ŽLIJEZDE SLINOVNICE

doc.dr.sc. Željka RojeKlinika za bolesti uha, nosa i grla s kirurgijom glave i vrata

KBC Split

SEKRECIJA SLINE

Ukupno 1000 do 1500 ml u 24 sata 60% u parotidnim žlijezdama, 30% u

submandibularnim, 5% u sublingvalnim i 5 % u malim žlijezdama

Stvara se iz plazme procesima difuzije i osmoze između kapilara i acinusnih stanica

SASTAV SLINE

99,42% voda 0,22% Kalcijev fosfat i karbonat 0,14% amilaza

FUNKCIJE SLINE

Probavna (oblikovanje bolusa, amilaza) Zaštitna općenito(lizozimi) Zaštitna lokalno (obnova i održavanje

cakline zuba, mehaničko čišćenje zubala) “Epidemiološka”(virusi) Posreduje u osjetu okusa Sudjeluje u održavnju AB ravnoteže

FUNKCIONALNI POREMEĆAJI SLINJENJA

HIPOSALIVACIJA (HIPOPTIJALIZAM) Smanjeno stvaranje sline U kroničnim upalama, degenerativnim bolestima,

nakon iradijacije, dehidracije, uporabe lijekova s antikolinergičnim učinkom (atropin), neuroleptika, sedativa, antihistaminika

Liječenje: palijativno HIPERSALIVACIJA (PTIJALIZAM)

Nepoznate geneze Liječenje: atropin, zračenje – male doze

DIJAGNOZA

Anamneza Klinički pregled (palpacija, inspekcija) Specijalne pretrage: sijalografija,

scintigrafija UZ, CT, NMR Citološka punkcija

Infectious parotitis Acute bacterial parotitis: The patient reports

progressive painful swelling of the gland and fever; chewing aggravates the pain.

Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement is present in most instances.

HIV parotitis: Nonpainful swelling of the gland occurs; otherwise, patient is asymptomatic.

Parotitis in tuberculosis: Chronic nontender swelling of one parotid gland occurs, or a lump is noted within the gland. Symptoms of tuberculosis are found in some cases.

Chronic punctate parotitis (chronic autoimmune parotitis) Mikulicz disease: This is a historical disease

only; it should not be diagnosed today. Sjögren syndrome: Recurrent or chronic

swelling of one or both parotid glands with no apparent cause is noted. It is frequently associated with autoimmune disease. Discomfort is modest in most cases and is related to dry mouth and eyes.

Lymphoepithelial lesion of Godwin: This is a historical category that is not used today.

Diseases of uncertain etiology  Recurrent parotitis of childhood: Repetitious

episodes of unilateral or bilateral mumps like episodes in a young child are indicative.

Sarcoidosis: Chronic nontender swelling of parotid gland occurs.

Chronic nonspecific parotitis: Most commonly, patients experience episodes of painful parotid inflammation that last for hours to weeks with relative asymptomatic periods between. Pain varies from mild to incapacitating.

Ca fosfat 74%Ca karbonat 11%ostalo

TUMORI

TUMORI

Najčešći u parotidi Što je žlijezda manja šansa da se radi

o malignom tumoru je veća!

TERAPIJA

kirurgijaradioterapija

KIRURGIJA

Superficijalna parotidektomija Totalna parotidektomija TP s disekcijom vrata TP sa žrtvovanjem ličnog živca (ev.

rekonstrukcija živca)