salivary gland disease

1. INFLAMMATORY DISEASE OF
PAROTID GLAND
BY DR. MOHAMMAD AHMED

2. RISK FACTORS ASSOCIATED WITH PAROTID
INFECTION
Reduced salivary flow
Drugs
Opiate
Irradiation
Sjogren’s syndrome
dehydration
Abnormal gland architecture
Sialoths (stones)
Strictures
Sialectasis
Oral microorganism
Mostly staph
SALIVARY GLAND
INFECTION

3. WHY ASK ABOUT
HISTORY?

4. 1. Gender : sjogren syndrome
common in menopausal women
2. Age : paromyxovirous most
common in children about 4 -
10 y
3. Medical profile : Dm ,
arteriosclerosis, hormonal
imbalance and neurological
disorder

5. 4. Drug history : xerostomia is
caused by diuretic and
antihypertensive drug
5. Postprandial swelling : is
associated duct obstruction
6. Radiation history
7. Nutrition history : patient
who dehydrated chronically
from bulimia or anorexia
suffer from porosities

6. OBSTRUCTIVE PAROTITIES
• Obstructive disease is sialolithiasis, mucous plugs, strictures,
and duct ectasia may also cause obstruction and give rise to
chronic sialoadenitis
• 80% of salivary calculi occur in the submandibular gland and
remaining stones occur in the parotid, of which around 60% are
radio-opaque

7. • he classical presentation is an intermittent postprandial salivary
gland swelling that gradually subsides over minutes to hours
• Secondary infection often supervenes with fever, redness, and
purulent discharge from the duct

8. RADIOGRAPHICALLY
Calculi measuring 2 mm or larger
are easily detected as echogenic
foci, which cast distal acoustic
shadows Obstructive calculi are
associated with ductal dilatation.

9. TREATMENT
IT IS RELATED TO THE SIZE OF STONE AND LOCATION
ALONG THE DUCT AND ALSO ITS CHRONICITY
1.Milking of duct
• The author successfully treats stones up to two times the narrowest
diameter of the natural duct

10. 2. Sialodochoplasty
• Those at the orifice or in the distal half of this duct, are removed
transorally via sialodochoplasty

11. • 3. Surgical exposure of parotid stone

12. • The branch of the facial nerve supplying the upper lip runs parallel with
the duct either on its surface or a few millimetres superior to the duct
• A longitudinal incision is made in
the duct wall and the calculus is
carefully teased out of the duct

13. • Cannulation of duct for re
epethilization

14. • 4. Ultrasound-guided basket retrieval of stone

15. 5. Parotidectomy
the stone is in gland parenchymal or in the
proximal part of the duct duct

16. B- INFECTIVE POROSITIES
ACUTE POROSITIES
• parotid gland is enlarged, possibly displacing the earlobe laterally,
and tender to palpation erythema of floor of the mouth
• The act of “milking” of the parotid gland with bimanual pressure to
Stensen’s duct express purulent material if the duct is patent.
• Constitutional symptoms, including fever, chills, and sweats, can
occur if an established infection is present

18. TREATMENT OF AP SALIVARY GLAND
• Remove the risk factor like stone
• antistaphylococcal penicillin (methicillin, oxacillin, or dicloxacillin) or
a first-generation cephalosporin (cephalexin) was considered a
reasonable choice for empiric therapy
• fluid intake
• heat packs
• sialogogues (e.g., sugar-free lemon drops or glycerin swabs
• analgesics as needed for pain

19. • The characteristic fluctuance typical of abscesses is absent due
to the tense fibrous capsule of the gland, which envelops the
abscess
• CT evaluation is warranted to evaluate for this potentially
serious complication
Incisions are made into
the parotid fascia
parallel to the course of
the facial nerve and its
branches.

20. UNCOMMON BACTERIAL INFECTION
TB
• Secondary to pulmonary
infection
ACTINOMYCOSI
S
• A.Israeli most common

21. VIRAL PARAMYXOVIRUS (MUMPS)
• Acute, nonsuppurative communicable infectious disease, primarily
of the parotid gland tissue, that often occurs in epidemics during
spring and winter months.
• The viral incubation period between exposure and the
development of signs and symptoms is 15 to 18 days.
• The disease includes a prodromal period that lasts 24 to 48 hours,
and includes fever, chills, headache, and preauricular tenderness.

22. ACUTE VIRAL PARAMYXOVIRUS ( MUMPS )
• Infection is characterized by rapid, painful, non erythematous
unilateral or bilateral swelling of the parotid glands that may be
sufficiently severe to displace the earlobe
• Serum amylase levels may also be elevated This is in contrast to
acute bacterial parotitis, which does not cause an elevation of
serum amylase levels

23. TREATMENT OF MUMPS
• The disease usually resolves spontaneously within 5 to 10 days;
therefore, symptomatic treatment of pain and fever and the
avoidance of dehydration are essential.
• Attempts to eradicate the disease have resulted in routine
administration of measlesmumps-rubella (MMR) vaccine in
children at 12 months of age

24. IMMUNOLOGICAL SALIVARY GLAND
DISORDERS
SJÖGREN SYNDROME (BENIGN LYMPHOEPITHELIAL LESIONS)
• Primary Sjögren syndrome is an autoimmune disease
affecting the major and minor salivary glands causing
xerostomia (dry mouth) and xerophthalmia (dry eyes)
• Secondary = primary + multisystem connective tissue
disorder, most commonly rheumatoid arthritis
• Ninety percent of the patients affected are female, typically
middle-aged

25. DIAGNOSIS:
• Clinical confirmation of dry eyes and dry mouth and two out of
three positive tests: (1) typical ultrasound findings; (2) detection
of autoantibodies, such as anti-Ro/anti-SS-A and anti-La/anti-
SSB; and (3) biopsy of the labial minor salivary glands
• Snow storm appearence in the sialogram of parotid gland

26. COMPLICATION OF SJOGREN
• The complications of Sjögren syndrome include acute and chronic
sialadenitis (which may be infective), sialolithiasis, dental caries
due to xerostomia, and corneal ulceration due to xerophthalmia
• In addition, the risk of parotid lymphoma is increased 44-fold
and must e excluded by FNA

28. TX OF SJOGREN
• Symptomatic treatment as artificial tears or saliva
• Follow up for parotid lymphoma
• Refer to rhomatology

29. IMMUNOLOGICAL SALIVARY GLAND
DISORDERS
COLLAGEN SIALADENITIS (SLE)
• Collagen sialadenitis occurs most frequently in women in the
fourth and fifth decades of life. The disorder can affect any of the
major salivary glands and usually manifests as a slowly enlarging
gland
• diagnosis is made by identification of the underlying systemic
disorder, and sialochemistry studies may reveal sodium and
chloride ion levels that are elevated twofold to threefold higher
than normal values.

30. IMMUNOLOGICAL SALIVARY GLAND
DISORDERS
SARCOIDOSIS
• Sarcoidosis is a chronic, granulomatous disease
characterized by non-caseating granulomas that may
affect the salivary glands in up to 6% of cases
• Heerfordt syndrome, or uveoparotid fever, occurs in 10%
of cases and consists of a triad of parotid enlargement,
uveitis, and seventh cranial nerve palsy

31. THANK YOU