Salivary gland disorders - 1

Dr.Abdulla Mufeed

Dept of Oral Medicine & Radiology

MES Dental College

INTRODUCTION

Classification

• DEVELOPMENTAL DISORDERS
• REACTIVE & OBSTRUCTIVE DISORDERS
• FUNCTIONAL DISORDERS
• INFECTIONS
• IMMUNE MEDIATED DISORDERS
• NEOPLASTIC DISORDERS

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DEVELOPMENTAL DISORDERS

• Aplasia/ hypoplasia
• Aberrancy
• Accessory duct
• Diverticuli
• Hyperplasia
• Congenital fistula

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REACTIVE & OBSTRUCTIVE DISORDERS

• Mucocele
• Mucous retension cyst
• Sialolithiasis
• Chronic sclerosing sialadenitis
• Necrotizing sialometaplasia
• Chelitis glandularis

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FUNCTIONAL DISORDERS

• Sialorrhea
• xerostomia

INFECTIONS

• Acute bacterial parotitis
• Chronic bacterial sialadenitis
• Recurrent bacterial sialadenitis
• Tuberculous sialadenitis
• Cat scratch disease
• Viral parotitis (mumps)
• CMV, HIV sialadenitits

IMMUNE MEDIATED DISORDERS

• Sjogren’s syndrome
• Mickulicz’s disease
• Uveparotid fever
• Allergic sailadenitis
• Amyloidosis
• SLE

Neoplastic disorders

• Benign

Ploemorphic adenoma

Monomorphic adenoma

Warthin’s tumor

Oncocytoma

• Malignant

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma

Ca in pleomorphic adenoma

adenocarcinoma

• Salivary gland aplasia/hypoplasia
• Agenesis of one or multiple glands
• Rare
• Malformations of the first brachial arch
• Asymptomatic/ hyposalivation
• Xerostomia and increased dental caries

• Aberrancy
• “Aberrant” salivary glands are salivary tissues that develop at unusual anatomic sites.
• Locations- middle-ear, external auditory canal, neck, posterior mandible, anterior mandible, pituitary.
• Usually incidental findings
• Staphne’s cyst

• Accessory Salivary Ducts
• Are common and do not require treatment.
• parotid glands
• frequent location was superior and anterior to the normal location of Stenson’s duct

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• Diverticuli
• diverticulum is a pouch or sac protruding from the wall of a duct.
• Diverticuli in the ducts of the major salivary glands often lead to pooling of saliva and recurrent sialadenitis.
• Patients are encouraged to regularly milk the involved salivary gland

Hyperplasia:

• Minor salivary glands
• 4^th to 6^th decades of life
• Localised swellings that mimic neoplasm
• Painless indolent palatal swelling- soft to firm on palpation

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Mucocele

• swelling caused by the accumulation of saliva at the site of a traumatized or obstructed minor salivary gland duct
• Mucous retention/ extravasation

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Extravasation is the leakage of fluid from the ducts or acini into the surrounding tissue.

Extra: outside, vasa: vessel

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Retention: narrowed ductal opening that cannot adequately accommodate the exit of saliva produced, leading to ductal dilation and surface swelling.

• Children & young
• Lower lip
• Fluctuant, non-ulcerated dome shaped mucosal swellings- 2mm and above
• Bluish translucent hue- superficial
• Normal mucosal color- deep
• Duration
• Intermittent appearance and shrinking
• DD: neoplasms, vascular lesions, vesiculobullous

Ranula

• Mucocele occuring in the floor of mouth
• Asso with ducts of submandibular/ sublingual glands
• ‘rana’ : frog
• Painless, slow growing
• Dome shaped fluctuant swelling
• Bluish hue
• Larger- elevates the tongue
• Plunging ranula

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Sialolithiasis

• Sialoliths are calcified bodies that develop within the salivary gland or ductal system
• The etiology is still unknown
• Inflammation, irregularities in the duct system,
• local irritants, and anticholinergic medications may cause pooling of saliva within the duct
• Nidus of salivary organic material

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• Composition :
• structure of sialoliths is crystalline- hydroxyapatite.
• calcium phosphate and carbon
• With trace amounts of magnesium, potassium chloride
• 50% of parotid sialoliths and 20% submandibular sialoliths are poorly calcified.

• Most common site- submandibular gland:
• Torturous course of Wharton’s duct
• calcium and phosphate levels
• dependent position of the submandibular glands prone to stasis.
• C/F:
• present with H/O acute, painful, and intermittent swelling of the affected salivary gland.

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• The degree of symptoms is dependent on the extent of salivary duct obstruction and the presence of II⁰infection.
• Eating will initiate the swelling & symptoms
• salivary pooling within the ducts and gland body.
• there is little space for expansion, and enlargement causes pain

• gland is usually enlarged and tender
• Salivary stasis lead to infection, fibrosis, and gland atrophy.
• Fistulae, a sinus tract, or ulceration.
• soft tissue surrounding the duct may show a severe inflammatory reaction.
• Palpation along the pathway of the duct may confirm the presence of a stone
• Radiographs, advanced imaging

• Management:
• Therapy is primarily supportive.
• Care includes analgesics, hydration, antibiotics, and antipyretics

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• Is a benign self-limiting reactive inflammatory disorder of the salivary tissue.
• Clinically, this lesion mimics a malignancy
• May be preceded by trauma injury - LA, or spontaneously
• Major & minor salivary glands can be affected.

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Necrotizing sialometaplasia

• Hard palate most common site- posterior
• Initially present as a tender erythematous nodule -- mucosa breaks down -- deep ulceration with a yellowish base
• A central necrotic crater develops
• Self limiting- 6 weeks
• Debridement & saline rinse

Cheilitis glandularis

• Rare inflammatory condition of minor salivary glands
• Cause is uncertain- tobacco, syphilis, actinic damage, hereditary etc.
• Lower lip
• Hypertrophy & inflamation of glands- swelling and eversion of lower lip
• Ductal openings dialated
• Mucopurulant secretions