This document provides information on diseases of the salivary glands. It discusses the anatomy of the major and minor salivary glands. It then covers specific diseases including mumps, sialolithiasis, Sjogren's syndrome, and various neoplasms of the salivary glands such as pleomorphic adenoma, Warthin's tumor, mucoepidermoid carcinoma, and adenoid cystic carcinoma. For each condition, it discusses etiology, clinical features, investigations, and treatment. The document also includes images illustrating the anatomical structures and various pathologies.
REGIONAL ENTERITIS (Crohn’s Disease)
DEFINITION
It is a granulomatous, non-caseating (transmural) inflammatory condition of the ileum commonly and of the colon often.
It is independent of age, sex, socioeconomic status and geographic areas.
ANORECTAL ABSCESS
AETIOLOGY
Most common causative organism is E. coli
Others are
Staphylococcus
Bacteroides
Streptococcus
B. proteus.
Commonly occurs due to infection of anal gland in perianal region.
TESTICULAR TUMOURS
PREVALANCE
99% of testicular tumours are malignant.
Life time prevalence of getting testicular tumour is 0.2%.
Very common in Scandinavia; least common inAfrica andAsia.
4 times common in whites than blacks.
ULCERATIVE COLITIS
DEFINITION
It is an inflammatory condition of rectum & colon of unknown aetiology perhaps related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor.
commonly starts in the rectum, spreads proximally to the colon & often into the ileum as back wash ileitis (5%).
CARCINOMA RECTUM
It is common in females.
In 3% of cases, it occurs in multiple sites (syn chronous).
Usually originates from a pre-existing adenoma or papilloma (tubular polyp).
Any tumour within 15 cm proximal to the anal margin is called as rectal tumour/cancer.
More than 95% are adenocarcinoma.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Diseases of salivary glands is a very important topic in the final MBBS/ MS ENT exam.
Dr. Krishna Koirala has described the salivary gland diseases in a lucid way in this presentation.
REGIONAL ENTERITIS (Crohn’s Disease)
DEFINITION
It is a granulomatous, non-caseating (transmural) inflammatory condition of the ileum commonly and of the colon often.
It is independent of age, sex, socioeconomic status and geographic areas.
ANORECTAL ABSCESS
AETIOLOGY
Most common causative organism is E. coli
Others are
Staphylococcus
Bacteroides
Streptococcus
B. proteus.
Commonly occurs due to infection of anal gland in perianal region.
TESTICULAR TUMOURS
PREVALANCE
99% of testicular tumours are malignant.
Life time prevalence of getting testicular tumour is 0.2%.
Very common in Scandinavia; least common inAfrica andAsia.
4 times common in whites than blacks.
ULCERATIVE COLITIS
DEFINITION
It is an inflammatory condition of rectum & colon of unknown aetiology perhaps related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor.
commonly starts in the rectum, spreads proximally to the colon & often into the ileum as back wash ileitis (5%).
CARCINOMA RECTUM
It is common in females.
In 3% of cases, it occurs in multiple sites (syn chronous).
Usually originates from a pre-existing adenoma or papilloma (tubular polyp).
Any tumour within 15 cm proximal to the anal margin is called as rectal tumour/cancer.
More than 95% are adenocarcinoma.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Diseases of salivary glands is a very important topic in the final MBBS/ MS ENT exam.
Dr. Krishna Koirala has described the salivary gland diseases in a lucid way in this presentation.
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Acute suppurative otitis media and and cortical mastoidectomykrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
This presentation gives a lucid idea about different neoplasms of nose like inverted papilloma, ca maxilla, ethmoid and so on.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Deviated nasal septum and other septal conditionskrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides were prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Anatomy
• Major salivary glands: Parotid, submandibular,
sublingual
• Minor glands : Distributed throughout the oral cavity
within the mucosa and submucosa
• Basic unit : acinus, secretory duct and collecting
duct
• Acini: serous, mucous or mixed
3. • Acini in the parotid glands are almost exclusively of the serous
type
• Acini in the In the submandibular glands are composed of
both serous and mucus epithelial cells
• Acini in the sublingual glands are predominantly mucus cells
4. Parotid Gland
• Largest salivary gland
• Divided into superficial and
deep lobes by the facial
nerve (Fasciovenous plane
of Patey)
5. • Submandibular gland
− Indented by posterior border of
mylohyoid muscle into
superficial & deep lobes
• Sublingual gland
– Lies at the anterior part of floor
of mouth between the mucous
membrane, mylohyoid muscle
and body of mandible
6. Acute viral parotitis (Mumps)
• Acute nonsuppurative inflammation of the parotid
gland caused by paramyxovirus (Mumps virus)
• Other viruses like Coxsackievirus A&B,
cytomegalovirus also can cause parotitis
• Mumps : Danish word ‘mompen’ meaning mumbling
• Spreads by droplet infection
• Secondary parotitis due to duct obstruction
7.
8. Clinical Features
• Prodrome: fever, headache, myalgia,
anorexia, arthralgia
• Pain - severe, made worse on eating
sour foods, due to tight fascia
• Pouting of the opening of parotid duct,
pus discharge from the duct on parotid
massage if suppuration
• Parotid swelling : 75% within 1-5 days
• Tenderness
• Trismus - swelling, spasm of muscles
9. Investigations
• Blood
– WBC count , ESR, viral titers might rise
– Increased serum amylase due to spillage to blood
circulation, subclinical form of pancreatitis
• USG Neck:
– Enlarged, heterogeneous gland, with ↑ed vascularity
– Parotid stones ? radiolucent
• Sialography
– Diagnostic and Therapeutic
10. Treatment
• Conservative
– Rest, oral hygiene, good nutrition, plenty of liquids
– Analgesics , local heat application to gland
– Adrenalin local application to reduce duct edema
– Antibiotic : Clindamycin
– Vaccination : Jerry Lynn vaccine at 12 months
– infection usually confers permanent immunity? recurrence
• Surgical
– Incision and drainage if patient develops abscess
11. Complications
• Aseptic meningitis: Frequent complication in children
• Pancreatitis
• Nephritis:
• Orchitis/ Oophoritis : common in adults (30-45%), unilateral or
bilateral , usually occurs during second week of infection
• SNHL: U/L> B/L, transient> permanent
• Myocarditis: precordial pain, bradycardia, fatigue, ST
depression rare finding in ECG
• Arthralgia, polyarthritis
12. Sialolith
• Formation of calculi in the ductal system of salivary glands
• Submandibular gland (70 to 90% stones)
– Mixed seromucinous gland with high calcium and
magnesium content, long and tortuous duct with
antigravity drainage, duct opening smaller than lumen
• Parotid (10 to 20% Stones)
– Serous gland, low calcium and magnesium content
• Predisposing factors: Salivary stasis, duct injury/inflammation
14. Clinical Features
• Postprandial salivary colic with pain and swelling
• Swelling on submandibular region due to duct
obstruction
• Duct opening : edematous, pouting
• Stone palpated in submandibular duct or within the
gland on bimanual palpation
25. Sjogren’s Syndrome
• Chronic autoimmune disease of exocrine glands
• Classification
– Primary
• Confined to exocrine gland
• Xerostomia and Xerophthalmia
– Secondary
• Xerostomia and Xerophthalmia
• Autoimmune disease (RA,SLE)
26. Clinical Features
• Multisystem disease
• Dryness of mouth and eyes, difficulty in chewing and
swallowing food due to xerostomia
• Intolerance to acidic and spicy foods
• Dental caries , smooth and fissured tongue
• Candidiasis/ Stomatitis / Parotid enlargement
• Decreased phonation due to dry oral mucosa
27.
28. Investigations
• ESR Raised
• Presence of HLA1 and B8 antigen
• Schirmer’s test
– Wetting <5mm in 5 mins
• Salivary flow rate
– Flow < 0.5ml Xerostomia
29. Treatment
• Steroids : anti inflammatory purpose
• For dry Mouth:
– Saliva substitutes: sprays /rinses
– Saliva stimulants: hard candy, pilocarpine
– Cholinergic agents: cevimeline
– Special toothpaste, oral gels, active dental care
• For dry eyes:
– Lubricant eye drops /ointments, punctal plugs, lateral
tarsorraphy
• For dry nasal mucosa: Saline nasal sprays, lavage, etc.
33. Radiological Tests
• Ultrasonography
– Neoplasms appear solid
– Provide guidance in obtaining FNAC
• CT scan
– Gold standard
– Administration of contrast provides details of
tumor volume, relation to vascular and bony
structures
– Irregular pattern - malignancy
34. • MRI scan
– Excellent soft tissue details
– Does not require contrast for vascular details
• Positron emission tomography (PET)
– Role in staging of salivary malignancy to rule out
distant and regional metastases
– Useful to follow-up patients with known salivary
malignancy after treatment
36. Heterogeneous, low-density mass in the tail of the right
parotid gland with minimal thin peripheral enhancement
consistent with Warthin’s tumor
37. • Fine-Needle Aspiration Cytology
– Mainstay of diagnosis and management
– Safe, simple and inexpensive
• Incisional biopsy
– If tumour is obviously malignant and involves the
skin
38. Pleomorphic Adenoma
• Most common of all salivary gland neoplasms
– 80% of parotid tumors
– 50% of submandibular tumors
– 6% of sublingual tumors
– 45% of minor salivary gland tumors
• 4th-6th decades, F:M = 3-4:1
39. • Slow-growing, painless mass
• Parotid: 90% in superficial lobe, most in tail of
the parotid gland (lower posterior part of gland)
• Capsule is a result of fibrosis of surrounding
salivary parenchyma, compressed by tumor called
as a false capsule
40. • Gross pathology
– Smooth, well-demarcated
– Solid and cystic changes
– Myxoid stroma
• Histology
– Mixture of epithelial,
myopeithelial and stromal
components
– No true capsule
41. Treatment
• Complete surgical excision
–Parotidectomy with facial nerve preservation
–Submandibular gland excision
–Wide local excision of minor salivary gland
• Avoid enucleation and tumor spill
42. Warthin’s Tumor
• Synonym : papillary cystadenoma lymphomatosum
• 6 -10% of parotid neoplasms
• Older, Caucasians, males, obese persons
• 10% bilateral or multicentric
• 3% with associated neoplasms
• Presents as a slow-growing, painless mass, ovoid in shape,
situated in the tail of the parotid
43. • Gross pathology
– Encapsulated
– Smooth/ lobulated surface
– Cystic spaces of variable size, with
viscous CHOCOLATE fluid
• Histology
– Papillary projections into cystic
spaces surrounded by lymphoid
stroma
– Epithelium has double cell layer of
luminal cells and basal cells
44. Mucoepidermoid Carcinoma
• Most common salivary gland malignancy
• 5-9% of salivary neoplasms
• Parotid 45-70% of cases
• Palate 18%
• F>M
• 3rd - 8th decades, peak in 5th decade
45. • Presentation
– Low-grade: slow growing,
painless mass
– High-grade: rapidly enlarging,
+/- pain, metastasize to lymph
nodes, lungs, bones ,brain
• Gross pathology
– Well-circumscribed to partially
encapsulated to unencapsulated
– Solid tumor with cystic spaces