1) Parotitis is inflammation of the parotid salivary glands, usually caused by viral infection in children or dehydration in elderly/ill patients. Symptoms include swollen glands, ear pain, difficulty swallowing. Treatment focuses on hydration, antibiotics, and sometimes surgery. 2) Sialadenitis is inflammation of any salivary gland that can be caused by dehydration, radiation, stress or infection. Symptoms are pain, swelling and discharge. Treatment is antibiotics, massage, hydration and sometimes surgery. 3) Salivary stones form from calcium deposits and cause pain from duct obstruction. Diagnosis is by ultrasound/x-rays. Treatment involves extracting stones

1. Disorders of
salivary glands

2. Parotitis
•Parotitis is the inflammation of the parotid
glands. It is the most common inflammatory
condition of the salivary glands, although
inflammation can occur in the other salivary
glands as well.

3. Causes
• Viral infection, most commonly affecting children
• Elderly, acutely ill, or debilitated people with
decreased salivary flow from general dehydration or
medications are at high risk for parotitis.
• The infecting organisms travel from the mouth
through the salivary duct. The organism is usually
Staphylococcus aureus (except in mumps).

4. Clinical manifestations
•The onset of this complication is sudden, with an
exacerbation of both fever and the symptoms of
the primary condition. The gland swells and
becomes tense and tender.
•Pain in the ear
•Swollen glands interfere with swallowing
•Skin soon becomes red and shiny

5. Management
• Maintaining adequate nutritional and fluid intake
• Good oral hygiene
• Discontinuing medications (e.g., tranquilizers, diuretics) that can
diminish salivation.
• Antibiotic therapy is necessary, and analgesics may be prescribed to
control pain. If antibiotic therapy is not effective, the gland may need
to be drained by a surgical procedure known as parotidectomy. This
procedure may be necessary to treat chronic parotitis. The patient is
advised to have any necessary dental work performed prior to
surgery.

6. Sialadenitis
• Sialadenitis is the inflammation of the salivary glands.
• Causes:
• Dehydration
• Radiation therapy
• Stress
• Malnutrition
• Salivary gland calculi (stones)

7. Causes
•Improper oral hygiene.
•Infection by S. aureus, Streptococcus
viridans, or pneumococci.
•In hospitalized or institutionalized patients,
the infecting organism may be methicillin-
resistant S. aureus (MRSA).

8. Symptoms
• Pain
• Swelling
• Purulent discharge
• Antibiotics are used to treat infections. Massage, hydration, warm
compresses, and corticosteroids frequently cure the problem. Chronic
sialadenitis with uncontrolled pain is treated by surgical drainage of
the gland or excision of the gland and its duct.

9. Management
• Antibiotics are used to treat infections.
• Massage
• Hydration
• Warm compresses
• Corticosteroids frequently cure the problem.
• Chronic sialadenitis with uncontrolled pain is treated
by surgical drainage of the gland or excision of the
gland and its duct.

10. Sialolithiasis, or salivary
calculi
• Sialolithiasis, or salivary calculi (stones), usually occurs in the
submandibular gland. Salivary gland ultrasonography or
sialography (x-ray studies filmed after the injection of a
radiopaque substance into the duct) may be required to
demonstrate obstruction of the duct by stenosis.
• Salivary calculi are formed mainly from calcium phosphate. If
located within the gland, the calculi are irregular and vary in
diameter from 3 to 30 mm. Calculi in the duct are small and
oval.

11. Clinical manifestations
•Calculi within the salivary gland itself cause no
symptoms unless infection arises; however, a
calculus that obstructs the gland’s duct causes
sudden, local, and often colicky pain, which is
abruptly relieved by a gush of saliva. This
characteristic symptom is often disclosed in the
patient’s health history.

12. Diagnostic evaluation
• On physical assessment, the gland is swollen and quite
tender, the stone itself can be palpable, and its
shadow may be seen on x-ray films.

13. Management
• The calculus can be extracted fairly easily from the duct in
the mouth. Sometimes, enlargement of the ductal orifice
permits the stone to pass spontaneously.
• Occasionally lithotripsy, a procedure that uses shock waves
to disintegrate the stone, may be used instead of surgical
extraction for parotid stones and smaller submandibular
stones. Lithotripsy requires no anesthesia, sedation, or
analgesia. Side effects can include local hemorrhage and
swelling.
• Surgery may be necessary to remove the gland if symptoms
and calculi recur repeatedly.

14. Neoplasms
• Neoplasms (tumors or growths) of almost any type may
develop in the salivary gland. Tumors occur more often in
the parotid gland.
• The incidence of salivary gland tumors is similar in men and
women.
• Risk factors include prior exposure to radiation to the head
and neck.
• Diagnosis is based on the health history and physical
examination and the results of fine-needle aspiration biopsy.

15. Management
• Management of salivary gland tumors may involve partial
excision of the gland, along with the tumor and a wide
margin of surrounding tissue. Dissection is carefully
performed to preserve the seventh cranial nerve (facial
nerve), although it may not be possible to do so if the tumor
is extensive.
• If the tumor is malignant, radiation therapy may follow
surgery. Radiation therapy alone may be a treatment choice
for tumors that are thought to be localized or if there is risk
of facial nerve damage from surgical intervention.

16. Management
• Chemotherapy is usually used for palliative purposes.
Local recurrences are common, and the recurrence
rate can be as high as 25%.
• Recurrent tumors usually are more aggressive than
initial tumors.
• Tumors of the salivary gland lead to an increased
incidence of second primary cancers, which may be
due to inadequate excision of the original tumor.

17. Cancer of the oral cavity
•Cancers of the oral cavity and pharynx, which
can occur in any part of the mouth or throat, are
curable if discovered early.

18. Risk factors
•Cigarette, cigar, and pipe smoking
•Use of smokeless tobacco; and excessive use of
alcohol.
•Oral cancers are often associated with the
combined use of alcohol and tobacco; these
substances have a synergistic carcinogenic effect.
Patient education directed toward avoiding high-
risk behaviors is critical to prevent oral cancers.

19. Risk factors
•The incidence of cancers of the oral cavity and
pharynx is greatest in men older than 50 years of
age.
•In general, it is almost twice as high in men as it
is in women.
•Cancers of the oral cavity and pharynx occur
more often in African Americans than in
Caucasians.

20. Clinical Manifestations
• Many oral cancers produce few or no symptoms in the early
stages.
• Later, the most frequent symptom is a painless sore or mass
that does not heal. It may bleed easily and it may present as
a red or white patch that persists.
• A typical lesion in oral cancer is a painless indurated
(hardened) ulcer with raised edges.
• As the cancer progresses, the patient may complain of
tenderness; difficulty in chewing, swallowing, or speaking;
coughing of blood-tinged sputum; or enlarged cervical lymph
nodes.

21. Assessment and Diagnostic
Findings
• Diagnostic evaluation consists of an oral examination as well as an
assessment of the cervical lymph nodes to detect possible
metastases.
• Biopsies are performed on suspicious lesions (those that have not
healed in 2 weeks).
• In people who use snuff or smoke cigars or pipes, high-risk areas
include the buccal mucosa and gingiva.
• In those who smoke cigarettes and drink alcohol, high-risk areas
include the floor of the mouth, the ventrolateral tongue, and the soft
palate complex (soft palate, anterior and posterior tonsillar area,
uvula, and the area behind the molar and tongue junction).

22. Medical Management
•Management varies with the nature of the
lesion, the preference of the physician, and
patient choice.
•Surgical resection and radiation therapy are
standard treatment. Addition of chemotherapy
may be useful for advanced disease.
•In cancer of the lip, small lesions are usually
excised liberally.

23. Medical Management
• Radiation therapy may be more appropriate for larger lesions
involving more than one third of the lip because of superior
cosmetic results. The choice depends on the extent of the
lesion and what is necessary to cure the patient while
preserving the best appearance. Tumors larger than 4 cm
often recur
• Cancer of the oral cavity has metastasized through the
extensive lymphatic channel in the neck region, requiring a
neck dissection and reconstructive surgery of oral cavity.