This document summarizes the anatomy and physiology of the major salivary glands - the parotid gland, submandibular gland, and sublingual gland. It describes the location, structure, duct system, blood supply, nerve innervation, and functions of each gland. It also discusses pathological conditions that can affect the salivary glands including inflammation (sialadenitis), salivary stones (sialolithiasis), and tumors. Common benign tumors include pleomorphic adenoma, while malignant tumors include carcinomas and sarcomas.
Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues.infection of orofacial & neck region, particularly those of odontogenic origin,have been one of the most common diseases in human being.
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
The Middle Third Of The Facial Skeleton Is Defined As An Area Bounded,
Superiorly –Line Drawn Across The skull from the Zygomatico frontal Suture across the Frontonasal & Frontomaxillary sutures to the Zygomaticofrontal suture on the opposite side
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
It is made up of the following bones:
1. Two maxillae
2. Tw o palatine bones
3. Two zygomatic bones and their temporal processes
4. Two zygomatic processes of the temporal bone
5. Two nasal bones
this presentation describes about each bone individually and its applied anatomy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
INTRODUCTIONSalivary glands are compound tubuloacinar, exocrine gland and the ducts opens in the oral cavity.
Salivary glands secretes a fluid called saliva that coats the teeth and the mucosa.
Saliva is a complex fluid, produced by the salivary glands, the most important function of which is to maintain the well- being of mouth.
Individuals with a deficiency of salivary secretion experience difficulty in eating, speaking, and swallowing and become prone to mucosal infections and dental caries.
Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues.infection of orofacial & neck region, particularly those of odontogenic origin,have been one of the most common diseases in human being.
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
The Middle Third Of The Facial Skeleton Is Defined As An Area Bounded,
Superiorly –Line Drawn Across The skull from the Zygomatico frontal Suture across the Frontonasal & Frontomaxillary sutures to the Zygomaticofrontal suture on the opposite side
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
It is made up of the following bones:
1. Two maxillae
2. Tw o palatine bones
3. Two zygomatic bones and their temporal processes
4. Two zygomatic processes of the temporal bone
5. Two nasal bones
this presentation describes about each bone individually and its applied anatomy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
INTRODUCTIONSalivary glands are compound tubuloacinar, exocrine gland and the ducts opens in the oral cavity.
Salivary glands secretes a fluid called saliva that coats the teeth and the mucosa.
Saliva is a complex fluid, produced by the salivary glands, the most important function of which is to maintain the well- being of mouth.
Individuals with a deficiency of salivary secretion experience difficulty in eating, speaking, and swallowing and become prone to mucosal infections and dental caries.
Salivary glands Disorders and management.Manish Shetty
Short, brief description of the salivary gland disorders.
it explain the basic anatomy, physiology of the salivary glands.
all the 3 salivary gland are individually explained with appropriate management of it disorders.
The surgical anatomy of major salivary glands has many significant applications in maxillofacial surgery. Understanding these important anatomic relations- variations enables surgeons to perform the surgical procedures safely. Knowledge of these concepts helps us to recognize the problems and complications as and when they occur and manage them accordingly.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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3. •
• A ) parotid gland :
•
• -It is the largest gland of the body
•
•
- shape :
Inverted three sided pyramid
Apex & base & 3 surfaces & 3 borders
It has 5 processes : 3 superficial & 2 deep
4. • - capsule :
• - site :
• Lies in front & below the parotid compartment
• 80% of the gland overlies the masseter muscle
• Lies within the investing layer of deep fascia of the
neck called parotid fascia
• 1) superficial layer : extend from masseter to
sternocleidomastoid muscle to zygoma
• 2) deep layer : from the fascia of posterior belly of
digastric muscle , forming stylomandinular membrane
separating the parotid and submandibular glands .
•
7. Posteromedial:
1)mastoid process and 2 muscles atrached
( sternocleidomastoid , posterior belly of digastric )
2) styloid process & structures attached to it : 3 muscles
( stylohyoid ,styloglossus , stylopharyngeus ) , 2 ligaments
(stylohyoid , stylomandibular)
3)carotid sheeth ( ICA, IJV , Lower 4 cranial nerves
9&10&11&12)
•
8. -borders & extent :
• Structures passing through the anterior border :
• 1)zygomatic branch of facial nerve
• 2)transverse facial vessels
• 3)buccal branch if facial nerve
• 4)parotid duct
• 5)mandibular branch of facial nerve
•
• -superior :
• From the EAM & TMJ
• Structures passing through it :
9. -inferior :
• Posterior belly of digastric & stylohyoid muscle
• Structures passing through it:
• 1)cervical branch if facial nerve
• 2) two devisions of retrandibular vein
•
• - structures within the parotid gland :
• 1)External carotid artery & its 2 terminal branches :
(maxilary and superficial temporal arteries ) ...
Deep
• 2)retromandibular vein ... Intermediate
• 3) facial nerve and its five terminal branches
10. Parotid duct : (Stensen's duct )
• - arises from the anterior border of the gland ,
parallel to the zygomatic arch
• -runs superficial to the masseter , then turn 90
degrees to pierce the buccinator muscle at the level
of the upper second mollar tooth where it opens
into the oral cavity .
• - buccal branch of facial nerve runs with the parotid
duct
11. • Accessory parotid gland :
• Typically found overlying the masseter
• Accessory duct lies cranial to the stensen's duct
• Have their own blood supply from transverse facial vessels
•
•
• Nerve supply
• Parasympathetic: glossopharyngeal (secretomotor ) .. otic
ganglion .. auriculotemporal nerve ... Parotid gland
• Sympathetic : plexus around the ECA
• Sensory : auriculotemporal nerve to the gland , great
auricular nerve from the parotid fascia
•
12.
13. 2 ) Anatomy of submandibuar
salivary gland
Site : in the anterior part of the digastric triangle
Extent :
Size : 4 cm long
Anterior : mental foramen
Posterior : angle of the mandible
Superior : mylohyoid line
Inferior : hyoid bone
•
14. • Parts :
• Facial covering :
• Superficial part is enclosed () 2 layers of deep
cervical fascia
• Superficial layer is attached to the base of the
mandible ..
• Deep layer attached to the mylohyoid line
• A) superficial part : superficial to mylohyoid ms
• B) deep part : deep to mylohyoid ms
• The two parts are connected to each other around
17. B) deep part :
• - deep to the mylohyoid muscle & superficial to
hyoglossus muscle
• - above : lingual nerve , submandibular ganglion
• -below : hypoglossal nerve
18. •Salivary Gland duct (wharton's duct ) :
• - 5 cm
• - emerge from the anterior end of the deep of the
gland
• -runs ()mylohoid & hypoglossususcles
• - then () sublingual gland genioglossus
• - it opens in the floor of the mouth on the summit of
sublingual papilla at the side the frenulum of the
tongue
The lingual nerve ( branch of the mandibular devision of
the trigeminal nerve (V) has triple relation to the duct :
1st descend lateral
Then below the duct
Then ascend medial to the duct
NB:NB:
19. Arterial supply : facial and lingual arteries
Venous drainage : common facial and lingual nerve
Lymph drainage : submandibuar & upper deep
cervical LNs
Nerve supply :
A) parasympathetic
From chorda tympani (branch from facial nerve )
pass to the gland through lingual nerve .
B) sympathetic :
Sympathetic plexus around the facial artery
C) sensory :
Lingual nerve
21. 1) acute sialadenitis
Predisposing factors
1 - bad oral hygiene
2 - Obstruction of salivary duct by food particles foreign body or stone
3 - dehydration
4 - Debility
22. route of entry
1- Direct : either along duct from mouth (commonest) or from a nearby Focus
2- blood borne
Organisms :
1- Viral : mumps influenza
2- bacterial : staph aureus (commonest), streptococci, pneumococci
23. •Clinical picture
• II. Local->
• 1. Pain : early , dull aching, later it is severe
Throbbing.
•
• 2. Swelling: elevating the lobule of the ear - red -
warm - edema - tender - fluctuate (late due to
thicker parotid fascia)
•
• 3. Opening of the duct: red, raised, and edematous,
with discharge.
•
• 4. Trismus: restricted movement of
tempromandibular joint.
25. • :
• (I) Conservative:
• A) General: rest antibiotic (clindamycin) analgesics a
tonics.
• B) Local: hot fomentation, H202 mouth wash, KI as
sialogogue.
• C) Observation: Pulse - temperature - swelling
After 3 days conservative treatment, patient either:
a. Improves : continue conservative treatment till complete cure.
b. Worsens : incision and drainage (Do not wait for fluctuation)
N.B :
26. 2) Surgical treatment:
• a. Parotid abscess:
• - A vertical skin incision in front of ear.
• - The deep fascia is incised transversely to avoid
injury of the branches of facial nerve.
• - A sinus forceps is then introduced closed and
then opened to drain the pus Hilton's method
•
• b. Submandibular abscess:
• - Skin incision parallel to lower border of the
mandible 1.5 inch below and in front of the angle
of mandible to avoid injury of mandibular branch of
27. 1) Chronic
sialadenitis
•Etiology:
•
• I. Chronic calcular sialadenitis
• 1. Infection: is a good former for stones
• 2. Stasis : by sepsis, stricture or FB.
•
• II. Chronic non calcular sialadenitis
• 1. Oral hygiene is poor.
• 2. Obstruction of salivary duct by food particles, F.B.
• 3. Imperfect drainage of acute sialoadenitis.
28. I. Chronic calcular sialadenitis
* Site:
Stones lie in the gland or in the duct. Submandibular glands to parotid ratio is 50 to 1
because :
A. Secretions of submandibular are more viscid.
Parotid secretion is watery
Submandibular secretion is mucoid & viscid
B. Its duct opens in floor of mouth -> obstruction by food particles.
C. Drainage of submandibular gland is independed.
*Composition: composed of Calcium, Mg phosphate & carbonate.
Pathology:
29. Complications:
I. Chronic calcular sialoadenitis
c. Malignancy.
II. Chronic non calcular sialoadenitis
a. Recurrent acute attacks.
b. Stone formation.
c. Sialactasis: dilatation of the salivary ducts.
a. Obstruction and infection may lead to abscess & fistula formation.
b. Migration: If small stone.
30. type of patient :
(4) Complications.
• male > female
• occurs in middle and old age.
•
• Symptoms
• (1) pain :
• Dull aching pain if the stone is in the gland or colicky
pain if it is in duct
• May refer to tip of the tongue due to irritation of
Clinical Picture:
31. Signs
(2) gland is enlarged, tender, cannot be rolled over lower border
of mandible (due to capsule of the gland which fix it to the
mandible) with preservation of the sulcus ( ) the gland & body of
the mandible
(3) Bidigital palation: the gland better felt from inside the mouth
(4) The duct itself may be palpated with stone in it.
(5) Opening of duct is seen red, raised, discharging blood or
pus. A stone may be seen peeping from the duct opening.
32. (1) Plain X -Ray. Stones are 100% radio opaque
(3) Neck US.
(2) Sialography.
A radio-opaque material as lipidol is injected in the
canulated duct to delineate it and shows sialactasis
behind stone.
Investigations:
33. Treatment:
(A) Stone in the Duct:
• a. Peeping stone from orifice -> meatotomy
•
• b. Stone in the duct:
• - Under local anesthesia, the duct is underrun by an
anchoring stitch to avoid slippage of stone to the
gland)
• -Slit duct open from orifice to stone.
• -Remove stone, and leave duct opened after
removal of anchoring stitch to allow a better
36. 80% of salivary neoplasms arise in the parotid
gland
80% affecting superficial lobe
80% are benign
80% of benign tumors are pleomorphic adenoma
Rule of 80%
37. Pleomorphic adenoma
(mixed salivary gland tumor)
• Pathology:
• Site : common in the parotid gland (80%)
• N/E:
• Small,firm,incompeletly capsulated mass with lobulated
surface
• Cut surface grayish white,occasionally it presents cystic
formation
38. M/E: there is pleomorphism:
2)stroma: appears blue resembling that of cartilage
but now it is found that blue material is a mucinous
secretion
3)there are microscopic extensions beyond capsule
of the tumor (satellite nodule with projections) and
this is responsible for high incidence of recurrence
after simple enculation (considered locally malignant
tumor )
1)cells: spindle or stellate shaped and arranged in
acini,clusters or sheets
41. •Signs:
• 2)no lymph nodes enlargement
•
• 1)single swelling (may be bilateral ) has the
following criteria
• a)site : usually in the parotid regin
• b)size :usually small
• c)shape:hemispherical
• d)surface: smooth & lobulated
• e)skin over: not attached to the tumor ( freely
mobile)
• f)surrounding structures(to eclude malignancy )
• facial nerve is free
42. Investigations :
1)US,CT&MRI: to assess the extent t deep lobe and the
relation to facial nerve
2)isotope scan tcm99 pertechnetate:
All salivary tumors give cold spot except warthin's tumor
give hot spot
3)biopsy
•
43. Treatment :
1)simple enucleation and localized resection
•
• 2) superficial parotidectomy:
•
• Removal of superficial lobe of the gland +
preservation of facial nerve
• Indicated if tumor is in superficial lbe
•
• 3)total conservative parotidectomy:
45. Pathology :
Site : in lower part of parotid , bilateral in 10%
• N.E:small,cystic&completely capsulated mass
• Cut section: white areas due to lymphoid tissues
surrounding cystic structures
• M/E:
• Cells are columnar arranged into cystic spaces with
formation of papillary projections into these cystic
spaces which contain mucoid material
• Stroma: consist of lymphoid tissues originating
from lymphoid aggregation present in normal
parotid gland and support cystic spaces
46. • Clinical picture :
• male>female & age >50y
• slowly growing ,painless swelling
• as pleomorphic adenoma but not elevating the lobule of ear
& consistency cystic
• Complications : not precancerous
• Investigations:
• As pleomorphic but gives hot spot in isotope scan
•
• Signs :
• Symptoms :
• Patient :
48. Carcinoma of salivaryCarcinoma of salivary
glandsglands
Etiology :
Predisposing factors : salivary stone &radiation
exposure
Precancerous factors : pleomorphic adenoma
•
49. Pathology :
•
• Site :
• - 20% of the parotid tumors are malignant
• - 50% of the submandibular tumors are
malignant
• - 100% of the sublingual tumors are malignant
• N/E :
• - large , hard, ill defined ,mass with nodular or
irregular surface
• - cut section ; non capsulated with areas of
hemorrhage , necrosis and cyst formation
50. • 1- Mucoepidermoid (commonest) :
• - arises from duct epithelium
• - contains both epidermoid and mucous
secreting epithelium forming cysts
• - three grades are described ; low grade ,
intermediate grade , high grade
• 2- Epidermoid (squamous cell) carcinoma (rare) :
• - arises from duct epithelium
• - rare tumor of parotid , more common in
submandibular gland
• 3- Adenocarcinoma :
• - arises from duct epithelium , arranged in acini
• 4- Adenoid cystic carcinoma :
51. • Spread:
•
• (1) Direct : - Intrinsic : within gland infiltrating facial nerve
• - Extrinsic : to the surroundings ( skin ,
masseter , mandible ,
oral cavity )
• (2) Lymphatic : to deep cervical L.N.
• (3) Blood : to lungs & bones
• (4) Perineural invasion (adenoid cystic type) which explains
high rate of recurrence
•
52. Staging TNM :
Primary tumor :
• Tx -----primary tumor cannot be assessed
• T1 -----Tumor < 2 cm in greatest dimension
• T2 -----Tumor 2-4 cm in greatest dimension
• T3 -----Tumor > 4 cm in greatest dimension
• T4 -----
• T4a ----Tumor invades skin , mandible , ear
canal or facial nerve involvement
• T4b ----Tumor invades skull base or
ptergoid plates or carotid artery
53. • Type of patient :
• - Male > female & age > 50 years ( old man )
• - Acinic cell carcinoma more common in female
•
• Symptoms :
• - Rapidly growing , painless swelling (painful in adenoid
cystic )
• - slow rate of growth in acinic cell tumor
•
•
Clinical picture :
54. Signs :
1-Single swelling has the following criteria :
1- Site : usually in parotid region
2- Size : variable (rapidly growing)
3- Shape : irregular
4- Surface : nodular or irregular
5- Skin over : attached to the tumor(not freely mobile)
6- Surrounding structures :
- Facial nerve ----- may be infiltrated
- Masseter muscle ----- may be attached
- Pulsation of superficial temporal a. -----may be absent
7- Special characters :
- fill space () ramus of mandible & mastoid process
- may raise lobule of ear
- become more prominent on contraction of masseter
- become less prominent on opening of the mouth
8- Consistency : hard ( soft in acinic cell tumor )
9- Edge : ill-defined edge
10- Tenderness : slightly tender
2- Lymph node :
- Enlarged , Hard , Painless , Early Mobile & Later Fixed
57. Treatment :
(A)Operable : Radical procedures
(1) Tumor :
a. Parotid tumors :
- ( total radical parotidectomy )
- removal of superficial and deep lobes of gland
sacrificing facial nerve
- as regard facial nerve :
1- may be grafted using great auricular nerve
2- transposition of hypoglossal nerve then
anastomosing it to peripheral branches
of facial nerve
3- facial slings to support facial tissue