Presentation on theme: "Salivary Glands Disorders"— Presentation transcript:
1 Salivary Glands Disorders Dr. Sirwan Abdullah Ali FASMBSIFSOASOFACHDr.med.univ.
2 Anatomical Considerations Two submandibularTwo ParotidTwo sublingual> 400 minor salivary glands
3 Minor salivary glands These lie just under mucosa. Distributed over lips, cheeks, palate, floor of mouth & retro- molar area.Also appear in upper aerodigestive tractContribute 10% of total salivary volume.
4 Sublingual Salivary glands Smallest of the major salivary glands.Almond shapeDeep to the floorof mouth mucosa.It is drained by approximately10 small ducts (Ducts of Rivinus)
5 Submandibular Gland Wharton’s duct lateral to the lingual frenulum The gland forms a ‘C’ around the anterior margin of the Mylohyoid muscle; a superficial and deep lobe.
6 Parotid Gland largest salivary gland FASCIAL NERVE divides it into 2 surgical zones (the superficial and deep lobes).
7 Stensen’s duct … 1.5 cm inferior to the Zygomatic arch. superficial to the masseter muscle,then turns medially 90 degreesto pierce the Buccinator muscleat the level of the second maxillary molar where it opens into the oral cavity.
8 Functions 1500 ml of saliva / day; It facilitates swallowing From the parotid gland: thin, watery fluid,Sublingual and Submandibular glands: much thickerIt facilitates swallowingIt keeps the mouth moist & aids speechIt serves as a solvent for molecules which stimulate the taste budsIt cleans the mouth, gum, & teeth.It contains enzymes
9 Diagnostic Approaches Evaluation of dry mouthPast & present medical historyClinical examinationSaliva collectionSalivary gland imagingSalivary gland biopsy & FNASerologic evaluation
10 Clinical History History of swellings / change over time? Trismus? Pain?Variation with meals?Bilateral?Dry mouth? dry eyes?Recent exposure to sick contacts (mumps)?Radiation history?Current medications?
11 Diagnostic approach Clinical examination Extra-Oral examination:Palpate cervical lymph nodesPalpate the gland- Slightly rubbery- Painless unless infected/inflammedCheck motor function of facial nerve
16 Sialadenitis Acute infection Allergic sialadenitisPost-irradiationSarcoidosisSialadenitis of minor glands
17 Bacterial sialadenitis Susceptible individuals:gland hypo-functionAge extremesPoor oral hygieneParotid gland most commonly affectedMandibular gland is less affected because of tongue movement and high level of mucin in saliva which as potent antimicrobial activity, while parotid is adjacent to first molar which has calculus and debris
18 Acute suppurative sialadenitis It is an ascending infection-Staph. Aureus & strept. Viridans-From the oral cavity-By a reduction in salivary flowFollowing major surgical operations;-Due to dehydration-Poor oral hygiene
19 Bacterial sialadenitis Clinical picture:- Sudden onset- Gland is painful- Indurated- Erythematous overlying skin- It raises the lobule of theear- Temp: above 37.8’C.Mandibular gland is less affected because of tongue movement and high level of mucin in saliva which as potent antimicrobial activity, while parotid is adjacent to first molar which has calculus and debris
20 Acute Suppurative Sialadenitis Brawny swelling on the side of the faceAdvanced cases: skin dusky red.Purulent discharge from orificeFluctuation: pus penetratedthe parotid sheath.
21 Lab Testing Parotitis ;a clinical diagnosis Elevated WBC MRI, CT or ultrasoundNeedle aspiration of abscessPus expressed from the duct for C&S.
22 Bacterial sialadenitis Treatment:- IV antibiotic- Milk the gland several times a day- Increase hydration- Improve oral hygieneMandibular gland is less affected because of tongue movement and high level of mucin in saliva which as potent antimicrobial activity, while parotid is adjacent to first molar which has calculus and debris
23 Acute viral infection Mumps parotitis: by the paramyxovirus Broad range of viral pathogensSYSTEMIC from the onset
30 Sialolithiasis ( salivary stones) One or more round or oval calcified structures in the duct of the major or minor salivary glands
31 Salivary calculi Submandibular Most common Pain subsides before swelling.Recurrent painful swelling at mealtimeAcute & subacute infectionPersistent obstruction damages the gland making it harder and tender
32 Salivary calculi Skin is red, oedematous , hot and tender if infected Bimanual palpation
34 SialographyDemonstrate the lumen of the ducts for stone, tumor, or stricture.
35 Sialolithiasis Treatment Conservative: antibiotics and anti-inflammatory:spontaneous stone passage.Excision: - Lithotripsy- sialendoscopy- manipulation fails then asurgical cut is made into ductGland excision- the stone is within the gland- the gland is severely damaged by chronic infection.
36 Granulomatous conditions 1- Tuberculosis:- Xerostomia- Salivary enlargement2- Sarcoidosis:- Severity and duration of disease varies- Mild improvement noticed with steroid therapy
37 Sjogren SyndromeAutoimmune condition causing progressive degeneration of salivary and lacrimal glandsconnective tissue disorder, such as rheumatoid arthritis
38 Clinical picture saliva and altered saliva composition xerostomia Mostly affects the parotid glandPersistent / intermittent gland enlargem.Bilateral, non-tender, firm, and diffuse swelling saliva and altered saliva composition xerostomiaSignificantly increased risk of developingB-cell lymphomaKeratoconjunctivitis sicca
41 Disorders of minor salivary Glands MalignancyExtravasation Cysts- Follow trauma- Mainly MSG lower lip- Visible painful swelling- Some resolve spont.or require surgery
42 Disorders of sublingual Glands Are very rareMinor mucous retention cystsPlunging ranula is a retention cyst that tunnels deepNearly all tumours are malignant
43 Disorders of sublingual Glands Tumours are rare90% are malignantWide excision andneck dissection
44 Tumors of Submandibular Glands UncommonSlowly growing, painless10 % malignantInvestigations:- CT/MRI- FNAC- No open biopsy
45 Management Small & encased within capsule: intracapsular excision Large benign:excisionMalignant tumours:require concomitantneck dissection
46 Parotid Tumours Most Common is pleomorphic adenoma (80-90%) Low grade Tumors are not distinguishable from benign tumoursHigh grade Tumours grow rapidly, are often painful and have LN metastasisCT/MRI are usefulFNAC better than open biopsyTx should be excised
47 Pleomorphic adenoma Benign Tumor The most common salivary T. In middle aged & more in woman than in men,Slowly growingTreatment :Superficial parotidectomy.
48 Carcinomas Hard, rapidly growing infiltrating mass with Fixation resorption of bone & ulcer.Pain, anesthesiamuscle spasmlater paralysis