salivary gland diseases

transcript

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

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

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

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

Mucoepidermoid tumorAcinic cell tumor

Carcinomas– Adenoid cystic carcinoma– Adenocarcinoma– Epidermoid carcinoma– Undifferentiated carcinoma– Carcinoma in pleomorphic adenoma

Non-epithelialNon-epithelial

Malignant lymphomaUnclassified tumors

Allied conditions– Benign lymphoepithelial lesions– Sialosis– Oncocytosis

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

Benign (often recurrent)– Pleomorphic adenoma (mixed tumor)– Mucoepidermoid tumor ( low-grade)– Acinic cell tumor (same)

Malignant– Carcinoma in pleomorphic adenoma– Adenoid cyctic carcinoma– Adinic cell tumor– Mucoepidermoid tumor (high-grade)

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

Treatment– During acute phase- same as acute sinusitis– If physical obstruction of ostic, septoplasty or

Caldwell-Luc with nasal antrostomy

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

salivary gland diseases

Education