InstrumentationNYQUIST_PLOTSInstrumentation

1. Salivary Gland Diseases
Salivary Gland Diseases
PreparedBy: AyatNabilChassab
SupervisedBy:Dr.MohammedAliAbbas

2. Introduction Classification Diagnosis Common Diseases
CONTENT

3. The salivary glands are exocrine glands that make, modify and
secrete saliva into the oral cavity. They are divided into two main
types: the major salivary glands, which include the parotid,
submandibular and sublingual glands, and the minor salivary glands
distributed in oral cavity, pharynx, and larynx. Human salivary glands
produce between 0.5 to 1.5 L of saliva daily, facilitating mastication,
swallowing, and speech, lubricating the oral mucosa, and providing an
aqueous medium for taste perception.
INTRODUCTION

4. .

5. .
Minor salivary glands

6. Salivaryglanddiseases
Neoplastic
Non-Neoplastic
Developmental
1.
Infectious and Inflammatory
2.
Obstructive and Traumatic Lesions
3.
Functional Disorders
4.
Allergic and Immunologic Disorders
5.
Metabolic and Hormonal Disorders
6.
Ageing
7.
Idiopathic
8.
Benign
1.
Malignant
2.

7. History and clinical examination
1.
Saliva collection and sampling
2.
salivary gland radiography
3.
Salivary Gland Biopsy
4.
DIAGNOSTI MODALITIES

8. DIAGNOSTI MODALITIES
1.History and clinical examination:
Is there salivary gland swelling?
Painful?painless
Unilateral? bilateral?
Diffuse? localized?
Is the lump mobile or firm?
What is the size of lump?
Are there any skin changes over the gland?
Is there nerve weakness?

9. DIGNOSTIC MODALITIES
2.Saliva collection and sampling:
Salivary flow rates can be calculated from the individual major
salivary glands or from mixed sample of the oral fluids, termed
“whole saliva”.
Whole saliva: is mixed
fluid content of the
mouth from all major
and minor glands.
The methods of whole saliva collection include the draining,
spitting, suction and absorbent methods.

10. A.Draining Method It is passive and requires the patient to allow saliva to flow
from the mouth into a pre­
weighed test tube or graduated
cylinder for a specific time period.
B-Spitting Method
C-Suction method
D-Absorbent Method
The patient allows saliva to accumulate in the mouth and then
expectorates into a pre­
weighed graduated cylinder, usually every
60 seconds for 2 to 5 minutes.
Uses aspirator or saliva ejector to draw saliva from the
mouth into a test tube for a defined time period.
Uses a preweighed gauze sponge that is placed in the patient’s
mouth for a set amount of time. After collection, the sponge is
weighed again, and the volume of saliva is determined.

12. Unstimulated whole saliva flow rates of less
than 0.1 ml/min and stimulated whole saliva
rates of less than 1.0 ml/min are considered
abnormally low and indicative of marked
salivary hypofunction.

13. Carlson–Crittenden collectors or Lashley cups placed over Stensen’s
duct orifices and held in place with gentle suction. Collection of saliva
from the submandibular/sublingual glands may be accomplished using a
Wolff collector or Schneyer apparatus placed over the opening of
Wharton’s duct or by using an alginate‐held collector called a
segregator
Mechanical stimulation may be
elicited by instructing the patient to
chew a piece of paraffin wax,
silicone, or unflavored gum base at
a controlled rate (usually 60 times
per minute).
.

14. Patient with Carlson–Crittenden collectors in place undergoing collection of parotid gland saliva

15. DIGNOSTIC MODALITIES
3.salivary glands radiography:
A-Conventional radiographs:
Include oblique lateral films of the mandible, intraoral occlusal views,
anteroposterior views , and panoramic radiography. 
The significance of
conventional radiographic examinations is limited in salivary gland diseases.
With regard to stone diagnosis, about 60-80% of stones can be visualized
radiologically.

16. DIGNOSTIC MODALITIES
3.salivary glands radiography:
B-Ultrasonography :
First imaging modality used to assess superficial salivary
gland lesions.
It is a fast, simple, and reliable basic imaging tool for
confirming or excluding a discrete lump in a major salivary
gland, verifying an enlargement inside or outside a salivary
gland, and visualizing salivary stones if present.

17. DIGNOSTIC MODALITIES
3.salivary glands radiography:
C-Sialography:
Sialography remains the only imaging modality for examining
the fine anatomy of the salivary gland ductal system.
It is an invasive procedure in which radiopaque contrast
material is injected into the gland’s ductal system through the
intraoral opening of Wharton’s or Stensen’s duct.
Differentiating between certain cases of sialadenitis,
autoimmune related disease, and sialosis .

18. Contrast agents are the chemical substances which
are introduced in the human body to enhance the
visualization of internal structures that are not seen
in plain radiography.
Types of the contrast media:Positive and negativ.
Positive contrast media includes iodine and barium
while negative contrast media include oxygen,
carbon dioxide and air.

19. DIGNOSTIC MODALITIES
3.salivary glands radiography:
D-Computed Tomography (CT):
CT is the fastest method of imaging head and neck and
provide excellent soft tissue and osseous delineation.
Superior to MRI.
Exposure to ionizing radiation and the administration of
contrast material are the only significant disadvantages to
CT scanning.

20. DIGNOSTIC MODALITIES
3.salivary glands radiography:
E-Magnetic Resonance Imaging (MRI):
MRI is mainly used to visualize lesions arising in the sublingual gland or in the
minor salivary glands and deep lobe of parotid gland.
It is more time-consuming and costly than CT, but is able to depict texture
changes in different weightings very well.
The lack of radiation exposure is advantageous in comparison to CT, but the
low informative value with regard to adjacent bony structures is
disadvantageous.

21. DIGNOSTIC MODALITIES
4.Salivary Gland Biopsy :
salivary gland biopsy involves the removal of cells or small pieces of
tissue from one or more salivary glands in order to be examined in
the laboratory.
Biopsy can be done to:
The most usual indication for a salivary gland or tissue biopsy is
when a tumor that was previously treated surgically has recurred, or
in patients presenting with diffuse unilateral salivary gland
enlargement.
Determine the type of tumer in a salivary gland lump.
1.
Determine if the gland and tumor need to be removed.
2.

22. Salivary gland biopsy

23. Abnormal dryness of the mouth due to insufficient secretions called
also dry mouth.
It has the following consequences(difficulty in chewing and
swallowing,erythematous and atrophic mucosa,lobulation and
depapillation of the tongue,dental caries,oral candidosis and
angular cheilitis).
Etiology:
Management: preventive,symptomatic,salivary stimulation.
XEROSTOMIA
Primary:xerostomia:Iatrogenic,Autoimmune,Inflammatory,Idiopathic.
1.
Secondary xerostomia:Drugs,Disorders leading to fluid/ electrolyte
imbalance,Neurological,Anxiet.
2.

24. SIALOLITHIASIS (SALIVARY CALCULI;
SALIVARY STONES):
Sialoliths are calcium phosphate stones that develop within the ductal
system of salivary glands.
Approximately 80–85% of sialolithiasis occurs in the submandibular gland
and 10–20% in the parotid gland. The incidence of this pathology is rare
in the sublingual gland and minor salivary glands.
Approximately 7% of sialoliths are bilateral.
Around 75–90% of submandibular stones are located in the
extraglandular duct with 10% of stones located in the intraglandular duct.
Parotid stones are located in the extraglandular duct in approximately
83% of cases and in the intraglandular duct in approximately 17% of
cases.

25. The cause of sialoliths is unclear, but their
formation can be promoted by chronic
sialadenitis and partial obstruction.
Small sialoliths of the major glands sometimes
can be treated conservatively by gentle
massage of the gland in an effort to milk the
stone toward the duct orifice,while larger
sialoliths usually need to be removed
surgically.

26. Sialadenitis refers to an infection in the salivary gland.
May be acute or chronic and is usually associated with pain, tenderness,
redness, fever, decreased saliva and localized swelling of the affected
area.
The parotid and submandibular glands are the most commonly affected
salivary glands by sialadenitis.
It is most commonly reported in individuals between the ages of 50 to 60
years.
It develops when harmful bacteria or viruses build up in the salivary
glands or blockage in the salivary duct.
The initial treatment for sialadenitis is to provide medical therapy for the
disorder, while surgical therapy being introduced if the disorder becomes
refractory to medical treatment.
SIALADENITIS:

27. Sialadenosis (sialosis) is a chronic, non inflammatory, nonneoplastic, bilateral,
often painless enlargement of the salivary glands, most frequently affecting the
parotid glands, with no sex predilection and frequently affecting the third to
seventh decade.
The condition frequently is associated with an underlying systemic problem,
which may be endocrine, nutritional, or neurogenic in origin . The best known of
these conditions include diabetes mellitus, general malnutrition, alcoholism, and
bulimia.These conditions are believed to result in dysregulation of the autonomic
innervation of the salivary acini.
The clinical management of sialadenosis is often unsatisfactory because it is
closely related to the control of the underlying cause.If the swelling becomes a
cosmetic concern, then partial parotidectomy can be performed.
SIALADENOSIS (SIALOSIS):

28. Sjögren syndrome is a chronic, systemic autoimmune disorder that
principally involves the salivary and lacrimal glands, resulting in
xerostomia (dry mouth) and xerophthalmia (dry eyes).
Traditionally, two forms of the disease are recognized:
SJÖGREN SYNDROME:
1. Primary Sjögren syndrome (sicca syndrome alone; no other autoimmune
disorder is present).
2. Secondary Sjögren syndrome (the patient manifests sicca syndrome in
addition to another associated autoimmune disease).
Sjögren syndrome is not a rare condition. with a 9 : 1 female-to-male
ratio. It is seen predominantly in middle-aged adults.

29. The principal oral symptom is xerostomia. Affected
patients may complain of difficulty in swallowing, altered
taste, or difficulty in wearing dentures. The tongue often
becomes fissured and exhibits atrophy of the papillae.
The oral mucosa may be red and tender, usually as a
result of secondary candidiasis. Related denture sore
mouth and angular cheilitis are common. The lack of
salivary cleansing action predisposes the patient to dental
decay, especially cervical caries.

30. From one-third to one-half of patients have diffuse, firm enlargement of
the major salivary glands during the course of their disease . This swelling
is usually bilateral, may be nonpainful or slightly tender.
The cause of Sjögren syndrome is unknown.Researchers have suggested
that viruses, such as Epstein-Barr virus (EBV) or human Tcell
lymphotropic virus, may play a pathogenetic role in Sjögren syndrome, but
evidence for this is still speculative.
The treatment of the patient with Sjögren syndrome is mostly supportive.

31. From one-third to one-half of patients have diffuse, firm enlargement of
the major salivary glands during the course of their disease . This swelling
is usually bilateral, may be nonpainful or slightly tender.
The cause of Sjögren syndrome is unknown.Researchers have suggested
that viruses, such as Epstein-Barr virus (EBV) or human T-cell
lymphotropic virus, may play a pathogenetic role in Sjögren syndrome, but
evidence for this is still speculative.
The treatment of the patient with Sjögren syndrome is mostly supportive.

32. It is a debilitating problem defined as the involuntary flow of
saliva beyond the lip margin .
Affecting both children and adults.
Sialorrhea is known to be difficult to treat. Management can
be conservative or more invasive. Conservative treatments
include changes in diet or habits, oral-motor exercises, intra-
oral devices such as palatal training devices, and medical
treatments such as medication or botulinum toxin injections.
More invasive treatments include surgery or radiation.
SIALORRHEA (DROOLING, PTYALISM OR
EXCESSIVE SALIVATION):

33. CAUSES OF
SIALORRHEA:

34. The mucocele is a common lesion of the oral mucosa that results
from rupture of a salivary gland duct and spillage of mucin into the
surrounding soft tissues.
Typically appear as dome-shaped mucosal swellings that can
range from 1 or 2 mm to several centimeters in size.
They are most common in children and young adults.
The lower lip is the most common site for the mucocele and
usually are found lateral to the midline.
Some mucoceles are short-lived lesions that rupture and heal by
themselves. Many lesions, however, are chronic in nature, and
local surgical excision is necessary.
MUCOCELE (MUCUS EXTRAVASATION
PHENOMENON):

35. Ranula is a term used for mucoceles that occur in
the floor of the mouth, arising from the sublingual
gland.
The ranula usually appears as a blue, dome-
shaped, fluctuant swelling in the floor of the mouth ,
but deeper lesions may be normal in color.
Treatment of the ranula consists of removal of the
feeding sublingual gland.
RANULA:

36. Salivary gland tumors are abnormal cells growing in the salivary gland or in the
tubes (ducts) that drain the glands.
Salivary gland tumors can be noncancerous (benign) or cancerous (malignant).
It’s also possible for benign tumors to become malignant over time if left
untreated.
Salivary gland neoplasms make up 6% of all head and neck
Most commonly appear in the sixth decade of life.
Rare in children.
Benign neoplasms occur more frequently in women than in men, but malignant
tumors are distributed equally between the sexes.
80% arise in the parotid glands, 10-15% arise in the submandibular glands, and
the remainder arise in the sublingual and minor salivary glands.
Pleomorphic adenomas are the most common type of salivary gland tumor.
TUMERS OF SALIVARY GLANDS:

37. The exact etiology of salivary gland cancer is unknown, but various
mechanisms have been proposed, including radiation, viruses (EBV and
HIV), immunosuppression, ultraviolet light exposure, occupational
exposures in rubber or nickel industries.
Symptoms may include:
treatment :surgical or chemotherapy.
Firm, usually painless swelling in one of the salivary glands. Slow swelling
usually indicates a benign tumor, while rapid swelling is more likely to
indicate a malignant tumor or infection.
1.
Difficulty moving one side of the face, known as facial nerve palsy. This
can signal a malignant and advanced tumor, primarily in the parotid gland.
2.

39. REFRENCES