Rapid onset,.it is a self ,limiting last approx 6 weeks and heals by secondary intention. No specific treatment is required.but debridement and saline rinses may help he healing process.
Mixed in origin because it contains both epithelial and mesenchymal elements both.most common neoplasm of children as well.stroma consist of chondroid,myoxid,fibroid.so the name given.presence of myoepithelial cells.
Due to its microscopic projection a wide resection is needed to be done to avoid re-occurrence.one of the characterictic of pleomorphic adenoma is that it has microscopic projections.if these projection are not removed , the lesion will re-occur.
Salivary gland diseases
SUPERVISER DR.AMAL ABBAS
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 .
• Two submandibular
• Two Parotid
• Two sublingual
• > 800 minor salivary
• 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
• 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
Sublingual Salivary glands
• Smallest of the major salivary
• Located in the sublingual space
• It drains directly into oral cavity by
several small ducts or into
submandibular duct through the
duration, onset, nature, and rate of growth ,pain, Evaluation of dry
mouth , Radiation history ,Past & present medical history
Intra oral inspection and palpation for examination of ductal
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
*occlusal and oblique lateral for locating stons in submandibular S.G.
*PA and true lateral for stones in parotid gland
by injection RO contrast agent and take radiograph
III-CT scan and MRI
*CBC show increase in leukocyte
*smear for culture and sensitivity test
Classification of salivary gland
*Atrsia –absence of the duct
*Aplasia-absence of the gland
2-Inflammatory and non inflammatory swelling
3-Cyst of salivary glands
4-Salivary gland dysfunction
2-inflammatory and non inflammatory
Inflammation of the Salivary
gland due to viral ,bacterial
infection or allergic reaction .
it may be acute or chronic
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
Headache, myalgia, anorexia, malaise,
Mild fever xerostomia followed by pain below the ear and sudden onset
firm rubbery swelling of the gland
Orchitis, testicular atrophy and sterility 20% of
Meningitis in 10%
Oophoritis in 5%
Pancreatitis in 5%
Hearing loss <5%
- Usually permanent
- 80% unilateral
- salivary gland infection caused by Staph.
Aureus & strept. Viridans
*From the oral cavity By a reduction in salivary
*Following major surgical operations;
-Due to dehydration
-Poor oral hygiene
Other factors are drugs (antihistamine
antidepressant diuretics and tranquilizers )
- Sudden onset
- Gland is painful enlarge at the
angle of the mandible and tender
-Warm and Erythematous overlying
-There is purulent disghare at its
- It raises the lobule of the ear
-Temp: above 37.8’C
-Swab taken from discharge for
culture and sensetivity test
- IV antibiotic
- Increase hydration and
stimulation the saliva
- Improve oral hygiene
If no improve do sugical drainage by
needle aspiration guided by CT or
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
3-surgical removal if no response
Sialolithiasis ( salivary stones)
• It’s the formation of the
salivary stone in the gland
or the its duct resulting in
the obstruction of the
-Pain and swelling during
and after eating
-Stone can palpated at
examination especially if
its present at peripheral
aspect of the duct
• Demonstrate the lumen of the ducts
-Sugical removal of the
-If its removal cause
extreme damage to the
gland may indicat
excision of the gland
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
This condition consist of dry mouth
dry eye and rheumatoid arthritis
Patient complain from xerostomia
,burning sensation ulceration on the
oral and conjectival mucosa
- 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)
- Treat recurrent infection
- Salivary substitutes/sprays
- cholinergic drugs (Pilocarpine)
- Avoid alcohol, tobacco
- Immunosuppressive; corticosteroids or cytotoxic
3-Cyst of salivary glands
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
If it superficially appear
bluish translucent and
Or cover by normal
mucosa and its firm
Treatment by surgical
Special type of mucocele in the floor of the
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
4-salivary gland dysfunction
Its sensation of dry mouth because of decrease of
glandular secretion due to aging, duct obstruction,
medication, radiation therapy, smocking, sjogren
Conservative treatment and maintain oral hygien
Use artifical saliva and sialogogues as pilocarpine
• 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
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.
Treatment: irrigation by hydrogen peroxide or saline ,its self
limited and healing by secondary intention
Bengin Tumors of salivary gland
• Also called benign mixed tumour
• Most common salivary neoplasm ,can involve any major or minor salivary
• Slow- growing, painless, firm non –tender
• Mobile in early stages. with increases in size irregular n nodular upon
• Intermittent growth period.
• The treatment for salivary gland tumor is
• Benign tumors of the parotid gland are
treated with superficial or total
• 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
• Painless until superinfected.
• Sialogram show displacement of glandular tissue
• Treatment by surgical excision
• most common type of malignant salivary gland
• 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.
*radiotherapy should be added
to improve local control.
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
• 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)
Primary treatment -surgical removal with clean margins.
Paliative radiotherapy is commonly given following surgery.