This document discusses diseases of the salivary glands, including both non-neoplastic and neoplastic disorders. It describes the anatomy and locations of the parotid, submandibular, and sublingual salivary glands. For non-neoplastic disorders, it covers mumps (viral parotitis), acute suppurative parotitis, chronic recurrent sialadenitis, sialectasis, granulomatous diseases, salivary calculi, and Sjogren's syndrome. It also discusses benign and malignant neoplasms that can occur in the salivary glands, such as pleomorphic adenoma, adenolymphoma, mucoepidermoid

1. DISEASES OF SALIVARY
GLAND
NUR AINA BINTI AB KADIR

2. INTRODUCTION
 Anatomy of salivary gland
 Non-neoplastic
 Neoplastic

3. PAROTID GLAND
 the
sternocleidomastoid
muscle behind;
 the ramus of
mandible in front;
 superiorly, the base of
the trench is formed
by the external
acoustic meatus and
the posterior aspect
of the zygomatic arch.

4. SUBMANDIBULAR GLAND
 elongate
submandibular
glands are smaller
than the parotid
glands, but larger
than the sublingual
glands.
 Each is hook
shaped

5. SUBLINGUAL GLAND
 Smallest
 Each is almond
shape
 Lateral to the
submandibular duct
and associated
lingual nerve in the
floor of the oral
cavity

6. INNERVATIONS

7. NON-NEOPLASTIC
DISORDERS
Mumps (viral
parotitis)
Acute
suppurative
parotitis
Chronic
recurrent
sialadenitis
Sialectasis
Granulomatous
disease
Salivary calculi
Sjogren’s
syndrome

8.  Paramyxovirus
 Droplets infection,
fomities
 Children
 IP: 2-3 weeks(7-23
days)
 Excreted through:
salivary, nasal and
urinary
 Orchitis
 Ophritis
 Pancreatitis
 Aseptic meningitis
 Unilateral
sensorineural
hearing loss
 Thyroiditis,
myocarditis,
nephritis, arthritis

9. MUMPS (VIRAL PAROTITIS)
CLINICAL FEATURES
 Fever(103’F)
 Malaise
 Anorexia
 muscular pain
 Unilateral parotid
swelling
 Other gland also
 Subside- 1 week

10.  Serum, urinary amylase-
1 week
 Serology
 IgG,IgM: ASAP, after
10-14 days of illness
 IgG : past exposure,
rise more than 4x
recent
infection(presence of
IgM)
 IgM : day 5(100%)
• Proper hydration
• Rest
• Analgesics
• Cold/hot
compresses
• Avoid food:
encourages
salivary flow
TREATME
NT
DIAGNOS
IS

11. PREVENTI
ON
Maternal
immunity- 1 year
MMR vaccine: 15
months
Older children,
adolescents,
adults:
monoclonal
mumps/MMR
vaccine

12.  INTRODUCTIONS
 Elderly, debilitated,
dehydrated patient
 Predisposing factor:
dry mouth
 Staphy. Aureus
 Route: from
mouth Stensen’s
duct(SD)
 CLINICAL
FEATURES
 Sudden onset
 Severe pain
 Enlargement of
gland
 Movements of jaw-
pain
 Opening of the SD
swollen,red,
discharging pus

13.  WBC: leucocytosis+
increase in
polymorphs
 Blood culture
 Pus collection
 Appropriate
antibiotics
 Adequate hydration
 Measures to
promote salivary
flow
 Oral hygiene
 Surgical drainage

14.  parotid gland
recurrent bacterial
infection
 Acute: enlarged,
tender, pus
 Between acute
episodes: firm,
slightly enlarged
 Culture: staph/strep
 Sialography: normal
duct system
 TREATMENT:
 Similar to ABS
 Between attacks:
keep good oral
hygiene, avoid drugs
which dry oral
mucosa
 sialogogues:
promote salivation

15.  Dilatation of the
ductal system
stasis of
secretions
infection
 Clinically: ~ CRS
sialography
 Different degrees:
 Punctuate, globular,
cavitary
 May be
 Congenital
 Granulomatous
disease
 Autoimmune
disease (Sjogren’s
syndrome)

16. Tuberculosis
• Parenchyma/LN, non tender mass
• Overlying skin undergoes necrosisfistula
• Surgical excision, ATT
Sarcoidosis
• Uveoparotid fever
• Fever, enlargement of the parotid&lacrimal gland,
chorioretinitis, cranial nerve palsies
Actino-
mycosis
• Uncommon, acute abscess with sinus formation
discharging sulfur-like granule/indolent swelling
• Surgical drainage, large doses of penicillin/tetracycline

17.  Forms in the ducts
of SM/ parotid
 Deposition of
calcium phosphate
on the organic
matrix of mucin or
cellular debris
 Ducts/parenchyma
 TREATMENT
 Peripheral: removes
intaorally
 Hilum/parenchyma:
excision of the gland
 Intermittent swelling
 Pain
 Stone:visible/
palpated
 80%(radio-opaque):
X-rays
 Radiolucent:
sialography

18.  Xerostomia
 Xeropthalmia
 Involvement:
salivary(P), lacrimal
glands
 Both sexes -equal
 Aka
 Benign
lymphoepithelial
lesion of parotid
 Keratoconjuctivitis
sicca (lacrimal gland)
 Xerostomia(salivary,
minor mucous gland
of oral cavity)
 Autoimmune CT
disorder
 Bilateral swelling
 90%: female
SJOGREN’S SYNDROME
(SICCA SYNDROME)

19. History, physical
examination
Schirmer’s test
Biopsy of lower lip
SS-A and SS-B
antibodies :
DIAGNOSIS
Raised ESR
Positive rheumatoid
factor & antinuclear
antibodies

20.  Epithelial or mesenchymal tissues
 Higher in larger size of
glandsbenign
 80% in parotid, 50-60% in
submandibular and 25% in minor
salivary glands
 Malignant features : rapid growth,
restricted mobility, fixity of overlying
skin, pain and facial nerve
NEOPLASM OF SALIVARY
GLAND

21. BENIGN TUMOURS

22. PLEOMORPHIC ADENOMA
 Most common
 P,SM, other minor
SG
 P: tail
 Slow-growing
tumour, quite large
initially
 3rd/4th decade of life
 Female
 “mixed tumor”
 Stroma: mucoid,
fibroid,vascular,
myxochondroid/
chondroid
 TREATMENT
 Surgical excision+
normal gland tissue
 Parotid: superficial
parotidectomy

23. ADENOLYMPHOMA (PAPILLARY
CYSTADENOMA LYMPHOMATOSUM,
WARTHIN TUMOUR)
 5th-7th decade
 Male:female (5:1)
 Tail of parotid
 Bilateral- 10%
 Multiple
 Rounded,
encapsulated tumor,
at times cystic,
mucoid/brownish
fluid
 Histologically:
epithelial, lymphoid
 TREATMENT:
 Superficial
parotidectomy

24. ONCOCYTOMA(OXYPHIL
ADENOMA)
 Acidophilic cells
(oncocytes)
 <1% of all SG
tumour
 Elderly
 Not grow>5cm
 Superficial lobe of P
 Benign: cystic
 Malignant also seen
 Increased uptake of
technetium-99
 TREATMENT
 Superficial
parotidectomy

25. HEMANGIOMAS
 Most common
benign tumor in
children
 Females
 Discovered at birth
 Grows rapidly in the
neonatal period,
involute
spontaneously
 50%: coexist with
cutaneous
hemangiomas
 Soft,painless
increase in size with
crying/straining
 Overlying skin:
bluish discoloration
 Not regress
spontaneously
surgical excision

26. LYMPHANGIOMAS
 Less common
 May involve P & SM
 Soft, cystic
 Not regress
spontaneously
surgical excision
 Rare: lipoma,
neurofibroma

27. MALIGNANT TUMOUR

28. MUCOEPIDERMOID
 Slow growing but
can invade facial
nerve
 Histologically: area
of mucin-producing
cells, squamous
cells
 Behaviour:
 Minor SG: akin to
adenoid cystic
carcinoma
 Major SG:
pleomorphic
adenoma

29. ADENOID CYSTIC CARCINOMA
(CYLINDROMA)
 Slow growing
 Infiltrates widely into
the tissue planes and
muscles
 Also: perineural
spaces,
lypmphatics pain
and VII nerve
paralysis
 Metastases: lymh
nodes
 Distant: lung, brain,
bone
 Local recurrences
 TREATMENT:
 Radical parotidectomy
+largest cuff of grossly
normal tissue around
the boundaries
 Radical neck not done
unless nodal
metastases
 Postoperative
radiation: margin of
resected specimen
are not free of tumour

30. ACINIC CELL CARCINOMA
 Low grade tumor
 Similar to a benign
mixed tumour
 Small, firm,
movable,
encapsulated tumor,
sometimes bilateral
 Metastases: RARE
 Conservative
approach of
superficial/total
parotidectomy is
adopted

31. ADENOCARCINOMA
 Minor SG
 Highly aggressive
locally
 Distant metastases

32. MALIGNANT MIXED TUMOUR
 Carcinoma
developing in pre-
existing benign
mixed tumor
 A “de-novo” tumour
 Shorter history
 Rapid growth, pain
developing in benign
tumour malignant
 TREATMENT
 Radical
parotidectomy
 Facial nerve
sacrificed grafted
immediately

33. SQUAMOUS CELL
CARCINOMA
 Rapidly growing
tumour
 Infiltratespain,
ulcerates through skin
 Metastasize to neck
nodes
 Radical
parotidectomy + cuff
of muscle,a portion of
mandible, temporal
bone, involved skin
 + radical neck: nodal
metastases
 Followed by
postoperative
radiation to primary
site& the neck

34. UNDIFFERENTIATED
CARCINOMA
 Rare
 Aggressive
 Tendency to spread
rapidly
 Pain
 Fixed to skin,
ulcerates
 Facial paralysis
 Cervical node
metastases
 TREATMENT
 Wide excision
 Radical neck
 Post-operative
radiation

35.  Rare
 Systemic disease
 May occasionally be
a primary tumour
 TREATMENT:
 Same with other
lymphomas
 Rarely other
sarcomas
 Rhabdomyosarcoma
may arise from the
parotid

36. FREY’S
SYNDROME(GUSTATORY
SWEATING
 Complication of
parotid surgery
several months after
surgery
 Sweating, flushing of
the preauricular skin
during mastication-
social embarrassment
 d/t: aberrant
innervation of sweat
glands by
parasympathetic
secretomotor fibres-
destined for the P
 TREATMENT:
 Reassurance
 Tympanic neurectomy
which intercepts
these PS fibres at the
level of middle ear
 Place sheet of fascia
lata between the skin
& the underlying fat,
to prevent
secretomotor fibers
reaching the sweat
gland
 SC infiltration of
botulinum toxin

37.  DISEASES OF EAR, NOSE, AND THROAT
& HEAD AND NECK SURGERY BY PL
DHINGRA, 6TH EDITION, PAGE 231-236
 GRAY’S ANATOMY FOR STUDENTS, BY
RICHARD L DRAKE, 3YH EDITION
REFERENCES