Salivary gland diseases

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Information about Salivary gland diseases
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Published on March 12, 2014

Author: magician10k

Source: slideshare.net

The salivary glands are exocrine glands that produce salvia.

 It is the largest , found around the mandibular ramus anterior and inferior to the external ear  It secretes saliva through Stensen duct into the oral cavity, to facilitate mastication and swallowing.  Facial nerve exits from the skull through stylomastoid foramen and enter the posterior aspect of the gland and divides in 2 trunks and gives 5 terminal branches and emerge from upper , anterior , inferior aspect of the gland to supply the muscles of facial expression .

Surgically the Facial nerve divides the gland into superficial and deep lobes. Also the retro mandibular vein , external carotid artery where it gives the maxillary and temporal arteries traverse the gland

Two parts the first part ( superficial ) is present beneath the deep fascia in the digastric triangle between the body of mandible and the mylohyoid It opens in the mouth floor.

 They lie anterior to the submandibular gland under the tongue, beneath the mucous membrane of the floor of the mouth.  They are drained by 8- 20 excretory ducts called the ducts of Rivinus.

Mumps is the commonest cause of salivary gland swelling. Bilateral or unilateral painful parotid gland swelling with fever  The disease is self-limiting

 Bacterial parotitis is common in the elderly postoperative patients, because of poor oral hygiene and dehydration.  Obstruction of the Stenson duct by a stone is another cause of infection.  The commonest organism is Staphylococcus aureus. The patient complains of pain and swelling in the side of the face. It becomes throbbing if an abscess forms with fever The gland is diffusely enlarged, tender , firm with red skin A stone may sometimes be felt in the duct by bimanual examination.

Gentle pressure on the gland can produce pus at the duct opening.  Antibiotics and hot fomentation is used initially Failure of 48 hour conservative treatment, or evidence of abscess formation( throbbing pain){don’t wait for fluctuation } needs surgical drainage

.  The saliva of the submandibular gland is more viscous with high calcium concentration, as well as the its dependant duct , so the submandibular stone incidence is higher than the parotid and the sublingual glands.  The stone either in the gland or in the duct. Salivary mud or stones can block the minor or major ducts, causing either localized or generalized painful swelling while eating.  A calculus may also cause acute or recurrent attacks of sialoadenitis

Plain radiograph stone in the submandibular gland is radio- opaque in 80% parotid stones are radiolucent. They shows as filling defects in Sialogram.

A stone that is palpable within a duct can be removed through the mouth but a stone within the gland must be removed with the whole submandibular gland

A fistula that discharges saliva to the skin of the cheek may result from accidental trauma injuring the parotid gland or duct.  Less commonly it complicates surgery on the gland. In some rare cases an internal fistula results from ulceration of a duct stone the mouth cavity, which is a harmless condition that needs no treatment

A fistula arising from the gland substance usually heals spontaneously, That arises from the duct is unlikely to heal because of the high rate of salivary flow. Surgical treatment is usually necessary.

 Sjogrens disease:  common in women .  Its manifestations include dryness of the mouth (xerostomia), dryness of the eye ,rheumatoid arthritis.  Some patients complain of salivary gland discomfort or have sialomegaly  Patients are 44 times prone to the development of lymphoma than the general population.  Treatment artificial tears helps to combat eye dryness oral hygiene  Steroids

Drug-induced enlargement of the salivary glands found with sulfisoxazole, phenylbutazone, iodide containing compounds, thiouracils, hypotensive drugs and contraceptive pills.  Metabolic and endocrine causes include liver cirrhosis, diabetes, alcoholism, malnutrition and pregnancy.

The majority of these neoplasms are benign and arise in the parotid gland. The incidence of malignancy varies inversely with the size of the gland, thus it occurs in 25% of parotid neoplasms, in 40% of submandibular neoplasms, and in 70% of neoplasms of the sublingual and minor salivary glands.

 The commonest salivary neoplasm is pleomorphic adenoma of the parotid.  This tumor is characterized by an incomplete capsule that allows extension of the Neoplastic epithelium into the surrounding tissues  It is slowly growing without infiltrating the facial nerve  Long-standing (more than 10 years) pleomorphic adenomas rarely turn into carcinoma  Adenolymphoma called also the warthins tumor  Soft and cystic  Affect older people

 Mucoepidermoid carcinoma arises from the duct epithelium  It usually affects the parotid.  Three grades are described; low, intermediate, or high- grade tumours. This tumor is not encapsulated . Poor prognosis for high-grade tumors.  Adenoid cystic carcinoma is the commonest malignancy  Its has slow rate of growth the perineural tissues of adjacent nerves.

The patient complains of a painless swelling on the side of the face for months or years and slowly growing, or has stopped growing The mass is non tender, firm in consistency and has a smooth surface.  It does not infiltrate the skin, the masseter nor the mandible No facial nerve affection.

 The patient commonly complains of a gradually enlarging swelling on the side of the face  Salivary malignancies do not usually grow as fast as other cancers in the body  The swelling is sometimes painful and pain may radiate to the ear.  It is firm or hard and has an irregular surface.  It may be adherent either to the skin or masseter or the mandible  If the tumor infiltrates the facial nerve, there is evident weakness or paralysis of the facial muscles  The cervical lymph nodes are sometimes involved.

CT scan and MRI for tumors arising from the submandibular and the parotid. Surgery is the only reliable form of treatment of salivary neoplasms.

Open surgical biopsy of intrinsic neoplasms of main salivary glands is contraindicated. Only allowed if there is skin infiltration or ulceration. Biopsy is done by FNAC .

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