodes of u/l acute or subacute inflammation.
- second m/c infl. Salivary gland disease of childhood.
- characterized by swelling, pain, fever and malaise.
Proposed etiologies:
• Congenital ectasia of portions of secondary ductal systems predisposed
to S. aureus and S. viridians colonization.
• Autosomal inheritance
• IgG3 and IgA deficiencies
• Juvenile onset primary Sjogren’s syndrome
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18. Recurrent Parotitis of Childhood
Treatment:
• Adequate hydration
• Gland massage
• Local heat application
• Sialagogues
• Appropriate antibiotics for penicillin-resistant staphylococcus
- Most cases resolve spontaneously in late adolescence.
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19. Chronic Sialadenitis
- Salivary stasis predisposes to episodes of infection and inflammation.
Inciting factors:
• Sialolithiasis
• Stricture of duct
• External compression by tumors.
• Stenosis secondary to scar.
• Congenital dilatation
• Foreign bodies
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20. Chronic sialadenitis
Clinical Features:
• Recurrent swelling and tenderness of the affected gland a/w eating.
• Minimal saliva can be milked from the salivary orifice.
• Usually the condition is preceded by an attack of acute suppurative
sialadenitis.
Treatment:
- Surgical removal of gland when conservative management fail.
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21. Chronic sialadenitis
Complications:
• Benign lymphoepithelial lesions
• Kutner's tumour – middle aged adults present with painless mass at the
submandibular gland.
• Ductal carcinoma
• Mikulicz’s disease – BLL a/w Sjogren’s syndrome.
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22. Sjogren's syndrome
- Chronic autoimmune disorder of exocrine glands.
- Salivary and Lacrimal glands are primarily affected.
- Lymphocytic infiltration results in glandular hypofunction.
- 4th–5th decade of life, >90% are women.
Types:
• Primary – confined to exocrine glands
• Secondary – characteristic signs and symptoms of primary disorder a/w
features of other autoimmune diseases, usually Rheumatoid arthritis.
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23. Sjogren’s syndrome
Clinical features:
• Oral findings
o Xerostomia causes difficulty in chewing, swallowing and phonation,
multiple dental caries
o Intolerance to acidic and spicy foods
o Tongue is typically smooth with fissures and atrophy of filiform
papillae.
o Oral thrush
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24. • Eye findings
o m/c foreign body sensation
o Keratoconjunctivitis sicca
• Systemic findings
o Fever, malaise
o Myalgia and arthralgia
o Vasculitis
o Peripheral sensory and motor polyneuropathies.
Sjogren’s syndrome
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25. Lab Investigations:
• ESR
• +ve Rheumatoid factor and ANA
• Sialography – sialectasis in 90% patients
• ELISA to detect anti-SSA/Ro & anti-La/SSB antibodies
• Biopsy – lymphocytic infiltrate
Sjogren’s syndrome
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26. Treatment:
• Saliva substitutes
• Systemic sialagogues – Pilocarpine 5mg TD or QD
• Systemic corticosteroids
• Eradicating fungal overgrowth
• Eye lubricants and patching if corneal ulcers have developed.
Sjogren’s syndrome
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