SALIVARY GLAND

DISEASES DR.LINDA MAHER

SALIVARY GLANDS group of glands that secretes salivaCLASSIFIED INTO :1\MAJOR SALIVARY GLANDS 1 -parotid glands 2 -submandibular glands 3 -sublingual glands2\MINOR SALIVARY GLANDS more than 400 small glands scattered all

around the oral cavity(except the Gingiva and anterior palate)

Parotid gland: secretes watery (serous) saliva rich in enzymes

The peripheral branches of the facial nerve(CN VII) are intimately associated with the parotid gland.Stenson’s duct(on the buccal mucosa opposite to

the maxillary second molar)

Submandibular gland: serous and mucinous salivaWharton’s duct(in the floor of the mouth on both

sides of tongue frenulum )

Sublingual gland: secretes viscous salivaMultiple small ducts

Stinson's duct

Wharton's duct

(3)Sublingual fold with multiple sublingual gland openings

MINOR SALIVARY GLANDSThey lie just under mucosa.Distributed over lips,

cheeks ,posterior palate , floor of mouth & retro-molar area.

Contribute 10% of total salivary volume.

SALIVAHealthy person secretes about

( 750-1500 ml of saliva / day)FUNCTION OF SALIVA:1\It facilitates swallowing2\It keeps the mouth moist & aids speech

3\It serves as a solvent for molecules which stimulate the taste buds

4\It cleans the mouth, gum, & teeth.5\It contains digestive enzymes

DIAGNOSTIC USES OF SALIVA:1\The Use of Saliva Testing for

Hormones2\monitor drug use 3\screen for various diseases.4\check for the presence of

antibodies to the HIV virus. saliva is becoming a preferable

diagnostic aid because it is the easiest to collect.

( 1) OBSTRUCTIV

E

(2)FUNCTIONAL

(3)INFECTIVE

( 4) CYSTS AND

TUMORS

DISORDERS OF

SALIVARY GLANDS

1\OBSTRUCTIVE SALIVARY GLAND DISEASE

Any Disease that causes obstruction of the ductal system of salivary glands.

Tow major causes:1-salivary calculi(stone)2-duct strictures

1\Salivary calculia stone can form in a salivary gland or duct80% of salivary calculi form in the submandibular

gland

CLINICAL FEATURES:Usually the calculi are unilateral1-The classical symptom is pain when the smell or

taste of food stimulates salivary secretion.2-ductal obstruction may lead to infection , pain and

swelling of the gland3-the stone can be seen and palpated in the floor of

the mouth or can be deeply located and seen only in radiograph

DIAGNOSIS:Sialography

MANAGEMENT:Removal of the calculi by 1\milking and manipulation out of the orifice2\surgical incision

2\salivary duct stricturesStrictures means Narrowing of the

duct or papilla of a glandMainly seen in the parotid glandAETIOLOGY:Chronic trauma(E.G. from projecting

clasps or faulty restorations )leading to fibrosis

CLINICAL FEATURES:Same as salivary calculi(pin and swelling during meal time-can be

infected causing further painful swellings)

DIAGNOSIS:SialographyTREATMENT:Removal of the causeDilation of the duct by bougies

2\FUNCTIONAL DISORDERSDisorders of saliva productionCan be :1\sialorrhea (increase salivary

production)2\xerostomia or dry mouth (decrease

salivary production)

1\sialorrheaIncrease saliva production also known as

hyper salivationIt is not a significant complain as any

excess saliva can readily be swallowed.AETIOLOGY:1\local reflex to oral infections or

ulcerations or new dentures2\nausea3\false sialorhea(normal salivary flow with

lack of neuromuscular control that leads to drooling)

2\Xerostomia (dry mouth)Reduction in saliva productionAETIOLOGY:1\ORGANIC CAUSE:(sjogren’s

syndrome-irradiation)2\FUNCTIONAL CAUSE:

(dehydration- persistent diarrhea and vomiting –hemorrhage)

3\SOME DRUGS

SJOGREN’S SYNDROME1\PRIMARY SJOGREN’S SYNDROME: Combination of dry mouth and dry eye2\SECONDARY SJOGREN’S SYNDROME

Combination of dry mouth ,dry eye associated with rheumatoid arthritis

AETIOLOGY:Sjogren's syndrome is an auto immune

disease

CLINICAL FEATURES:ORAL MANIFISTATIONS:1\The oral mucosa becomes

dry ,often red shiny.2\The tongue is red and the dorsum

becomes lobulated 3\Calculus accumulation and rapidly

progressive dental caries

Oral effects of low salivary production:

1\discomfort2\difficulties with eating or swallowing3\disturbed taste sensation4\disturbance of speech5\predisposition to infections

OCULAR MANIFISTATIONS:1\failure of tear secretion2\inflammations in the eye3\risk of vision loss

DIAGNOSIS:1\low salivary flow rate2\labial salivary gland biopsy 3\antibody screenTREATMENT:Salivary gland damage is

irreversibleTreat dry mouth with artificial saliva

substitutes and frequent drinking of water

Maintain good oral hygiene and caries control

3\INFECTIVE SALIVARY GLAND DISORDERS (SIALADENITIS)CAN BE BACTERIAL,VIRAL OR

FUNGALTHE MOST COMMON INFECTIVE

DISEASES OF THE SALIVARY GLANDS:

1\mumps2\suppurative parotitis

1\mumpsHighly infectious salivary gland disease that

causes painful swelling of the parotid gland and some times other glands.

AETIOLOGY:Paramixovirus (mumps virus)

CLINICAL FEATURES:1\affect mainly children2\headache , malaise ,fever and painful swelling

of the parotids3\permanent nerve damage may occur4\after one infection the immunity is long lasting

DIAGNOSIS:Usually obvious from clinical

manifestationAntibody screenMANAGEMENNT:Symptomatic treatment (analgesics-

antipyretics)Supportive treatment (bed rest –fluid

intake-warm or cold compress to the swollen glands to reduce the pain)

2\suppurative parotitisIt is a bacterial infection of one or both parotid

glands

AETIOLOGY:Staphylococcus aureus bacterial speciesMostly seen in patients with severe xerostomia

CLINICAL FEATURES:Pain on one or both parotid glandsSwelling , redness and tendernessPus exudates from the parotid ductIf not treated may lead to abscess formation with

fever and malaise.

DIAGNOSIS: Culture and sensitivity testing for

the pus.TREATMENT: antibiotics

4\CYSTS AND TUMORSA)CYSTS OF SALIVARY GLANDSMUCOCELES:The most common type of salivary cystsAffects minor salivary glandsAETIOLOGY:Extravasations of saliva as result of damage

to the duct of the salivary glandIt is not a true cyst as it has no epithelial

lining

CLINICAL FEATURES:Mucoceles most often form in the lower lip but occasionally on the buccal mucosa or floor of the mouth (mucoceles in the floor of the mouth is named ranula)

Appear as rounded fleshy swelling about 1cm in diameter

Then it become cystic ,hemispherical and bluish due to thin wall

mucocele ranula

TREATMENT:Surgical excision of the cyst with the

underlying minor gland

B)TUMORS OF SALIVARY GLANDS

70% of salivary glands tumors develop in parotid gland and few affect the submandibular gland. Sublingual tumors are very rare.

AETIOLOGY:Unknown but can result from

irradiation to the head and neck region

CLASSIFICATION OF SALIVARY GLAND TUMORS:

S.G TUMORS

EPETHELIAL

BENIGN(ADENOMA)

MALIGNANT(CARCINOMA

)

NON-EPETHELIAL

SARCOMA LYMPHOMA

TYPICAL CLINICAL FEATURES OF SALIVARY GLAND TUMORS

BENIGN MALIGNANT 1-slowly growing2-soft or rubbery

in consistency3-do not ulcerate4-no associated

nerve signs

1-fast growing and painful

2-hard consistency3-may ulcerate and

invade bone4-cause cranial

nerve palsies(dysfunction of the nerve affected)

Pleomorphic adenoma(benign)

Adenocarcinoma(malignantPleomorphic adenoma(benign)

Lymphoma(malignant)

DIAGNOSIS:MRI or CT-SCANBiopsy and histological examinationTRETMENT:1\surgical excision for both

malignant and benign tumors2\if the tumor is malignant

chemotherapy is indicated after excision

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