Salivary glands

Dr Suraj Nair
Senior Lecturer
Dept. Of Pedodontics
Malabar dental college

 Introduction
 Classification Of Salivary Glands
 Anatomy of salivary glands
 Development of salivary glands
 Structure of terminal secretory units
 The Ductal system
 Clinical considerations
 Conclusion
 References

Salivary Gland is any cell or organ discharging a
secretion into the oral cavity.
Group of compound exocrine glands secreting saliva

Based on size
Major salivary glands
Parotid gland
Sublingual
gland
Minor salivary glands
Serous glands of Von Ebner
Palatine glands
Submandibular
gland
Labial and Buccal glands
Lingual glands
Glossopalatine glands

Based on type of secretory cells and histochemical
nature of the secretory product
1.Serous glands
2. Mucous glands
3.Mixed glands

 Largest salivary gland
 Average weight:15g
 Purely serous gland
 Situation:below the external acoustic
meatus between the ramus of the mandible and
sternocleidomastoid.
 Anteriorly overlap Masseter
 Accessory parotid

 Derived from investing layer of deep cervical fascia
 Superficial lamina-thick, closely adherent-sends fibrous
septa into the gland.
 Deep lamina-thin- attached to styloid process,mandible
and tympanic plate.
 Stylomandibular ligament.

 inverted 3 sided pyramid
 Four surfaces
Superior(Base of the
Pyramid)
Superficial
Anteromedial
Posteromedial
 Three borders
Anterior
Posterior
Medial

 Overlaps posterior belly of
digastric and adjoining part of
carotid triangle
 Cervical branch of the facial
nerve
 Two divisions of
retromandibular vein

 Concave
 Related to
Cartilaginous part of external
acoustic meatus
Post. Aspect of
temperomandibular joint
Auriculotemporal Nerve
Superficial Temporal vessels

 Covered by
Skin
Superficial fascia containing facial branches of great
auricular Nerve
Superficial parotid lymph nodes and posterior fibers of
platysma and risorius
Parotid fascia
few deep parotid lymph nodes

 Grooved by posterior border of
ramus of
mandible
 Related to
Masseter
Lateral Surface of
temperomandibular joint
Medial pterygoid muscles
Emerging branches of Facial
Nerve

 Related to
mastoid process with sternocleidomastoid
and posterior
belly of digastric.
Styloid process with structures attached to it.
External Carotid Artery which enters the
gland through
the surface
Internal Carotid A. which
lies deep to styloid process

 Separates superficial surface
from anteromedial surface.
 Structures which emerge at this
border
Parotid Duct
Terminal Branches of facial
nerve
Transverse facial vessels

 Separates superficial surface from posteromedial surface
 Overlaps sternocleidomastoid
Medial Border
 Separates anteromedial surface from posteromedial surface
 Related to lateral wall of pharynx

 ductus parotideus; Stensen’s
duct
 5 cm in length
 Emerges from the middle of
anterior border of the gland
 Thick walled
 Runs forwards and slightly
downwards on masseter

Relations Pierces
 Superiorly
Accessory parotid gland
Upper buccal branch of
facial nerve
Transverse facial vessels
 Inferiorly
Lower buccal branch of
facial nerve
 Buccal pad of fat
 Buccopharyngeal fascia
 Buccinator Muscle
Opens to

Blood supply Lymphatic drainage
 Arterial
Branches of External
Carotid Artery
 Venous
Into External Jugular Vein
 Upper Deep cervical
nodes
 via Parotid nodes

 Parasymapthetic
Secretomotor via auriculotemporal Nerve
 Symapathetic
Vasomotor
Delivered from plexus around the middle meningeal
artery
 Sensory
Reach through the auriculotemporal nerve
parotid fascia-great auricular nerve

Purely serous
Fat cells may be seen
Produces saliva that is watery and rich in
enzymes (amylase and lysozyme) and
antibodies
Has short striated ducts and long
intercalated ducts

 Appear early in 6th week of IU life
 First major salivary gland to form
 The epithelial buds of this gland are located in
the inner parts of cheek
 These buds grow towards otic placode
 Branch to form solid cords and round terminal
ends near developing facial nerve

Parotid abscess may be caused by spread
of infection from the opening of parotid
duct in the oral cavity.
FREY SYNDROME(auriculotemporal
syndrome )
Parotid calculi
Viral infection --mumps

Situated in the anterior part of digastric
triangle.
The gland is about the size of a walnut
It is roughly J-shaped.

 Mixed gland
 Large superficial and small deeper part
continous with each other around the post. Border of
mylohyoid
 Superficial Part
 Situated in the digastric triangle
 Wedged between body of mandible and mylohyoid
 3 surfaces
Inferior,Medial,Lateral

 Derived from deep cervical fascia
 Superficial Layer is attached to base of mandible
 Deep layer attached to mylohyoid line of mandible

 Inferior surface
Skin
Supeficial fascia containing platysma and cervical
branches of facial Nerve
Deep Fascia
Facial Vein
Submandibular Nodes

 Lateral surface
Related to submandibluar fossa on the mandible
Madibular attachment of Medial pterygoid
Facial Artery

 Lies deep to mylohyoid and superficial to
hyoglossus
 Posteriorly continuous with superficial part around the
posterior border of mylohyoid
 Anteriorly extend up to
sublinual gland

 Whartons duct
 5 cm long
 Emerges at the anterior end of deep part of the gland
 Runs forwards on hyoglossus between lingual and
hypoglossal Nerve
 At the ant. Border of hyoglossus it is crossed by lingual nerve
 Opens in the floor of mouth at the side
of frenulum of tongue

 Arteries
Branches of facial and lingual arteries
 Veins
Drains to the common facial or lingual
veins
 Lymphatics
Deep Cervical Nodes via submandibular nodes

 Branches from submandibular ganglion,
through which it receives
Parasymapthetic fibers from chorda tympani
Sensory fibers from lingual branch of mandibular nerve
Sympathetic fibers from
plexus on facial Artery

 smallest of the three glands
 weighs nearly 3-4 gm
 Mixed gland, predominantly
 mucous
 Lies beneath the oral
mucosa in contact with
the sublingual fossa on
lingual aspect of mandible.

 Above
Mucosa of oral floor, raised
as sublingual fold
 Below
Myelohyoid
 Behind
Deep part of
Submandibular gland

 Lateral
Mandible above the anterior part of
mylohyoid line
 Medial
Genioglossus and separated from it by lingual nerve and
submandibular duct

 8-20 ducts
 Most of them open
directly into the
floor of mouth
 Few of them join the
submandibular duct

 Blood supply
Arterial from sublingual and submental arteries
Venous drainage corresponds to the arteries
 Nerve Supply
Similar to that of submandibular glands( via lingual nerve
,chorda tympani and sympathetic fibers)

 No. between 600 and 1000.
 Exist as aggregates of secretory tissue
present in submucosa throughout most of the oral cavity.
 Not seen in gingiva & anterior part of hard plate.

 Labial and Buccal glands
 Palatine glands
 Glossopalatine glands
 Lingual glands
 Von Ebner’s glands

 They are 1 to 2 mm in diameter.
 A minor salivary gland may have a common
excretory duct with another gland, or may
have its own excretory duct.
 Their secretion is mainly mucous in nature
 Problems with dentures are sometimes
associated with minor salivary glands if there
is dry mouth present .
 The minor salivary glands are innervated by
the seventh cranial or facial nerve.

Von Ebner's glands are glands found in a
trough circling the circumvallate
papillae on the dorsal surface of the
tongue near the terminal sulcus.
They secrete a purely serous fluid that
begins lipid hydrolysis.
 They also facilitate the perception
of taste through secretion of digestive
enzymes and proteins.

Oral epithelial
buds invading the
underlying mesenchyme
ECTODERMAL ENDODERMAL
PAROTID GLAND
AND
MINOR SALIVORY
GLANDS
SUBMANDIBULA
R AND
SUBLINGUAL
GLAND

 Bud formation
 Formation and growth of epithelial chord
 Initiation of branching in terminal parts of
epithelial chord.
 Branching of epithelial chord and lobule formation
 Canalization
 Cytodifferentiation

 composed of serous, mucous and myoepithelial cells
arranged into secretory tubules called-acini
 Saliva formed in acini flows down DUCTS to empty into
the oral cavity.

 8-12 cells .
 Cells are pyramidal in shape, with its broad base resting
on a thin basal lamina and its narrow apex bordering on
the lumen of end piece.
 The spherical nucleus is located in the basal region of
the cell

 secrete a watery fluid, essentially devoid of mucous
 contain zymogen granules containing a
precursor of ptyalin enzyme for digesting starches

 Polyhedral & Contain mucinogen granules.
 Differ from serous secretion
(1) they have little or on enzymatic activity and serve for
lubrication and protection of the oral tissues
(2) the ratio of carbohydrate to protein is
greater, and larger amounts of sialic acid and sulphated
sugar residues are present.

 Present in relation to alveoli and
intercalated ducts
 Those on the alveoli are branched-’Basket Cells’
 Those on the ducts are fusiform
 Contractile cells helps to squeeze out secretions from
alveoli

Secretions pass through a system of
ducts
Smallest-Intercalated ducts lined by
low cuboidal cells cells
Intercalated ducts open into striated
ducts lined by tall columnar cells
Striated ducts open into excretory ducts
lined by pseudostratified columnar
epithelium-stratified cuboidal-stratified
squamous epithelium

 The alteration of salivary gland function during disease
state have profound influences on oral tissue
 Loss of salivary function or reduction involume of saliva
secreted-Xerostomia(sjogren,s syndrome,effect of
chemo/radiation therapy,as a result of various
medications)

 Developmental Disturbances
 Aplasia/Agenesis
 Hyperplasia of minor salivary gland
 xerostomia
 Inflammatory conditions
 Mucocele
 Ranula
 Sialolithiasis
 Sialidinitis
 Necrotizing sialometaplasia

 Non inflammatory conditions
 Sialadenosis
 Orofacial granulomatosis
 Sarcoidosis
 Viral induced salivary gland pathology
 Mumps
 HIV

 Benign tumors
 Pleomorphic adenoma
 Canalicular adenoma
 Basal cell adenoma
 Oncocytoma
 Warthins tumor
 Malignant tumors
 Mucoepidermoid carcinoma
 Acinic cell adenocarcinoma
 Malignant mixed tumor
 Metastasizing mixed tumor
 Adenoid cystic carcinoma

 Agenesis
 First described by Gruber in 1985
 Etiology : local disturbances in the early fetal life.
 Clinical features : xerostomia and its sequelae
 Patient may report with increased caries, burning
sensation, oral infections and taste abarration.
 Management : relieve xerostomia by the use of salivary
substitutes.

 Giansanti et al 1971, reported unusual localized
hyperplasia of minor accessory salivary glands in the
palate.
 Etiology : hormonal and metabolic disorders.
 Clinical features : usually asymptomatic
 Present as small localized swelling.
 Management : primary mode of treatment is an
excisional biopsy.

 Inflamation of the salivary gland.
 Affects mainly major salivary glands.

Causes :
1 . Retrograde contamination of salivary
ducts and parenchymal tissues by bacteria
inhabiting the oral cavity.
2 . Stasis of salivary flow through the ducts
and parenchyma promotes acute
suppurative infection.

More common in parotid gland
The etiologic factors most associated with
this entity is the retrograde infection from
the mouth.
20% cases are bilateral

Systemic dehydration
Chronic diseases and
immunocompromised patients
Liver failure
Renal failure
DM
Hypothyroidism
Elderly, debilitated bedridden patients

Neoplasms
Salivary duct dilatation increases the risk
for retrograde contamination.
Extremes of age
Poor oral hygeine
calculi

Rapid onset of the preauricular swelling
Erythema
Pain
Palpation of the involved gland will reveal
purulent discharge from the orifice of duct

Purulent saliva should be sent for culture.
Staphylococcus aureus is most common
Streptococcus pneumoniae ans pyogenes
Haemophilus influenzae is also common

Symptomatic and supportive care
IV fluid hydration
Warm compreses, maximize oral hydration
Give sialogogues(lemon drops)
External salivary gland massage if
tolerated

Antibiotic treatment
70% of organism produces B-lactamases
or penicillinase
Need B-lactamase inhibitor like augmentin
or second generation cephalosporin

Mucus is the exclusive secretory product
of the accessory minor salivary glands and
the most prominent product of the
sublingual gland
The mechanism for mucus cavity
development is extravasation or retention
Secondary to trauma
70% occur in lower lip

Extravasation is the leakage of fluid from
ducts or acini into surrounding tissue.
Retention : narrowed ductal opening that
cannot adequately accommodate the exit
of saliva produced, leading to ductal
dilatation and surface swelling, less
common phenomenon.

Excision with strict removal of associated
minor salivary glands.

It is the mucocele that occur in the floor of
the mouth.

Presents as a blue dome shaped swelling
in the floor of mouth.
They tend to be larger than mucocele &
can fill the floor of the mouth and elevate
tongue.
Located lateral to the midline, helping to
distinguish it from a midline dermoid cyst.

Occur when spilled mucin dissects through
the mylohyoid muscle and produces
swelling in the neck.
Swelling in the floor of the mouth may or
may not be visible.

Sublingual gland removal via intraoral
approach.
Marsupialization is not favoured

Sialolithiasis results from mechanical
obtruction of the salivary duct.
It is the major cause of unilateral diffuse
parotid or submandibular gland swelling.

Hypercalcemia
Xerotomic medications
Tobacco smoking- increased cytotoxic
effect on saliva, decreases phagocytic
activity and reduces salivary proteins.

Sialolithotomy-intraoral route
Sialadenectomy –external route

Subjective complaints of a dry mouth
(xerostomia) and objective evidence of
diminished salivary output (salivary gland
hypofunction)

Medications Anticholinergics, tricyclic
antidepressants, sedatives,
tranquilizers,
antihistamines, antihypertensives,
cytotoxic agents, anti
Parkinsonian drugs, anti-seizure
drugs, skeletal muscle relaxants
Oral diseases Acute and chronic parotitis, sialolith,
mucocele,
partial/complete salivary obstruction
Systemic diseases Mumps, Sjogren’s syndrome,
diabetes, HIV/AIDS, scleroderma,
sarcoidosis, lupus, Alzheimer’s
disease, dehydration,
graft versus host disease, Hepatitis C
infection
Head and neck radiotherapy

 Dental caries and dental erosion
 most common oral conditions that develop as a result of
salivary gland
hypofunction is new and recurrent dental carie
 With deficient remineralisation, dental erosion is a more
frequent occurrence inpatients with salivary gland
hypofunction.s.

Gingivitis
 salivary gland hypofunction is frequently associated with
 retained food particles, particularly in interproximal
regions and beneath denture
 surfaces, and can cause gingivitis.

Impaired use of removable prostheses
Removable intra-oral prostheses depend
upon a thin film of saliva on mucosal
surfaces in order to enhance adhesion
Oral fungal infections
increased susceptibility to developing
microbial infections, the most prevalent of
which is candidiasis.

Dysgeusia
Dysphagia
Impaired quality of life

 establishment of a diagnosis.
 frequent oral health evaluations due to the high
prevalence of oral complications
 Maintenance of proper oral hygiene and hydration
 A low sugar diet, daily topical fluoride use (e.g. fluoride
toothpaste and mouth rinses),anti-microbial mouth
rinses, and use of sugar-free gum or candy to stimulate
salivary flow, help to prevent dental caries.

 Dry mucosal surfaces and dysphagia are managed with
oral moisturisers, lubricants,and saliva substitutes, as
well as careful use of fluids during eating.

 Saliva regulates the oral environment
 Widespread distribution of the salivary glands in the oral
cavity.
 Great impact of salivary gland pathology on clinical
practice in dentistry
 Understanding of the anatomy ,histology, physiology and
pathology of the salivary glands is essential for good
dental practice

 BD Chaurasia’s Human Anatomy –vol 3
6th edition
 Orban’s Oral Histology and Embryology
12th edition
 Indebir Singh’s Human Embryology
 Saliva and oral health: Michael Edgar, Colin Dawes &
Denis O’Mullane

BENIGN:
Pleomorphic adenoma
Papillary cystadenoma
Sebaceous cell adenoma
Benign lymphoepithelial lesion

MALIGNANT:
Malignant mixed tumor
Mucoepidermoid tumor
Squamous cell carcinoma
adenocarcinoma

 Adenomas
 Pleomorphic adenoma
 Warthin’s tumor
 Oncocytoma
 Myoepithelioma
 Basal cell adenoma
 Canalicular adenoma
 Sebaceous adenoma
 Ductal papilloma
 Cystadenoma

 Carcinoma
 Mucoepidermoid carcinoma
 Adenoid cystic carcinoma
 Acinic cell carcinoma
 Polymorphous low grade adenocarcinoma
Epithelial – myoepithelial carcinoma
 Basal cell adenocarcinoma
 Sebaceous carcinoma
 Adenocarcinoma
 Oncocytic carcinoma
 Salivary duct carcinoma
 Malignant myoepithelioma
 Ca in pleomorphic adenoma
 SCC Small cell Carcinoma
 Undifferentiated Carcinoma

• Relatively uncommon – 3% of head and
neck neoplasms : 75% benign
• Distribution
– Parotid: 80% overall; 80% benign; 80%
pleomorphic
– Submandibular: 15% overall; 50% benign
; 95% pleomorphic
– Sublingual/Minor: 5% overall; 40% benign

Exact cause is UNKNOWN
 Probable causes :
Exposure to radiation
 Survivors of childhood malignancy
Thyroid CA pts. Treated with Radioactive
iodine
 Long term effects of high freq.
electromagnetic fields.
 EBV

 Most common of all salivary gland
neoplasms
 80% of parotid tumors
 50% of submandibular tumors
 45% of minor salivary gland tumors
 6% of sublingual tumors
 4 th-6th decades
 F:M = 1.4:1

Slow growth, Benign course
Clinical features : Asymptomatic /
Symptomatic
 Prone to recurrence
 Associated with another salivary gland
tumor
 Incidence of malignant change 6%

 Gross pathology & Cut surface
 Smooth
 Well-demarcated
 Solid Cystic changes
 Nodularity
 Greyish white
 Myxoid stroma
 characterstic – Haemorrhagic
degeneration

Histology - Epithelial tumor of complex
morphology
 Mixture of epithelial, myoepithelial and
stromal components
 Epithelial cells: nests, sheets, ducts,
trabeculae
 Stroma: myxoid, chrondroid, fibroid,
osteoid
 Calcification of bone

Treatment : complete surgical excision –
Parotidectomy with facial nerve
preservation

Papillary cystadenoma lymphomatosum /
Adenolymphoma
14% of salivary gland neoplasms
 Second most common tumor.
 Exclusively a tumor of Parotid gland.
 Seventh decade; M:F::1.5:1
 high incidence in whites
10% bilateral

Most common site Tail of parotid
 Gross pathology
 Encapsulated
 Smooth / lobulated surface
 Soft, fluctuant, compressible
 Cystic spaces of variable size, with
viscous fluid, shaggy epithelium
 Solid areas with white nodules
representing lymphoid follicles

Histology
 Papillary projections into cystic spaces
surrounded by lymphoid stroma
 Epithelium: double cell layer
 Luminal cells
 Basal cells
 Stroma: mature lymphoid follicles with
germinal centers

Second most common tumor
 Almost Never Malignant
 Recurrences very rare

 Oxiphilic Adenoma- Outer part of parotid
gland
 Rare: 2% of benign salivary tumors
 7 th – 8th decade
 M:F = 1:1
 Parotid: 78%
 Submandibular gland: 9%
 Minor salivary glands: palate, buccal
mucosa, tongue
 Arises from striated duct cells
 Benign

 Gross
 Encapsulated
 Homogeneous, smooth
 Orange/rust color
 Histology
 Large polyhedral eosinophilic cells
with mitochondria.
 Distinct cell membrane
 Granular, eosinophilic cytoplasm
 Central, round, vesicular nucleus

Relatively UNCOMMON
 Slow growth pattern does not lessen their
malignant nature
 Considerable morbidity & mortality
 INCIDENCE : 1.2 PER 1,00,000
population
 Parotid 58% ; minor salivary glands 23%
 Malignancy is far more frequent in Minor
salivary glands & Sublingual glands

Environmental
 Ionizing radiation
 Diet & nutritional habits
 Occupation : Workers involved with
Livestock feed processing-aflatoxin
 EBV
 Carcinogens - Benzopyrine, Dihydrodiol
analogue

Features suggestive of Malignancy
 Induration
Fixed to overlying skin or mucosa
Ulceration of overlying skin or mucosa
Rapid growth
 Pain often severe
 Facial nerve palsy Short duration

 Most common major salivary gland
malignancy
 Most Common salivary gland neoplasm
in children
 5-9% of salivary neoplasms
 Parotid 45-70% of cases
 Palate 41%
 3rd-8th decades, peak in 5th decade
 M:F 1:1

Presentation
 Aggressive
 Classified histologically :
 Low-grade: 80 %, slow growing, painless
mass
 High-grade: 33%, rapidly enlarging, +/-
pain
 Grows slowly & recur locally

 Gross pathology
 Well-circumscribed , partially
encapsulated to unencapsulated
 Solid tumor with cystic spaces

 Histology
 Low-grade
 Mucus cell > epidermoid
cells
 10% tumour cells and 90%
intracystic spaces
 Prominent cysts
 Mature cellular elements
 High-grade
 Epidermoid > mucus
 90% tumour cells,

 Treatment
 Influenced by site, stage, grade
 Stage I & II
 Wide local excision
 Stage III & IV
 Radical excision
 neck dissection
 postoperative radiation therapy
 low grade-local resection and follow up.
 high grade –Radical resection and RT

40% of malignant tumors of all salivary
sites
 Most common in minor salivary glands –
25% parotid, 15% submandibular gland,
1% sublingual gland, 60% minor glands.
 41% locally advanced, 11% distant
metastasis

 F > M
 6 th decade
 Source – intercalated ducts
 Spreads perineural –central and peripheral
 Presentation
 Asymptomatic enlarging mass
 Pain , paresthesias , facial weakness
/paralysis
 Nodal spread - 8% early and 7% late.
 7 th nerve palsy – 20%

Gross pathology
 Well-circumscribed
 Solid, rarely with cystic spaces
Infiltrative
 hard and fixed

Histology — 4 types
 Solid pattern 25%
 Cribriform 40% (MC)
Tubular 20%
Cylindromatous
 Solid pattern -worst prognosis. Cure never
achieved

Histology
tubular pattern
 Layered cells forming duct
 like structures
 Basophilic mucinous substance

 Bad prognosis in the long term
 Treatment – Radical operation
 Sacrifice facial N
 Postoperative RT
 Recurrent tumour - surgery + RT
 Role of Chemotherapy
 Prognosis
 Primary site recurrence rate : 100% within 30
yrs.
 Neck node recurrence 23% within 15 yrs.
 Distant metastasis: lung, bone, liver
 Indolent course: 5-year survival 75%, 20-
year survival 13%

 Low grade malignancy
 2 nd most common parotid and pediatric
malignancy
 2.5 –4% of all salivary gland tumors
 5 th decade
 F>M
 Bilateral parotid disease in 3%
 Source-terminal tubular intercalated duct
cells
 Presentation – Solitary, slow-growing, often
painless mass

Gross pathology
 Encapsulated lesion
 Well-defined margins
 Most often not homogeneous

Histology
Solid microcystic pattern
 Most common
 Numerous small cysts
 Polyhedral cells
 Small, dark, eccentric nuclei
 Basophilic granular cytoplasm
 Constituent cells contain zymogen
granules

 Best survival rate
 Treatment
 Complete excision of gland
 Preservation of uninvolved nerve
 postoperative RT
 Prognosis
 5-year survival : 82%,10-year survival: 68%
25-year survival : 50%
 Late recurrence
 10% recurrence
 15% - distant metastasis

 80% Skin of face, pinna, temple or scalp
 Parotidectomy with neck dissection in
continuity with primary lesion

INVESTIGATION :
 Clinical History
 Examination
 Lab tests
 USG Neck
 CT Or MRI
 FNAC
 Frozen section - 5-12% false negative

USG
Distinguish intrinsic from extrinsic tumors
 USG guided FNAC
 Malignant tumors have low reflectivity with
poorly defined borders.
Disadv
 Deep lobe parotid masses
Masses with parapharyngeal extension
 Bone & dental artefacts

 CT Scan
 Differentiate benign from malignant masses
 Differentiate superficial from deep lobe tumors
 Separate a parapharyngeal mass from deep lobe
tumor
 Relationship of mass to facial nerve
 Considerable insight into probable histology
 Malignant tumors
 irregular outline
 Diffuse border
 Nodal metastases

 Efficacy is well established
 Accuracy = 84-97%: Sensitivity = 54-95%
 Specificity = 86 - 100%
Safe(controversial– tumor seeding): well
tolerated
 Limitations
 offers least possibility of pre operative
diagnosis
 Missing critical area at tumor border

 Watery or oily iodinated contrast
 Multiple radiographs
 Adv-
 Quick
 Widely available
 Depiction of extra and intra glandular ducts
 Disadvantage-
 Invasive
 Complications
 In complete obstruction, not useful

 TREATMENT
 Surgery
 Radiotherapy
 Chemotherapy
 Factors that influence treatment
 Age
 Metastatic spread
 Facial nerve involvement
 Mandibular / Temporal bone involvement •
Skin
 Site of tumor
 Size, Extent, Grade & stage

 Parotid masses
 Superficial parotidectomy Most benign
tumors
 Total conservative parotidectomy
 deep to nerve and deep lobe of gland
 Total Radical parotidectomy
 Extended radical parotidectomy
 Submandibular masses : Total excision of
gland
 Sublingual & Minor salivary gland tumors :
Wide local excison

Deep lobe parotid tumors
 Close or positive histologic surgical
margins
 Undifferentiated or high-grade histology
 Recurrent malignancy
 Bone or connective tissue involvement
 Metastatic regional cervical lymph nodes
 Perineural involvement

Cisplatin – slow i.v 50-100mg/m2 every 3-
4wks
 Doxorubicin – slow i.v,60-75mg/m2 every
3wks
 5-fluorouracil – 12mg/kg/day for 4
days,6mg/kg i.v on alternate days

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