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Salivary gland diseases

salivary gland diseases

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Salivary gland diseases

  1. 1. Salivary gland diseases BY DR.ESRAA BAHJAT SUPERVISER DR.AMAL ABBAS
  2. 2. Salivary gland diseases • Normal health and function of oral structure depend on the normal structure and secretion of saliva by both minor and major salivary gland in a way that if one of them fails to supply the demand the other group may compensate . • one of the most important factor in diagnosis of diseases its composition and flow rate .
  3. 3. Anatomical Considerations • Two submandibular • Two Parotid • Two sublingual • > 800 minor salivary glands
  4. 4. Parotid Gland • largest salivary gland • Facial nerve divides it into 2 surgical zones (the superficial and deep lobes). • Its stensen’s duct turn at right angel to reach oral cavity at the level of the second maxillary molar
  5. 5. Submandibular Gland • The gland forms a ‘C’ around the anterior margin of the Mylohyoid muscle; a superficial and deep lobe • its Wharton’s duct open lateral to the lingual frenulum
  6. 6. Sublingual Salivary glands • Smallest of the major salivary glands. • Located in the sublingual space • It drains directly into oral cavity by several small ducts or into submandibular duct through the bartholin’s duct
  7. 7. Diagnosis 1-history duration, onset, nature, and rate of growth ,pain, Evaluation of dry mouth , Radiation history ,Past & present medical history 2-medical examination Intra oral inspection and palpation for examination of ductal lesion (stone) extra oral examination and palpation : *fluctuant in abcess *Firm ,tense and not movable in infected and obstructed S.G. *firm and movable in benign tumors *indurated and fixed in malignant tumors
  8. 8. 3-Diagnostic imaging I-conventional radiograph *occlusal and oblique lateral for locating stons in submandibular S.G. *PA and true lateral for stones in parotid gland II.sialography by injection RO contrast agent and take radiograph III-CT scan and MRI IV.Laboratory investigation *CBC show increase in leukocyte *smear for culture and sensitivity test *biopsy
  9. 9. Classification of salivary gland diseases 1-Developmental abnormalities *Atrsia –absence of the duct *Aplasia-absence of the gland *Aberrancy-ectopic gland 2-Inflammatory and non inflammatory swelling 3-Cyst of salivary glands 4-Salivary gland dysfunction 5-Necrotizing sialometaplasia 6-Tumors
  10. 10. 2-inflammatory and non inflammatory swelling Sialadenitis Inflammation of the Salivary gland due to viral ,bacterial infection or allergic reaction . it may be acute or chronic
  11. 11. Acute sialadenitis A.viral infection (mumps) Its most common viral infection affecting salivary gland caused by paramyxo virus and usually affecting both side of the parotid gland Clinical presentation Headache, myalgia, anorexia, malaise, Mild fever xerostomia followed by pain below the ear and sudden onset firm rubbery swelling of the gland
  12. 12. Diagnostic Evaluation • Leukocytopenia • Increased serum amylase • Viral serology : antibodies
  13. 13. Treatment *its self limited disease *Fluid *Anti-inflammatory to prevent secondary infection & analgesics
  14. 14. Complications Orchitis, testicular atrophy and sterility 20% of young men Meningitis in 10% Oophoritis in 5% Pancreatitis in 5% Hearing loss <5% - Usually permanent - 80% unilateral
  15. 15. Acute bacterial sialadenitis - salivary gland infection caused by Staph. Aureus & strept. Viridans *From the oral cavity By a reduction in salivary flow *Following major surgical operations; -Due to dehydration -Poor oral hygiene Other factors are drugs (antihistamine antidepressant diuretics and tranquilizers )
  16. 16. Clinical picture: - Sudden onset - Gland is painful enlarge at the angle of the mandible and tender -Warm and Erythematous overlying skin -There is purulent disghare at its duct - It raises the lobule of the ear -Temp: above 37.8’C investigation. -luekocytosis -Swab taken from discharge for culture and sensetivity test
  17. 17. Treatment: - IV antibiotic - Increase hydration and stimulation the saliva - Improve oral hygiene If no improve do sugical drainage by needle aspiration guided by CT or US
  18. 18. Chronic sialadenitis This may follow acute infection of S.G. or may occur after pneumonia ,papillary obstruction due to ill fitting denture or duct stone ,causing inflammation and blockage of S.G. duct. The resultant sialadenitis produce stricture of the duct ,stasis,dilation,stone formation and chronic recurrent infection. Clinicaly S.G. is firm tender and palpable bimanually Treatment 1-antibiotic 2-conservative treatment 3-surgical removal if no response
  19. 19. Sialolithiasis ( salivary stones) • It’s the formation of the salivary stone in the gland or the its duct resulting in the obstruction of the salivary flow Submandibular Most common
  20. 20. Clinical feature -Pain and swelling during and after eating -Xerosomia -Stone can palpated at examination especially if its present at peripheral aspect of the duct
  21. 21. Diagnostics: radiograph Plain occlusal film
  22. 22. Sialography • Demonstrate the lumen of the ducts for stone.
  23. 23. Treatment -Sugical removal of the stone -If its removal cause extreme damage to the gland may indicat excision of the gland
  24. 24. sialadenosis Its non inflammatory non neoplastic swelling of the S.G. The enlargment are painless and bilateral usually ,more common in woman Its occur in the following condition Hormonal disorder ,autoimmune disorder ,DM, HIV, liver cirrhosis, kidney pancreas and malnutrition
  25. 25. Sjogren's Syndrome This condition consist of dry mouth dry eye and rheumatoid arthritis Patient complain from xerostomia ,burning sensation ulceration on the oral and conjectival mucosa
  26. 26. Diagnosis: - Biopsy of salivary gland: lower lip -lab test rheumatoid factor ,ESR, Antinuclear antibody -sialogram demostarat the cavity defect filled with radiopaque contrast media (branchless fruit laden tree) Treatment: - Treat recurrent infection - Salivary substitutes/sprays - cholinergic drugs (Pilocarpine) - Avoid alcohol, tobacco - Immunosuppressive; corticosteroids or cytotoxic
  27. 27. 3-Cyst of salivary glands Mucocele Swelling due to accumulation of saliva as a result to trauma or obstruction to the duct Extravasation cyst caused by trauma bite the lip or cheek result in accumulation of mucin in . Retention cyst :caused by Obstruction by stone, tumor or scar
  28. 28. Clinical appearance Painless swelling If it superficially appear bluish translucent and fluctuant Or cover by normal mucosa and its firm Treatment by surgical excision
  29. 29. Ranula Special type of mucocele in the floor of the mouth. Associated with ducts from the submandibular or sublingul gland. Start as painless swelling Translucent blue colour in apperance . Can cause elevation of the tongue Slow enlarging swelling on the floor of the mouth can cause difficulty in speech or eating.When deep lesion herniates through mylohyoid muscle and extend along the fascial planes it is referred plunging ranula. Investigation by aspiration biopsy Treatment :marsupialization
  30. 30. 4-salivary gland dysfunction Xesrostomia Its sensation of dry mouth because of decrease of glandular secretion due to aging, duct obstruction, medication, radiation therapy, smocking, sjogren syndrom Treatment Conservative treatment and maintain oral hygien Use artifical saliva and sialogogues as pilocarpine
  31. 31. Sialorrhea(ptyalism) • Its excessive salivation it may be mild intermittent or continuous drooling • This condition may be due to irritation from ill fitting denture or heavy metal poisoning, mental retardation, medicaton (cholinergic agonist) • Treatment by physical therapy and anticholinergic (atropin)
  32. 32. 5-Necrotizing sialometaplasia Non neoplastic inflammatory lesion of unknown etiology of minor salivary gland tissue, which both clinically and histologically mimics a salivary gland malignancy. • Truma lead to ischemia, acinar necrosis and Squamous metaplasia of the duct. • The lesion generally presents as an ulcer Seen- Posterior in hard palate. Invistigation :biopsy Treatment: irrigation by hydrogen peroxide or saline ,its self limited and healing by secondary intention
  33. 33. Bengin Tumors of salivary gland Pleomorphic adenoma • Also called benign mixed tumour • Most common salivary neoplasm ,can involve any major or minor salivary gland Clinical feature • Slow- growing, painless, firm non –tender • Mobile in early stages. with increases in size irregular n nodular upon palpation. • Intermittent growth period.
  34. 34. Treatment: • The treatment for salivary gland tumor is surgical resection. • Benign tumors of the parotid gland are treated with superficial or total parotidectomy
  35. 35. Warthin’s tumor • slowly growing benign tumor of the parotid gland. the tumor is Firm, non tender , painless, and usually appears in the tail of the parotid gland near the angle of the mandible. • Painless until superinfected. • Investigation • Biopsy • MRI,CTS • Sialogram show displacement of glandular tissue • Treatment by surgical excision
  36. 36. Malignant tumors Mucoepidermoid carcinoma • most common type of malignant salivary gland tumour. clinical feature • Mostly affected parotid gland • Presents as painless unless infection or invasion of vital structure , slow-growing mass that is firm or hard not movable . some tumors grow rapidly • Metastasis is seen in high grade tumor. • Poor prognosis.
  37. 37. TREATMENT: *surgical excision *radiotherapy should be added to improve local control.
  38. 38. Adenoid cystic carcinoma • Rare type of CANCER that can exist in many different body sites. • It most often occurs in the areas of the head and neck, in particular the salivary glands. • Patients may survive for years with metastases because this tumor is generally well-differentiated and slow growing. • It is the second most common malignant salivary gland tumor overall (after mucoepidermoid carcinoma)
  39. 39. TREATMENT Primary treatment -surgical removal with clean margins. Paliative radiotherapy is commonly given following surgery.

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