Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
8 salivary glands
1. Salivary Glands
Prof. Faisal Ghani Siddiqui
MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
Professor of Surgery
Liaquat University Of Medical & Health Sciences Jamshoro,
and
Head of Clinical Faculty
Alfarabi College Of Medicine Riyadh
2. Preamble
• Anatomy of the salivary glands
• Sialolithiasis
• Mumps
• Acute bacterial parotitis
14. 80% of salivary stones occur in
submandibular gland because;
•Secretions are thick, mucus
•Duct opens at a higher level than the
gland (antigravity drainage)
•Duct kinked by lingual nerve
15. Sialolithiasis -Clinical Features
• Painful swelling in submandibular region appearing during
meals
• Disappears 1-2 hours after meals
• Submandibular gland palpable, tender and firm
• Stone palpable (occasionally)
16.
17.
18. Sialolithiasis -Treatment
• Incising the duct and removing the stone
• Excision of submandibular gland (if stone in the proximal
part of the duct
22. Mumps
-caused by the mumps virus, which
belongs to a family of viruses
known as paramyxoviruses
23.
24. Mumps –Clinical
Features
• Predominantly affects children
• Spreads via airborne droplets of
infected saliva
• Prodromal period: fever, nausea
and headache
• Followed by painful swelling(s)
• Symptoms resolve within 5-10
days
Salivary glands are divided into two groups as major and minor glands.
There are three pairs of major salivary glands
• Parotid • Submandibular • Sublingual
Hundreds of minor salivary glands lie in submucosa of upper aero-digestive tract like lips, cheek, floor of mouth, oropharynx, trachea, larynx and palate. The function of salivary glands is to keep the oral cavity moist and lubricated. The salivary volume secreted by the glands is 1500 ml/day.
Histologically, salivary glands are:
Serous: Parotid glands
Mucus: Sublingual and minor glands
Mixed: Submandibular glands
Parotid Gland
Parotid gland is located in the retromandibular fossa in an area anterior and inferior to external auditory canal. The duct of the gland (Stensen’s duct) opens in the mucosa of cheek opposite to upper second molar tooth.
Relationship with Facial Nerve
Facial nerve emerges through stylomastoid foramen. The anatomical landmark for its location is the point where tip of mastoid, cartilaginous auditory canal and posterior belly of digastric muscle meet. The nerve enters the substance of parotid gland and divides into two main branches—upper temporofacial and lower cervicofacial divisions. The upper division further divides into zygomatic, temporal and buccal branches while the lower division divides into mandibular and cervical branches (Box 15.1A).
As the facial nerve passes through the parotid gland, it divides the gland into superficial (80%) and deep (20%) parts.
Submandibular Gland
The gland is located in the digastric triangle.
The gland has superficial and deep parts.
The superficial part is located in submandibular space within digastric triangle overlying mylohyoid and hyoglossus muscles.
The deep part is deep to mylohyoid muscle.
The two parts join round the posterior free edge of mylohyoid muscle
The duct of submandibular gland, called the Wharton’s duct runs from the deep lobe of the gland and opens on floor of the mouth lateral to frenulum of the tongue.
Sublingual Gland
It is located just beneath mucosa of floor of mouth.
It drains by several small ducts directly into oral cavity or into submandibular duct.
Sialolithiasis
Stone in the salivary gland or its duct
80% of salivary stones occur in submandibular gland because:
Secretion is thick, mucus in nature.
Antigravity drainage of secretion since duct opens at a higher level than the gland.
The Wharton’s duct is kinked by lingual nerve
Patient presents with painful swelling in submandibular region appearing during meals and disappearing 1-2 hours after meals.
On examination, submandibular gland is tender, firm and palpable bimanually.
Sometimes stone may be palpable in the gland or in the duct (in floor of mouth).
The opening of the duct at sublingual papilla may exude pus.
Diagnosis
Since 80% stones are radiopaque, an oblique lateral or posterior oblique occlusal X- ray may show stone in the submandibular region.
Treatment
Stone lying in the duct can be removed by incising the duct over stone in floor of mouth. After stone removal, the opening in the duct should be left unsutured for free drainage of saliva.
If stone is palpable in proximal duct (lateral to second molar region) it should not be removed through intraoral route since there is risk of damage to lingual nerve that hooks the duct in this region. In such cases or in cases having stone in the gland, treatment is submandibular gland excision.
Mumps is caused by the mumps virus, which belongs to a family of viruses known as paramyxoviruses.
Mumps predominantly affects children.
It is spread via airborne droplets of infected saliva.
The disease starts with a prodromal period of 1–2 days, during which the patient experiences fever, nausea and headache.
This is followed by pain and swelling in one or both parotid glands. Parotid pain can be very severe and exacerbated by eating and drinking.
Symptoms resolve within 5–10 days.
The diagnosis is based on history and clinical examination; a recent contact with an infected patient with a painful parotid swelling is often sufficient to lead to a diagnosis.
Treatment of mumps:
Symptomatic with regular paracetamol and adequate oral fluid intake.
Complications of mumps:
orchitis, oophoritis, pancreatitis, sensorineural deafness and meningoencephalitis
Acute ascending bacterial salinities is common in dehydrated elderly patients following major surgery. Reduced salivary flow secondary to dehydration results in ascending infection via the parotid duct into the parotid parenchyma.
The infecting organ- ism is usually Staphylococcus aureus or Streptococcus viridans
The patient presents with;
A tender, painful parotid swelling. The pain is exacerbated by eating or drinking
Malaise, pyrexia and occasional cervical lymphadenopathy.
The parotid swelling may be diffuse, but often localizes to the lower pole of the gland.
Intraoral examination may reveal pus exuding from the parotid gland papilla.
Intraoral examination may reveal pus exuding from the parotid gland papilla.
Treatment
appropriate intravenous antibiotics
If the gland becomes fluctuant, ultrasound may identify abscess formation within the gland that may require aspiration with a large- bore needle or formal drainage under general anesthesia. In the latter procedure, the skin incision should be made low to avoid damage to the lower branch of the facial nerve.
