SALIVARY GLANDS DISEASES by: Dr. Saad Al Asiri MD, DLO, KSF, Rhino General Secretary Assistant for Training & Program Accreditation ENT Consultant and Rhinologist

Clinical Anatomy Parotid Gland The largest of all major salivary glands It lies in preauricular region deep to skin & subcutaneous tissues

The parotid region contain: Parotid gland Vessels, nerve, lymphatic Secrete serous type The facial nerve divide the gland into large superficial + small deep lobe The parotid region contain: Parotid gland Vessels, nerve, lymphatic 7/16/2018

The stensen duct 1. 5 cm below zygoma, anterior is masseter M The stensen duct 1.5 cm below zygoma, anterior is masseter M. & pierce buccinator → open intraorally just opposite 2nd upper molar It run with buccal branch of Facial Nerve The parotid facial is surrounding firmly the gland

Facial Nerve Emerge from skull "stylomastoid foramen" lies lateral to styloid process Three muscular branch at syloid foramen Styloid M Post auricular M Post belly of digestive M

Tragal pointer - junction cartilage, bony Ex. Meatus Facial Nerve lies 6-8 mm anterior & inferior to tympenomastoid suture line Variation of FN & parotid gland Branches - temporal, zygomatic, buccal, marginal "mandibular" & cervical 7/16/2018

Auriculotemporal Nerve Mandibular → Foramen Oval innervate scalp Carries post ganglion fiber " parasympathetic" from otic ganglion to P. Gland Frey's syndrom "gustatory sweating" Artery Supply & Venous Drainage Superior Temporal A. Transverse F A 

Nerve → Vein → Artery Lymphatic drainage Upper deep Cx L N Sublingual salivary gland Minor salivary gland

Submandibular Gland It lies in the submandibular triangle The triangle is formed by Anterior belly of digastric muscle Posterior belly of digastric muscle Inferior margin of mandible Wrap around mylohyoid muscle in C shaped "two lobe Facial Wharton duct 5 cm length

Duct & hypoglossal & lingual Lingual nerve → duct XII nerve Chorda tympani nerve carry parsymphatetic supply There marginal mandibular 7 nerve relation Facial artery is the major artery supply

The main function of salivary gland is: production of saliva Aid in digestion Protect mucosa from desiccation Dental caries Assists in the maintenance of homeostasis  

The salivary gland secretory unit Myoepithelial cells Acinar cells Intercalated duct cell Striated duct cell Excretory duct cell

Differential Diagnosis "DD" of parotid region mass Other Tumors Haemangioma, sarcoma, lipoma, metastatic tumors Differential Diagnosis "DD" of parotid region mass Masseter hypertrophy Dental abscess

Parapharyngeal space tumor Infra temporal fossa Intraparotid lession "V, N, A, LN, fat" Metabolic disease Drug induced 7/16/2018

Parotitis Acute bacterial parotitis Common in elderly, dehydrated patient Dry mouth is predisposing factor Staph Auries > other organism C/F symptoms & signs W/ UP Rx AB antistaph + hydration 

Viral Parotitis Children > adults Incubation period 2-3 weeks Infection persist 10 days post Rx G/F unilateral swelling > than others

Complication: Orchitis, ophritis Pancreatitis mild Meningitis Unilateral SNHL Dx is clinically Serum & urine amylase is high Serology 1gG 1gM Rx - supportive, hydration, analgesia, prevention, MMR vaccine

Chronic " recurrent sialadenitis" Parotid & submandibular secretion Less secretion Recurrent infection Sialectasis + stone formation C/F Rx w/up - lab Salivary flow rate Role of radiology

Sjogren's Syndrome Rx - supportive Primary "dry mouth , eye" Conservative Surgery rarely when. Sjogren's Syndrome Primary "dry mouth , eye" Secondary RA C/F

Salivary Gland Tumors 60 - 80% of benign tumors of parotid gland are pleomorphic adenoma Warthin tumor benign Oncocytoma Vascular lymphatic malformation

Symptoms of Benign Tumor Painless slow growing When it become painful → malignancy or hemorrhage When present with LN enlargement or nerve palsy

Common malignancies Adenoid cystic CA Mucoepidermoid CA Sg cell CA Acinous cell CA Adeno carcinoma Malignant mixed tumor

Investigation Management: CT, MRI FNA Biopsy TNM staging Surgery - superficial parotidectomy Total Submandibular excision Neck dissection

Complication of Surgery Frey's syndrome Nerve damage Salivary fistula Predisposing factor to salivary malignancy Recurrent infection Radiation exposure

7/16/2018