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Salivary Gland DiseasesSalivary Gland Diseases
Dr shabeel pn
Salivary Gland DiseasesSalivary Gland Diseases
Functional disordersObstructive disordersNon-neoplastic disordersNeoplastic disorders
Functional DisordersFunctional Disorders
Sialorrhea (Increase in saliva flow)– Psychosis, mental retardation, certain
nuerologicval diseases, rabies, – mercery poisoning
Xerostomia (Decrease in saliva flow)– Mumps, sardoidosis, Sjogrens, syndrome, lupus,
post-irradiation
Funtional DisordersFuntional Disorders
Mucocele– Secondary to trauma– 70% occur in lower lip– Excisional biopsy usually curative
Ranula– Sublingual salivary gland mucocele– Treatment should include removal of sublingual
gland
Obstructive DisordersObstructive Disorders
Sialolithiasis– 92% occur in submandibular gland– 6% in parotid gland– Multiple occurrence in same gland is common
Submandibular Gland LithiasisSubmandibular Gland Lithiasis
Diagnosis– Pain and sudden enlargement of gland while
eating– Palpation of stone submandibular duct– Occlusal radiograph (80%)
Submandibular Gland LithiasisSubmandibular Gland Lithiasis
Treatment– Can be removed transorally if in duct and easily
palpable– If in gland and gland is damaged, then gland
should be removed
Parotid LithiasisParotid Lithiasis
Diagnosis– Based on history– Swelling during meals– Bimanual palpation of painful gland– 40% non-radiopaque– Most parotid stones are multiple
Partiod LithiasisPartiod Lithiasis
Treatment– Stones in extraglandular portion of duct can
be removed transorally– Intraglandular stones removed from extraoral
approach
Non-Neoplastic DisordersNon-Neoplastic Disorders
Acute SialadentisAcute Sialadentis
Etiology– Viral - ( Mumps)– Bacterial
Acute SialadentisAcute Sialadentis
Bacterial - swelling and dehydration, xerostomia, failure of secretion with ascending infection– (Staph aureus, Strep pyogenes, most
common infective organism)
Painful swelling parotid gland, overlying skin red, shiny & tense, pus from parotid duct
Acute SialadentisAcute Sialadentis
Treatment– Culture pus – Appropriate antibiotic– Supportive therapy
• Fluids
• Heat
• Salivary stimulants
Chronic SialadenitisChronic Sialadenitis
Chronic recurrent parotitis– Age 3-6– Caused by Strep viridans– May spontaneously heal during puberty
Necrotizing SialometaplasisNecrotizing Sialometaplasis
Benign inflammatory conditionUsually involves in minor salivary gland
of hard palateWill often simulate a malignant conditionNo definite etiology1-3 cm ulcer heals spontaneously
Neoplastic DisordersNeoplastic Disorders
Salivary Gland TumorsSalivary Gland Tumors
Adenomas (Epithelial)– Pleomorphic adenoma– Monomorphic adenoma– Adenolymphoma– Oxyphil adenoma– Other types
Salivary Gland TumorsSalivary Gland Tumors
Mucoepidermoid tumorAcinic cell tumor
Salivary Gland TumorsSalivary Gland Tumors
Carcinomas– Adenoid cystic carcinoma– Adenocarcinoma– Epidermoid carcinoma– Undifferentiated carcinoma– Carcinoma in pleomorphic adenoma
Non-epithelialNon-epithelial
Malignant lymphomaUnclassified tumors
Salivary Gland TumorsSalivary Gland Tumors
Allied conditions– Benign lymphoepithelial lesions– Sialosis– Oncocytosis
Salivary Gland TumorsSalivary Gland Tumors
80 % occur in parotid gland5-10 % occur in the submandubular
gland1 % occur in sublingual gland10-15% occur in the minor salivary
glands
Incidence of Malignancy Incidence of Malignancy According to SiteAccording to SiteSublingual 70%Submandibular 40%Parotid 20 %
Clinical ClassificationClinical Classification
Benign (seldom recurrent)– Adenolymphoma (Wharthins Tumor)– Oxyphil adenoma (Oncocytoma)– Other types of Monomorphic adenoma
Clinical ClassificationClinical Classification
Benign (often recurrent)– Pleomorphic adenoma (mixed tumor)– Mucoepidermoid tumor ( low-grade)– Acinic cell tumor (same)
Clinical ClassificationClinical Classification
Malignant– Carcinoma in pleomorphic adenoma– Adenoid cyctic carcinoma– Adinic cell tumor– Mucoepidermoid tumor (high-grade)
Clinical ClassificationClinical Classification
Malignant– Squamous carcinoma– Adenocarcinoma, other types– Undifferentiated carcinoma
Sinus DiseaseSinus Disease
SinusitisSinusitis
AcuteChronic
Acute SinusitisAcute Sinusitis
Deep-seated ache which rapidly increases in intensity over evolved sinus
May cause pain in upper molar teethPain is generally accompanied by
increase in temperatureRadiographic evidence of “air fluid level”
Acute SinusitsAcute Sinusits
Treatment (early in course)– Humidification– Antibotics– Systemic decongestants and nasal spray
Refractory cases– Surgical intervention
Chronic SinusitisChronic Sinusitis
Recurrent bouts of sinus infectionLow-grade in nature
– Multiple causes• Viral, bacterial, fungal, allergic, anatomic
– Radiographis findings of thickening of mucosa, polys
Chronic SinusitisChronic Sinusitis
Treatment– During acute phase- same as acute sinusitis– If physical obstruction of ostic, septoplasty or
Caldwell-Luc with nasal antrostomy
Chronic SinusitisChronic Sinusitis
If allergy related:
– Avoidance of precipitating allergens– Short course of topical – Decongestants– Allergy testing and desensitization therapy
Complications of SinusitisComplications of Sinusitis
Orbital cellulitis– Can result in blindness secondary to ischemia of
the retina or retinal detachment
Cavernous sinus thrombosis– Can result in blindness– Deficits of the central nervous system and death