Salivary Gland Neoplasms

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Salivary Gland Neoplasms

  1. 1. SALIVARY GLANDS
  2. 2. Parotid gland Surgical anatomy
  3. 3. <ul><li>Serous gland </li></ul><ul><li>Irregular shape </li></ul><ul><li>Fills the gap </li></ul>
  4. 4. <ul><li>Upper& lower poles </li></ul><ul><li>Lateral, anterior & deep surfaces </li></ul>
  5. 5. <ul><li>Surrounded by parotid sheath </li></ul><ul><li>Derived from cervical fascia </li></ul><ul><li>Very tough capsule </li></ul>
  6. 6. <ul><li>Upper pole concave </li></ul><ul><li>Adheres to ext acoustic meatus </li></ul><ul><li>Lower pole rounded </li></ul>
  7. 7. Ant surface <ul><li>U shaped </li></ul><ul><li>Clasping the ramus of mandible </li></ul><ul><li>Masseter & medial pterygoid </li></ul><ul><li>Stylomandibular ligament </li></ul>
  8. 8. Anterior border <ul><li>Parotid duct </li></ul><ul><li>Branches of facial nerve </li></ul><ul><li>Terminal branches of ECA </li></ul>
  9. 9. Deep surface <ul><li>Mastoid with the muscles </li></ul><ul><li>Styloid with the muscles, two ligaments </li></ul><ul><li>Styloid seperates it from ICA &IJV </li></ul>
  10. 10. Lateral surface <ul><li>Subcutaneous </li></ul><ul><li>flat </li></ul>
  11. 11. <ul><li>Facial nerve </li></ul><ul><li>Retromandibular vein </li></ul><ul><li>ECA </li></ul>
  12. 12. Parotid duct <ul><li>5cm long </li></ul><ul><li>Across masseter </li></ul><ul><li>Pierces buccinator </li></ul>
  13. 13. Nerve supply <ul><li>Otic ganglion- secretomotor fibres </li></ul><ul><li>Inferior salivatory nucleus - 9 th N – tympanic branch – tympanic plexus – lesser petrosal N – otic ganglion </li></ul>
  14. 14. <ul><li>Sympathetics - superior cervical ganglion </li></ul><ul><li>Sensory fibres auriculotemporal N </li></ul><ul><li>Parotid fascia great auricular N </li></ul>
  15. 15. Submandibular gland Surgical anatomy
  16. 16. <ul><li>Mixed gland </li></ul><ul><li>Large superficial part </li></ul><ul><li>Small deep part </li></ul>
  17. 17. Superficial lobe <ul><li>Fills space b/n mandible , mylohyoid &cervical fascia </li></ul><ul><li>Three surfaces </li></ul>
  18. 18. Lateral surface <ul><li>SM fossa of mandible </li></ul><ul><li>Medial pterygoid insertion </li></ul><ul><li>Facial artery </li></ul>
  19. 19. Superficial surface <ul><li>Covered by skin , platysma , deep fascia </li></ul><ul><li>Crossed by facial vein & cervical br of facial N </li></ul><ul><li>SM lymph nodes lie outside & within the gland </li></ul>
  20. 20. Medial surface <ul><li>lies against the mylohyoid and its NV bundle </li></ul><ul><li>Hyoglossus, lingual N , SM ganglion , hypoglossal N </li></ul>
  21. 21. Deep part <ul><li>b/n mylohyoid & hyoglossus </li></ul><ul><li>Lingual N above </li></ul><ul><li>Hypoglossal SM duct below </li></ul>
  22. 22. Submandibular duct <ul><li>5cm long </li></ul><ul><li>Emerges from superficial part </li></ul><ul><li>b/n mylohyoid & hyoglossus </li></ul><ul><li>Then b/n SL gland & geniohyoid </li></ul>
  23. 23. Nerve supply <ul><li>Secretomotor SM ganglion </li></ul><ul><li>Sup salivary N - nervus intermedius - chorda tympani - lingual N </li></ul>
  24. 24. Sublingual gland <ul><li>Almond shaped </li></ul><ul><li>In front of ant border of hyoglossus </li></ul><ul><li>b/n mylohyoid & genioglossus </li></ul><ul><li>Mucous gland </li></ul>
  25. 25. Diseases of salivary glands benign
  26. 26. Sialolithiasis <ul><li>Most commonly occurs in c/c sialadenitis </li></ul><ul><li>80% of stones occur in whartons duct </li></ul>
  27. 27. Reasons <ul><li>More alkaline </li></ul><ul><li>More viscous </li></ul><ul><li>Higher concentration of Ca & PO4 </li></ul><ul><li>Angulation of duct & vertical orientation </li></ul>
  28. 28. Diagnosis <ul><li>History & clinical examination </li></ul><ul><li>X – ray </li></ul><ul><li>sialography </li></ul>
  29. 29. Treatment <ul><li>Mannual pushing of stones to the opening </li></ul><ul><li>Surgical incision over the stone & removal </li></ul>
  30. 30. Parotitis <ul><li>Mumps MC cause of non suppurative parotitis </li></ul><ul><li>Bilateral </li></ul><ul><li>Paramyxo virus </li></ul>
  31. 31. <ul><li>1-2 days prodromal period – fever ,chills , head ache </li></ul><ul><li>Followed by pain & swelling of parotid glands </li></ul><ul><li>Very severe pain aggravated by eating & drinking </li></ul>
  32. 32. <ul><li>Resolve spontaneously in 5 – 10 days </li></ul><ul><li>Life long immunity </li></ul>
  33. 33. Bacterial parotitis <ul><li>Acute – parotid </li></ul><ul><li>Ascending infection </li></ul><ul><li>Dehydration , cachexia , obstruction </li></ul>
  34. 34. Presentation <ul><li>Tender,red, painful parotid swelling </li></ul><ul><li>Malaise, pyrexia </li></ul><ul><li>Lower part more involved </li></ul><ul><li>Staph & strep </li></ul>
  35. 35. Treatment <ul><li>Conservative </li></ul><ul><li>Drainage – in case of abscess </li></ul>
  36. 36. c/c sial adenitis <ul><li>Sub mandibular gland </li></ul><ul><li>Poor recovery </li></ul><ul><li>Intial conservative treatment </li></ul><ul><li>Sial adenectomy </li></ul>
  37. 37. Parotitis <ul><li>HIV – SGD </li></ul><ul><li>Lymphoproliferative & cystic enlargement </li></ul><ul><li>Virus in saliva </li></ul><ul><li>surgery </li></ul>
  38. 38. Granulomatous <ul><li>TB </li></ul><ul><li>Non TB mycobacteria </li></ul><ul><li>Actinomycosis </li></ul><ul><li>Cat scratch disease </li></ul>
  39. 39. Salivary fistula <ul><li>Common in parotid </li></ul><ul><li>Congenital/acquired </li></ul><ul><li>Surgery, trauma , sepsis </li></ul>
  40. 40. <ul><li>Salivary gland fistula – saliva collects S/c </li></ul><ul><li>Aspiration </li></ul><ul><li>Pressure bandage </li></ul>
  41. 41. Salivary duct fistula <ul><li>Intra oral - no treatment </li></ul><ul><li>Cutaneous </li></ul>

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