management of salivary glands diseases

1. Salivary Glands & Diseases
Sahand mohajer

2. Salivary Glands
• The parotid glands
• The submandibular glands
• The sublingual glands
• Many minor salivary glands in mucosa of
cheeks, lips, palate

3. Parotid glands
• The biggest one
• Parotid divided into superficial and deep lobes by
the facial nerve
• Most benign tumors in superficial lobe
• Signs of malignant transformation :
◦ Becomes painful
◦ Starts growing rapidly
◦ Becomes stony hard
◦ Facial nerve involvement
◦ L. node involvement

4. Parotid duct
• Stensen’s duct
• Pierces buccinator and opens in buccal mucosa opposite
crown of second upper molar tooth
• Contains Serous cells and produce a thin watery secretion

5. Submandibular Gland
• Located in the submandibular triangle of the
neck
• inferior & lateral to mylohyoid muscle
• Superficial part lies in the submandibular
triangle between 2 bellies of digastric muscle
• Deep part lies above & deep to mylohyoid in
the floor of mouth

7. Submandibular duct (Wharton’s
duct)
Mucose secretion
Opens on a papilla beside the
frenulum of the tongue

8. Sublingual Glands
• Lie on the superior surface of the mylohyoid
muscle and are separated from the oral cavity
by a thin layer of mucosa.

9. Sublingual Duct
• The ducts of the sublingual glands are called Bartholin’s
ducts
• In most cases, Bartholin’s ducts consists of 8-20 smaller
ducts of Rivinus. These ducts are short and small in diameter.

10. DIAGNOSIS OF THE PATIENT WITH
SALIVARY GLAND DISEASE
• Common sign is Xerostomia
• Other signs:
 dryness of all the oral mucosal surfaces, including the lips and throat
 difficulty chewing, swallowing, and speaking.
 Other associated complaints may include oral pain, an oral burning
sensation
 chronic sore throat and pain with swallowing.
 The lips are often dry with cracking, peeling, and atrophy
 The buccal mucosa may be pale and corrugated.
 The dorsal tongue may appear smooth
 the “lipstick” and “tongue blade” signs.

11. • Complaints of oral dryness at night or on awakening have not
been found to be associated reliably with reduced salivary
function, the complaints of oral dryness while eating, the
need to sip liquids to swallow food, or difficulties in
swallowing dry food have all been highly correlated with
measurable decreases in secretory capacity.

12. Normal salivary gland
• inspection and palpation should be painless and without
detection of a mass or masses
• The consistency should be slightly rubbery but not hard
• saliva expressed from each major gland gently compressing
the glands
• saliva should be colorless and transparent, watery, and
copious.
 Viscous or scant secretions suggest chronically reduced
function.

13. • Salivary gland neoplasms :
parotid glands
>submandibular>sublingual>minor salivary
glands
malignant neoplasms : is greater the smaller the
Gland: that is, a neoplasm in the parotid gland is
statistically more likely to be benign than one
arising in a minor salivary gland.

14. Malignancy signs of glands
1. include ulceration of the overlying mucosa
2. Fixation of the mass to deeper tissue planes
3. Induration
4. invasion, and cervical lymphadenopathy

15. Sialometry
• methods of WS collection :
a) Draining
b) Suction
c) Spitting
d) Absorbent methods (sponge)
For a general assessment of salivary function,
unstimulated WS collection is recommended

16. Salivary Gland Imaging
• Plain Film Radiography
• Sialography
• Ultrasonography
• MRI
• Radionuclide imaging(scintigraphy)
• CT
• PET

17. Biopsy
• Definitive diagnosis of salivary pathology may
require histologic examination.

18. The Minor Salivary Gland Biopsy
• An incision is made on the inner aspect of the
lower lip, near the midline, so that it is not
externally visible
• Focus Score

19. The major salivary gland biopsy
• Parotid : extra oral
• Sublingual : intra oral

20. DISEASES AND DISORDERS
OF THE SALIVARY GLANDS
1) Developmental abnormalities
2) Sialadenitis
3) Obstructive and Traumatic lesions
4) Sjögren syndrome
5) Sialolithiasis
6) Cyst
7) HIV-Associated salivary gland disease
8) Salivary gland tumors
9) Age changing diseases

21. Developmental abnormalities
Aplasia , Hypoplasia , Hyperplasia
Heterotopic salivary tissues
Diverticuli
Accessory duct

22. Sialadenitis
1. Bacterial
Chronic
Acute
2. Viral
Mumps
CMV
3. Post irradiation
4. Sarcoidosis
5. Minor glands Sialadenitis

23. Acute bacterial sialadenit
• Dihydration
• Salivary gland function
• Common in parotid
• Age
• 50 – 60
• Clinical diagnose
• Common pathogen : S.A
• Viral : usually bilateral
• 20 – 40 % mortality

24. Risk Factors
Systemic dehydration (salivary stasis)
Poor oral hygiene
Neoplasms (pressure occlusion of duct)
Sialectasis
Extremes of age
Calculi, duct stricture
NPO status
Chronic disease and/or immunocompromise

25. Chronic bacterial sialadenitis
• Repetitive bacterial infections
• More common in submandibular
• Usually unilateral
• Swelling
• Fever
• Inflammation
• Suppuration

26. treatment
• resolution of signs and symptoms of infection,
elimination of the causative bacteria, rehydration,
and elimination of obstruction where present
• Anti Biotic + Analgesics + massage + oral hygiene +
salivary stimulus + elimination of drugs cause
hyposalivation
• Incision & drainage

27. Clinical presentation
Swelling
Fever
Cold like symptoms
Trismus
Dysphagia
Dry mucosa

28. Mucocele
 Mucoceles, exclusive of the irritation fibroma, are
most common of the benign soft tissue masses in the
oral cavity.
 Muco: mucus , coele: cavity. When in the oral floor,
they are called ranula.

29. • Consist of a circumscribed cavity in the
connective tissue and submucosa producing
an obvious elevation in the mucosa
• The majority of the mucoceles result from an
extravasation of fluid into the surrounding
tissue after traumatic break in the continuity
of their ducts
• Lacks a true epithelial lining.

30. • Extravasation : more common
• Retention : Retention cyst , obstruction ,
repetitive use of hydrogen peroxide as mouse
rinse

31. Treatment of Mucoceles
in Lip or Buccal mucosa
• Excision with strict removal of any projecting
peripheral salivary glands
• Avoid injury to other glands during primary
wound closure
• Laser , micromarsopialization , electrosurgery

32. Ranula

34. • More common in females and in second
decade
• Originate from sublingual gland and trauma to
rivinis
• Oral / plunging / mixed

35. Treatment
• Marsupialization has fallen into disfavor due
to the excessive recurrence rate of 60-90%
• Sublingual gland removal via intraoral
approach

36. sialoliathiasis
• salivary stones
• 40- 50
• Recurrence 20%
• usually Asymptomatic
• Immunologic factors :
Local inflammation
Dehydration
Anti cholinergic
Calcium saturate
Bacterial infection

37. Signs and symptoms
• Acute pain
• Swelling
• Tender
• Plain radiography
• Sialography
• CT

38. treatment
• Supportive
• Hydration
• Antibiotics
• Stones at or near the orifice of the duct can
often be removed transorally by milking the
gland, but deeper stones require intervention
with conventional surgery or sialendoscopy

39. Present by :
• Farshad bahadivand
• Sahand Mohajer
• Alireza Mehraban