Salivary gland disorders can be classified as reactive lesions or immune-mediated diseases. Mucocele is a common reactive lesion caused by trauma that results in mucus escaping into surrounding tissues from a severed salivary duct, often appearing as a blue swelling on the lower lip. Sjögren's syndrome is an immune-mediated disease where the exocrine glands are targeted, causing dryness of the mouth and eyes due to decreased saliva and tear production. It is diagnosed based on criteria including ocular and oral symptoms, positive lab tests, and biopsy showing inflammatory infiltrates in salivary glands. Treatment focuses on symptom relief rather than curing the underlying condition.

1. salivary glands disorders

2. Salivary glanddisorders
• These are classified as
– Reactive lesions
• Mucocele
• Muous retention cyst
• Sailolithiasis
• Chronic sclerosing sialadinitis
• Necrotising sailometaplasis
– Immune mediated diseases
• Sjogren syndrome

3. Mucocele
• Tissue swelling composed of pooled mucus that escaped
into the connective tissue from a severed excretory duct.
• This mucous escape phenomenon is called as mucocele
(extravasation)
• Occurs secondary to trauma
• 70% occurs in lower lip (minor salivary glands)
• Mucocele of major salivary glands are rare
• Mucocele formed in the floor of the mouth as a
consequence of severance of duct of sublingual
gland(ranula)
• Submandibular duct severance causes massive
extravasation of mucous into submandibular, submental,
sublingual regions causing plunging ranula

5. • Clinical features:
• Children and young adults
• Male and female are equally affected
• Lower lip is most affected area
• Buccal mucosa>floor of the mouth> ventral tongue>palate
• Mucocele of upper lip are uncommon
• Appears as a fluctuant mass
• Superficial masses show Bluish translucent appearance
• Deep masses – appears as a soft fluctuant submucosal
nodule with normal mucosal color
• After small puncture the swelling heals and re
accumulation of mucin leading to reoccurrence

7. • Histopathology
• Circumscribed cavity within the connective tissue
• Distended epithelium
• Mucin is walled off by a rim of granulation tissue
• Cavity is not lined by epithelium – false cyst
• Mucin appears basophilic
• Numerous amount of inflammatory cells – neutrophils,
foam cell histiocytes (mucinophages)
• The duct which supply secretions to the cavity is called
feeder duct

10. • Treatment :
• Excision with removal of associated minor salivary glands
to minimize the chance of reccurence.
• Avoid injury to other glands during primary wound
closure.

11. ranula
• Term used for mucocele occuring in the floor of the mouth
• The name derived from word RANA, because the swelling
resemble the transulucent underbelly of the frog.
• Presents as a blue dome shaped swelling in the floor of
mouth.
• Larger then mucocele
• Fill the floor of the mouth and elevate the tongue.
• Located lateral to the midline distinguishing from dermoid
cyst (midline).

13. Plunging ranula or cervical ranula
• Occurs when spilled mucin dissects through the mylohyoid
muscle and produces swelling in the neck

14. • Treatment:
• Marsupilization (deroofing)
• Sublingual gland removal via intraoral approach

15. Mucus retention cyst
• Swelling caused by an obstruction of a salivary gland
excretory duct resulting in an epithelial lined cavity
containing mucus

16. • Clinical features
• Major salivary glands – parotid is most commonly
involved
• Minor salivary glands
• Floor of the mouth> buccal mucosa> lower lip
• Clinically mucocele and mucus retention cyst are
indistinguisable.
• Common in adults
• Painless, cystic, fluctuant and superficial

17. • Histopathology:
• Treatment:
• Simple excision
• Recurrence is rare

18. sialolithiasis
• Presence of one or more oval or round calcified structures
(salivary stones) in a duct of a major or minor salivary
gland.
• Caused due to mechanical obstruction of salivary duct
• Exact pathogenesis is unknown
• Thought to form from
– Organic nidus around which deposition of layers of
organic and inorganic substances.

20. • Etiology:
• Hypercalcemia
• Xerostomia
• Tobacco smoking
• Sailolithiasis is most common in submandibular gland due
to
– Anatomy :
• Upward route
• Longer duct
• Curved duct
• Anti gravity flow
– Components of saliva
• More alkaline
• More amount of Ca and Po4
• Mucin

21. • Clinical features:
• Ductal obstruction may occur at meal time – saliva
production is maximum
• Gradually swelling reduces but recurs repeatedly when
flow is stimulated

22. • Treatment:
• Small calculi removed by manipulation or increased
salivation
• Large stones need surgical exposure for removal
• Piezoelectric shock wave lithotropsy

23. Necrotizing sialometaplasia
• Uncommon locally destructive inflammatory condition of
salivary glands.
• Cause: unknown but believe it is a result of ischemia of the
salivary tissue

24. • Predisposing factors:
• Traumatic injuries
• Dental injections
• Ill fitting dentures
• Upper respiratory infections
• Adjacent tumors

25. • Clinical features:
• Frequently develops in palatal salivary glands
• Hard palate > soft palate
• Unilateral or bilateral
• Most common in adult men
• Initially as non ulcerated swelling associated with pain and
paresthesia
• Punched out crater like ulcer

26. • Histopathology:
• Acinar necrosis followed by squamous metaplasia of
salivary duct.
• Treatment:
• The lesion is self limiting in most instances and heals
uneventfully

27. xerostomia
• Refers to subjective sensation of a dry mouth
• Frequently but not always associated with salivary gland
hypo function.
• Causes:
• Salivary gland aplasia
• Water or metabolite loss or impaired fluid intake
– Hemorrhage
– Vomiting or diarrhea

28. • Iatrogenic
– Medications
• Local factors
– Decreased mastication
– Smoking
– Mouth breathing
• Systemic disease
– Sjogren syndrome
– Diabetis mellitus
– Diabetis insipidus
– Sarcoidosis
– Hiv infection
– Graft versus host disease
– Psychogenic disorder

29. Sjogren syndrome
• A chronic autoimmune inflammatory disease which
involves the exocrine glands, significantly decreasing the
quality and quantity of saliva and tears.
• Disease was first identified by a Swedish physician Henrik
Sjogren in 1933
• Two forms
– Primary- occurs alone
– Secondary – primary sjogren syndrome when occurs
with another connective tissue diseases like rheumatoid
arthritis, lupus, scleroderma

30. • Etiology:
• Genetic, hormonal, infectious, and immunologic cause
• Out of which immunologic is main etiology
• Virus like EBV, CMV, paramyxo virus are also implicated
but not proven

31. • Clinical features:
• Age: 40- 60 years
• Women are more commonly effected
• Female:male ratio is 10:1
• Dryness of mouth and eyes due to hypo function of salivary
gland and lacrimal glands
• Painful and burning sensation of mouth
• Primary Sjogren syndrome – 80% show parotid gland
enlargement
• Secondary Sjogren syndrome - lymphadenopathy

32. • Diagnostic criteria for sjogren syndrome
• 1. eye symptoms ( at least 1 of the following)
– Dry eyes for 3 months
– Repeated sensation of foreign bodies in the eyes
– Artificial tears required for at least 3 times a day
• 2.mouth symptoms
– Dry mouth for at least 3 months
– Recurrent salivary gland enlargement
– Frequent drinking while swallowing dry food

33. • 3. positive eye test : schirmer test , positive rose bengal test
• 4. positive salivary gland (lower lip) biopsy
• 5. salivary gland involvement (at least one of the following)
– Positive scintigraphy
– Positive parotid sailography
– Un stimulated salivary flow (1.5ml/15ml/ mins)
• 6. autoantibodies (at least one of the following)
– SS-A antibody
– Antinuclear antibody
– Rheumatoid factor

34. • Definitive diagnosis requires at least 4 criteria
• In absence of other systemic autoimmune disease, the
diagnosis is primary sjogrens syndrome

35. Schimer test : measuring the tear
production
Rose bengal test: Eye drops
containing dyes used by specialist
shows dry spots

36. Severe xerostomia with dry
tongue
Diffuse submandibular
gland enlargement

38. • Radiographic features:
• Sailography has a diagnostic value for sjogren syndrome
• The glands appear as cherry blossom or branchless fruit
leden tree in radiography

39. • Treatment:
• No known treatment for sjogren syndrome
• Treatment focuses on relieving the symptoms and
preventing complications
• Treatments can be grouped into regimens for
keratoconjunctivitis sicca, xerostomia, and systemic
manifestation