Diseases of the salivary glands

Diseases of the salivary glands
Three pairs of major salivary glands:
1. Parotid gland which secrete serous secretion.
2. Submandibular salivary glands which secrete seromucinous saliva.
3. Sublingual salivary glands which secrete mainly mucinous saliva.
There are thousands of minor salivary glands in the oral cavity, pharynx and
paranasal sinuses.
Major salivary glands.
A. Inflammatory Lesions of Salivary Glands
I. Acute Inflammation
• Viral:
• Mumps parotitis.
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• Bacterial
• Acute suppurative parotitis
Parotid abscess.
Mumps.
II.
Chronic inflammation:
• Chronic parotitis (Sialectasis): dilation of ductules of the parotid due to
fibrosis of its proximal parts due to intercurrent inflammation (or stones).
The gland is enlarged, soft tender, usually bilaterally with attacks of acute
exacerpations with high fever and pain.
• Mikulicz’ syndrome: Enlargement of all the salivary glands (parotid,
submandibular and sublinguals in addition to lachrymal gland. It is an
autoimmune disease.
• Sjögren’s syndrome: is similar to Mikilicz plus dryness of mouth and eye –
xerostomia and xerophthalmia.
B. Cysts of the salivary glands
Mucocele: It is a retention cyst which affect either minor salivary glands (in the
oral cavity especially in the buccal mucosa) or in the major salivary glands.
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Rannula: A mucocele of the sublingual salivary gland, it presents as large tense
bluish swelling in the floor of mouth which displaces the tongue.
Mucocele
Ranula
C. Stones of the salivary glands
They are 30 times more common in submandibular glands than in parotids. Why?
• Secretion of submandibular gland is more viscid.
• The drainage is less dependent.
• The opening of the submandibular duct is in the floor of the mouth, so food
debris can precipitate in it.
Clinical picture
• The obstruction caused by the stone together with the superadded infection
leads to acute (or chronic) submandibular calculous sialadenitis.
• This condition is manifested by pain and swelling of the gland on eating,
swelling or seeing food. It may be associated with fever.
• Clinically, the gland is felt bidigitally, the stone can be felt as well in the
floor of mouth.
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The submandibular stone lies in one of four positions;
(1) meatal, (2) intraductal,(3) juxtaglandular, and (4) intraglandular.
Treatment
Anatomy of the submandibular gland.
• meatal stone: only meatotomy and extraction.
• intraductal stone: open the duct in the floor of mouth under local (nerve
block) or general anaesthesia, extract the stone and do not close the incision.
• juxtaglandular stone: do not try to extract the stone intra-orally to avoid
injury to lingual nerve which hooks on the duct at this point, so excision of
the gland is mandatory.
• intraglandular stone: The treatment is submandibular sialadenectomy.
D. Tumours of salivary glands
The larger the gland, the more benign is the higher incidence
Parotid glands 80% benign,
Submandibular 60% benign,
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Minor salivary glands 50% malignant.
Parotid is gland of tumor while submandibular is a gland of stones.
Criteria of parotid gland swelling.
• Elevation of ear lobule
• Obliteration of furrow between the mandible and mastoid process.
• Get prominent on clenching of teeth.
• Less prominent on opening of the mouth.
Benign tumors
1. Pleomorphic adenoma
Rule of 80%
• 80% of tumors of salivary occurs in parotid
• 80% of them are benign
• 80% of them are pleomorphic adenoma
Treatment:
Superficial parotidectomy. If the tumour is in the deep lobe, we do total
conservative parotidectomy.
2. Warthin’s tumour. ( Adenolymphoma or Papillary cystadenoma
lymphomatosum).
• It occurs after 60 years of age, male to female = 4:1.
• Only occurs in the parotid gland (15% of all parotid tumours).
• Mostly in the tail of the parotid.
• It is soft or cystic.
• It has high incidence of bilaterality and multiplicity.
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• Treatment: Superficial parotidectomy.
Malignant salivary gland tumors.
1. Acinic cell carcinoma
It is a low grade tumour with very late lymph node and distant metastasis.
Prognosis is good in comparison to other types.
2. Mucoepidermoid carcinoma (2 types)
Low grade malignancy type.
High grade variant: with lymph nodes.
3. Adenoid cystic carcinoma (cylinderoma)
It is aggressive and has tendency to perineural spread even intracranially.
4. Carcinoma ex pleomorphic adenoma (rare).
Clinical picture of a malignant salivary tumors:
• Pain.
• Rapid rate of growth.
• Consistency is mainly hard.
• Facial nerve dysfunction or even paralysis.
• Fixity to skin → Ulceration.
• Fixity to deeper structures: muscles, bone.
• Cervical lymph node metastasis.
• Bone and lung metastasis.
Investigations of a salivary gland mass
• X-ray: Oblique view and intra-oral film for submandibular stone.
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• Ultrasonography.
• CT.
• MRI.
• PET.
• FNAC.
• Sialography: Dye study is beneficial in diagnosing sialectasis.
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