1. NURSING CARE Salivary Gland DisordersBy
Ni Ketut Alit A
Faculty Of Nursing Airlangga University

2. REFERENCES
Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care. J.B. Lippincott.co.
Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.
Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B. Saunders Company.
Journals and article related to..

3. OVERVIEW Salivary glands are exocrine glands
(have duct system to flow their secretions)
The saliva that is produced by these glands is brought to the oral cavity.

4. Types of salivary glands
The Major Salivary Glands
Parotid glands.
Submandibular glands.
Sublingual glands.
The Minor Salivary Glands
numerous in the oral cavity and are named according to their locations
Labial & buccal glands.
Glossopalatine glands.
Palatine glands.
Lingual glands.

5. Parotid gland The largest salivary glands.
Located inferior and anterior to the ears, between the skin and the masseter muscle.
The parotid duct (stanson’s duct ) emerges from the anterior border of the gland and passes forward over the lateral surface of the masseter, enters the vestibule of the mouth upon a small papilla opposite the upper second molar tooth.
It’s a pure serous gland, composed mostly of serous acini.
Structures passing through parotid gland:
Facial nerve.
Retromandibular vein.
External carotid artery.

6. Submandibular gland
Found in the floor of the mouth; it is medial and partly inferior to the body of the mandible.
It is divided into superficial and deep parts by the mylohyhoid muscle.
The submandibular duct ( wharton’s duct ) emerges form the anterior end of the deep part of the gland and runs forward beneath the mucous membrane of the mouth, It opens at the lingual frenulum on the floor of the mouth.
It has a mixed secretion both serous and mucous, consists of a mixture of serous and mucous acini.

7. Sublingual gland
Located beneath the tongue and superior to the submandibular gland.
It’s ducts open into the floor of the mouth in the oral cavity.
It’s a mixed gland, it has both serous and mucous acini, with the latter predominating.

8. Nerve supply of major salivary glands
Parotid Gland
Parasympthetic secretomotor supply arises from the glossopharyngeal nerve.
The nerves reach the gland via the tympanic branch, the lesser petrosal nerve, the otic ganglion, and the auriculotemporal nerve.

9. Nerve supply of major salivary glands
Submandibular Gland
Parasympathetic secremotor supply is from the facial nerve.
The postganglionic fibers pass directly to the gland.
Sublingual Gland
Parasympathetic secretomotor supply is from the facial nerve.
Postgaglionic fibers pass directly to the gland. 

10. Function of saliva Digestion : Moistens dry foods to aid swallowing.
Disinfectants : Salivary lysozyme, IgA and other antibacterial substances protect against caries and oral cavity infections.
Hormonal : Saliva secretes Gustin hormone which is thought to play a role in the development of taste buds.

11. Non-neoplastic diseases (Infections and Inflammations )
Salivary Glands
Non-neoplastic diseases
(Infections and Inflammations )

12. Mumps Mumps is an acute sialadenitis which caused by an RNA virus
This RNA virus is the “paramxovirus”
Other virus which can cause salivary infections are:
Cytomegalovirus
Coxsackieviruses
Echovirus

13. Mumps CLINICAL FEATURES Airborne droplets transmit mumps virus
It mainly effects the parotid gland.
Children between the ages of 5-18 years are infected the most.
Once exposed the patient will develop the disease within 2-3 weeks
There is rapid swelling of the parotids bilaterally
There is an acute pain while salivation.
Symptoms:
  Asymptomatic   
Swollen, painful salivary glands on one or both sides .
Pain with chewing or swallowing
Fever
Weakness and fatigue
:Complications
Complications of mumps are potentially serious, but rare. These include:
Pancreatitis
Orchitis
Meningitis
Orchitis= Inflammation and swelling of the testes, caused by infection

14. Mumps Treatment: Mumps is a self-limited disease .
Treated with bed rest .
Use analgesics to relieve pain and reduce fever such as:
Acetaminophen .
Nonsteroidal anti-inflammatory drugs.
Complications may require treatment in the hospital.
Prevention:
The most common preventative measure against mumps is immunization with
a mumps vaccine.
relieves pain by inhibiting prostaglandin synthesis in the central nervous system and reduces fever by acting on the temperature-regulating centre of the brain

15. Sialolithiasis
Sialolithiasis is the formation or presence of a calculus or
calculi in a salivary gland.
It is most commonly seen in the submandibular gland
and duct (about 80% of cases), then the parotid gland
and duct .
Sialolithiasis is rare in the sublingual gland.
Most stones are solitary, but multiple stones may be present.
The reason why a stone forms is unknown

16. Sialolithiasis Symptoms: May be asymptomatic
Dull pain from time to time over the affected gland  
Swollen .
Pain with chewing or swallowing
:Complications
Oral infection
Investigations:
CT scan, ultrasound scan or MRI scan.
Sialography (silogram).
Sialendoscopy.

17. Sialolithiasis Treatment:
Gentle probing into the duct from inside the mouth with a thin blunt instrument can sometimes free a stone which then falls into the mouth. This is done by a doctor.
Therapeutic sialendoscopy It uses a very thin endoscope (tube) with a camera and light at the tip. The tube is pushed into the duct. If a stone is seen, then a tiny pair of 'grabbers' that are attached to the tube is used to grab the stone and pull it out.
A small operation. It can be used
if therapeutic sialendoscopy
is not an available
Shock wave treatment uses
ultrasound waves to break
stones. The broken fragments
then pass out along the duct.

18. Sialadenitis
The salivary glands contain a network of ducts. Saliva flows through them into the mouth. If the flow is reduced or stopped for some reason, infection can grow.
This infection called sialadenitis .
The most common infection is bacterial.
Sialadenitis is most common in the parotid gland and the submandibular gland.

19. Sialadenitis Symptoms: Tender, painful in cheek or under chin.
Pus may drain through the gland into the mouth.
If the infection spreads, fever, chills and malaise may occur.
:Complications
Oral infection.
Upper respiratory tract infection.
Upper GIT infection.
Investigations:
Physical examinations.
CT scan, ultrasound scan or MRI scan.
Culture for identify the organism.

20. Sialadenitis Treatment:
The first step is to make sure about fluid balance.
Patient needs to receive fluids intravenously
Antibiotics to destroy the bacteria.
Sugarless sour candies or gum is recommend ,they can stimulate the glands to produce more saliva.
If the infection is not improving, surgery may be needed to open and drain the gland.
Prevention:
Always drink plenty of fluids. This is especially important after surgery, during illness or in elderly people

21. ASSESSMENT History : pain, swelling, edema Change Of appetite Diet
Physical examination
The nurse assesses for client anxiety and fear.

22. NURSING PROBLEM Discomport : pain Fluid volume deficit
Nutrition deficit
Anciety
Regiment terapeutic inefectif