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salivary gland diseases

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salivary gland diseases

  1. 1. Salivary Gland Diseases Dr shabeel pn
  2. 2. Salivary Gland Diseases <ul><li>Functional disorders </li></ul><ul><li>Obstructive disorders </li></ul><ul><li>Non-neoplastic disorders </li></ul><ul><li>Neoplastic disorders </li></ul>
  3. 3. Functional Disorders <ul><li>Sialorrhea (Increase in saliva flow) </li></ul><ul><ul><li>Psychosis, mental retardation, certain nuerologicval diseases, rabies, </li></ul></ul><ul><ul><li>mercery poisoning </li></ul></ul><ul><li>Xerostomia (Decrease in saliva flow) </li></ul><ul><ul><li>Mumps, sardoidosis, Sjogrens, syndrome, lupus, post-irradiation </li></ul></ul>
  4. 4. Funtional Disorders <ul><li>Mucocele </li></ul><ul><ul><li>Secondary to trauma </li></ul></ul><ul><ul><li>70% occur in lower lip </li></ul></ul><ul><ul><li>Excisional biopsy usually curative </li></ul></ul><ul><li>Ranula </li></ul><ul><ul><li>Sublingual salivary gland mucocele </li></ul></ul><ul><ul><li>Treatment should include removal of sublingual gland </li></ul></ul>
  5. 5. Obstructive Disorders <ul><li>Sialolithiasis </li></ul><ul><ul><li>92% occur in submandibular gland </li></ul></ul><ul><ul><li>6% in parotid gland </li></ul></ul><ul><ul><li>Multiple occurrence in same gland is common </li></ul></ul>
  6. 6. Submandibular Gland Lithiasis <ul><li>Diagnosis </li></ul><ul><ul><li>Pain and sudden enlargement of gland while eating </li></ul></ul><ul><ul><li>Palpation of stone submandibular duct </li></ul></ul><ul><ul><li>Occlusal radiograph (80%) </li></ul></ul>
  7. 7. Submandibular Gland Lithiasis <ul><li>Treatment </li></ul><ul><ul><li>Can be removed transorally if in duct and easily palpable </li></ul></ul><ul><ul><li>If in gland and gland is damaged, then gland should be removed </li></ul></ul>
  8. 8. Parotid Lithiasis <ul><li>Diagnosis </li></ul><ul><ul><li>Based on history </li></ul></ul><ul><ul><li>Swelling during meals </li></ul></ul><ul><ul><li>Bimanual palpation of painful gland </li></ul></ul><ul><ul><li>40% non-radiopaque </li></ul></ul><ul><ul><li>Most parotid stones are multiple </li></ul></ul>
  9. 9. Partiod Lithiasis <ul><li>Treatment </li></ul><ul><ul><li>Stones in extraglandular portion of duct can be removed transorally </li></ul></ul><ul><ul><li>Intraglandular stones removed from extraoral approach </li></ul></ul>
  10. 10. Non-Neoplastic Disorders
  11. 11. Acute Sialadentis <ul><li>Etiology </li></ul><ul><ul><li>Viral - ( Mumps) </li></ul></ul><ul><ul><li>Bacterial </li></ul></ul>
  12. 12. Acute Sialadentis <ul><li>Bacterial - swelling and dehydration, xerostomia, failure of secretion with ascending infection </li></ul><ul><ul><li>(Staph aureus, Strep pyogenes, most common infective organism) </li></ul></ul><ul><li>Painful swelling parotid gland, overlying skin red, shiny & tense, pus from parotid duct </li></ul>
  13. 13. Acute Sialadentis <ul><li>Treatment </li></ul><ul><ul><li>Culture pus </li></ul></ul><ul><ul><li>Appropriate antibiotic </li></ul></ul><ul><ul><li>Supportive therapy </li></ul></ul><ul><ul><ul><li>Fluids </li></ul></ul></ul><ul><ul><ul><li>Heat </li></ul></ul></ul><ul><ul><ul><li>Salivary stimulants </li></ul></ul></ul>
  14. 14. Chronic Sialadenitis <ul><li>Chronic recurrent parotitis </li></ul><ul><ul><li>Age 3-6 </li></ul></ul><ul><ul><li>Caused by Strep viridans </li></ul></ul><ul><ul><li>May spontaneously heal during puberty </li></ul></ul>
  15. 15. Necrotizing Sialometaplasis <ul><li>Benign inflammatory condition </li></ul><ul><li>Usually involves in minor salivary gland of hard palate </li></ul><ul><li>Will often simulate a malignant condition </li></ul><ul><li>No definite etiology </li></ul><ul><li>1-3 cm ulcer heals spontaneously </li></ul>
  16. 16. Neoplastic Disorders
  17. 17. Salivary Gland Tumors <ul><li>Adenomas (Epithelial) </li></ul><ul><ul><li>Pleomorphic adenoma </li></ul></ul><ul><ul><li>Monomorphic adenoma </li></ul></ul><ul><ul><li>Adenolymphoma </li></ul></ul><ul><ul><li>Oxyphil adenoma </li></ul></ul><ul><ul><li>Other types </li></ul></ul>
  18. 18. Salivary Gland Tumors <ul><li>Mucoepidermoid tumor </li></ul><ul><li>Acinic cell tumor </li></ul>
  19. 19. Salivary Gland Tumors <ul><li>Carcinomas </li></ul><ul><ul><li>Adenoid cystic carcinoma </li></ul></ul><ul><ul><li>Adenocarcinoma </li></ul></ul><ul><ul><li>Epidermoid carcinoma </li></ul></ul><ul><ul><li>Undifferentiated carcinoma </li></ul></ul><ul><ul><li>Carcinoma in pleomorphic adenoma </li></ul></ul>
  20. 20. Non-epithelial <ul><li>Malignant lymphoma </li></ul><ul><li>Unclassified tumors </li></ul>
  21. 21. Salivary Gland Tumors <ul><li>Allied conditions </li></ul><ul><ul><li>Benign lymphoepithelial lesions </li></ul></ul><ul><ul><li>Sialosis </li></ul></ul><ul><ul><li>Oncocytosis </li></ul></ul>
  22. 22. Salivary Gland Tumors <ul><li>80 % occur in parotid gland </li></ul><ul><li>5-10 % occur in the submandubular gland </li></ul><ul><li>1 % occur in sublingual gland </li></ul><ul><li>10-15% occur in the minor salivary glands </li></ul>
  23. 23. Incidence of Malignancy According to Site <ul><li>Sublingual 70% </li></ul><ul><li>Submandibular 40% </li></ul><ul><li>Parotid 20 % </li></ul>
  24. 24. Clinical Classification <ul><li>Benign (seldom recurrent) </li></ul><ul><ul><li>Adenolymphoma (Wharthins Tumor) </li></ul></ul><ul><ul><li>Oxyphil adenoma (Oncocytoma) </li></ul></ul><ul><ul><li>Other types of Monomorphic adenoma </li></ul></ul>
  25. 25. Clinical Classification <ul><li>Benign (often recurrent) </li></ul><ul><ul><li>Pleomorphic adenoma (mixed tumor) </li></ul></ul><ul><ul><li>Mucoepidermoid tumor ( low-grade) </li></ul></ul><ul><ul><li>Acinic cell tumor (same) </li></ul></ul>
  26. 26. Clinical Classification <ul><li>Malignant </li></ul><ul><ul><li>Carcinoma in pleomorphic adenoma </li></ul></ul><ul><ul><li>Adenoid cyctic carcinoma </li></ul></ul><ul><ul><li>Adinic cell tumor </li></ul></ul><ul><ul><li>Mucoepidermoid tumor (high-grade) </li></ul></ul>
  27. 27. Clinical Classification <ul><li>Malignant </li></ul><ul><ul><li>Squamous carcinoma </li></ul></ul><ul><ul><li>Adenocarcinoma, other types </li></ul></ul><ul><ul><li>Undifferentiated carcinoma </li></ul></ul>
  28. 28. Sinus Disease
  29. 29. Sinusitis <ul><li>Acute </li></ul><ul><li>Chronic </li></ul>
  30. 30. Acute Sinusitis <ul><li>Deep-seated ache which rapidly increases in intensity over evolved sinus </li></ul><ul><li>May cause pain in upper molar teeth </li></ul><ul><li>Pain is generally accompanied by increase in temperature </li></ul><ul><li>Radiographic evidence of “air fluid level” </li></ul>
  31. 31. Acute Sinusits <ul><li>Treatment (early in course) </li></ul><ul><ul><li>Humidification </li></ul></ul><ul><ul><li>Antibotics </li></ul></ul><ul><ul><li>Systemic decongestants and nasal spray </li></ul></ul><ul><li>Refractory cases </li></ul><ul><ul><li>Surgical intervention </li></ul></ul>
  32. 32. Chronic Sinusitis <ul><li>Recurrent bouts of sinus infection </li></ul><ul><li>Low-grade in nature </li></ul><ul><ul><li>Multiple causes </li></ul></ul><ul><ul><ul><li>Viral, bacterial, fungal, allergic, anatomic </li></ul></ul></ul><ul><ul><li>Radiographis findings of thickening of mucosa, polys </li></ul></ul>
  33. 33. Chronic Sinusitis <ul><li>Treatment </li></ul><ul><ul><li>During acute phase- same as acute sinusitis </li></ul></ul><ul><ul><li>If physical obstruction of ostic, septoplasty or Caldwell-Luc with nasal antrostomy </li></ul></ul>
  34. 34. Chronic Sinusitis <ul><li>If allergy related: </li></ul><ul><ul><li>Avoidance of precipitating allergens </li></ul></ul><ul><ul><li>Short course of topical </li></ul></ul><ul><ul><li>Decongestants </li></ul></ul><ul><ul><li>Allergy testing and desensitization therapy </li></ul></ul>
  35. 35. Complications of Sinusitis <ul><li>Orbital cellulitis </li></ul><ul><ul><li>Can result in blindness secondary to ischemia of the retina or retinal detachment </li></ul></ul><ul><li>Cavernous sinus thrombosis </li></ul><ul><ul><li>Can result in blindness </li></ul></ul><ul><ul><li>Deficits of the central nervous system and death </li></ul></ul>

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