DR.LINDA MAHER. SALIVARY GLANDS group of glands that secretes saliva CLASSIFIED INTO : 1\MAJOR...
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Transcript of DR.LINDA MAHER. SALIVARY GLANDS group of glands that secretes saliva CLASSIFIED INTO : 1\MAJOR...
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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