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Amm

Salivary Glands
The salivary glands are
exocrine glands, glands with
ducts, that produce saliva.
There is 3 pairs of major
glands: Parotid,
submandibular, sublingual.
Other minors (approximately
450) that are distributed in
the mucosa of the lips,
cheeks, palate, floor of the
mouth and retromolar area.
A few are also found in the
nasopharynx , paranasal
sinuses, larynx, trachea,
bronchi & lacrimal glands.

-lying mainly below the
external acoustic meatus
between mandible and
sternomastoid.

Structures within Parotid
Gland
– Branches of the facial
nerve.
– The terminal branch of the
external carotid artery
that divides into the
maxillary artery and the
superficial temporal artery.
– The retromandibular
vein.(((temporomaxillary
vein), formed by the
union of the superficial
temporal and maxillary
veins)
– Intraparotid lymph nodes.

Parotid
gland

Submandibula r gland: .Large superficial and small deeper part continuous with each other around the post. Border of mylohyoid • .

(The deep part of the gland lies on the hyoglossus muscle closely related to the lingual nerve and inferior to the hypoglossal nerve. – Lingual nerve. (running over the surface of the gland) – Facial artery. anatomical relationship of the gland – Anterior facial vein. – Hypoglossal nerve.) – Marginal mandibular branch of the facial nerve .• Impo.

Sublingual • Lies beneath the oral mucosa .

or a mixture of serous and mucous. The acini can either be serous. • Histology .serous and mucous.• Compound Tubuloalveolar glands • Salivary glands are made up of secretory acini (acini . There are two types of secretions .means a rounded secretory unit) and ducts. mucous.

We have Three Types of Cells . • Submandibular glands have a mixture of mucous and serous acini. SECRETORY CELLS : 1-Serous : proteins in an isotonic watery fluid.(some mucous alveoli capped by serous cresents – ’Demilunes’) . Tow secretory (serous and mucus ) and myoepithelial cells. 2-Mucus :Mucin (lubrication ) MYOEPITHELIAL CELLS: Surround each secretory portion and are able to contract . • Sublingual glands have mainly mucous acini. • Parotid glands have mainly serous acini.

. an enzyme which breaks-down starch into dextrin and maltose. – It contains ptyalin. gum. & teeth.Function of Salivary Glands Physiolo gy About 1500ml of saliva is produced each day – It facilitates swallowing – It keeps the mouth moist & aids speech – It serves as a solvent for molecules which stimulates the taste buds – It cleans the mouth.

Carcinoma )  Non Epithelial ( Fibromas ) .Salivary GlandsDiseases • Inflammatory – – – – – Acute parotitis TB Mumps Actinomycosis Cat scratch disease • Obstructive – Sialolithiasis – Sjögren syndrome – Strictures • Tumors  Epithelial ( adenoms . Mucoepidermoid .

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Tumors • BENIGN I.Salivary Glands. MALIGNANT I. Pleomorphic adenoma “mixed tumor” II.Adenolymphoma “warthin’s tumor” •. Mucoepidermoid tumor II. Carcinomas .

60% are benign and 95% of the benign are pleomorphic ad.• Parotid gl. 75% of all salivary t. 10% of all salivary t.... • Sub mand. gl. only 40% are benign pleomorhic ad. . 15% of all salivary t. 80% are benign and 80% of the benign are pleo-morphic ad. • Minor salivary gl.

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Benign Tumors I.ADENOLYMPHOMA “WARTHIN’S TUMOR” .Salivary Glands.PLEOMORPHIC ADENOMA “MIXED TUMOR” II.

Pleomorphic adenoma .

epidemiology • Appears in early and middle adult life • occurs more often in males than in females. .Pleomorphic Adenoma • is the most common salivary gland tumor • accounts for about 60% of all salivary neoplasms.

.• The tumor is usually solitary and Slowly growing benign tumor but strands or lobules of the tumor tends to penetrate the thin capsule and extend beyond the main limits of the mass (enucleation is inadequate). • Pleomorphic adenoma shows a remarkable degree of morphological diversity.

epithelial and myoepithelial cells. . Cystic areas may appear due to excessive mucoid accumulation. and mesenchymal or stromal elements. cells proliferate in sheets with the production of a mucoid material which separate the cells producing a myxomatous appearance cartilage like.cells proliferate in strands or duct like • Myoepith.• The essential components are the capsule. Histopathology: • Epit.

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• After many years(10-30). few tumors may exhibit malignancy(carcinoma in pleomorphic adenoma).(NOT by simple enucleation ) . • Treatment of benign tumor is by superficial parotidectomy.

• Clinical presentation: – The patient complains of a painless swelling on the side of their face which has been present for months or years and which is slowly growing. – Tenderness :Not tender – Shape mostly Spherical . it may present as an eversion of the ear lobe. . • Examination: – Position :The majority of parotid adenoma are found just anterior and superior to the angle of the jaw. – Lump may be more prominent when the mouth is open or when eating. of overlaying skin are normal. – When found in the parotid tail. but as they grow they become flat on their deep surface and slightly pointed superficially . – Color and temp.

Paralysis of any facial muscles indicates infiltration of the nerve . hard consistence . (not attached to the lump . • Surface :Smooth • Edge : distinct and easy to feel • Composition :rubbery . . • It is usually mobile unless found in the palate • Lymph drainage: Cervical LNs should not be enlarged. which means that the lump is a carcinoma . • Relation: Overlying skin and ear are freely movable . not fluctuant or translucent and not compressible.• Size :Vary from pea-sized nodules to large masses 20 cm across.dull to percussion . not a benign adenoma. • Local tissue: The facial nerve should function normally .

Adenolymphoma Warthin’s Tumor .

• recent studies show slight female predilection ( possibly due to the tumor's association with cigarette smoking and the growing use of cigarettes by women. but there is a strong association with cigarette smoking.) .Adenolymphoma. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population. Epidemiology • Warthin's tumor primarily affects in middle aged or elderly males (age 60–70 years).Warthin’s Tumor etiology is unknown.

• The stroma contains lymphoid tissues and follicles.Histopathology : • It is formed of a double layered epithelium with spaces of cysts “papillary-like appearance”. .( does not turn into malignancy) • Can be multiple and bilateral. • It forms a hot spot in a 99m Tc-pertechnetate Treated by superficial parotidectomy. • Purely benign.

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of overlaying skin looks and feels normal. – Tenderness :Not tender – Shape Spherical . painless swelling over the angle of the a jaw (tail of the parotid gland). The swelling may be bilateral.• Clinical presentation: – The patient complains of a slow-growing . . – Color and temp. slightly lower than common site of origin of the pleomorphic adenoma. (10% of parotid tumors ) • Examination: – Position :Usually develop in lower part of the parotid gland .

dull on percussion and not translucent but they often fluctuate.• Size : 1 – 3 cm in diameter • Surface : smooth and well defined. • Composition :Soft consistence . . The site and consistence of the lesion are the features which make one suspect that a parotid swelling is an adenolymphoma. • Local tissue: the adjacent tissues are all normal. • Relation: the lump can be moved a little in all directions and is not attached to the skin . • Edge : distinct and sometimes seem separate from parotid . • Lymph drainage: Cervical LNs should not be enlarged.

at the right of the image. is well-demarcated from the adjacent parotid tissue  .The tumor.

Malignant Tumors I.Salivary Glands. Mucoepidermoid tumor II. Carcinomas .

Mucoepidermoid tumor .

as bronchi.Mucoepidermoid tumor • is the most common type of malignant salivary gland in adults. Histology This tumor is not encapsulated and is characterized by squamous cells. • Mucoepidermoid carcinoma can also be found in other organs. A causal link with cytomegalovirus has been strongly implicated in a 2011 research. It is composed of sheets and masses of epidermoid cells and cystic spaces lined by mucus secreting cells (no cartilage like appearance) . and intermediate cells. Epidemiology Occurs in adults. with peak incidence from 20–40 years of age. lacrimal sac and thyroid. mucus-secreting cells.

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Clinical Features
Presents as painless, slow-growing hard mass. Most
appear clinically as mixed tumors.
• harder than mixed tumor, yet become fixed when
large.
• Mostly they do not cause facial paralysis.

• They are of varying speed of growth and degree of
differentiation.
• Mostly they are slow-growing and invade local tissues
to a limited degree.
• Only occasionally grow rapidly and metastasize to
lymph nodes, lungs or skin.

• FNA is necessary for diagnosis.

Management :
• Superficial parotidectomy if the tumor is of the
benign variety, but if it’s of the malignant variety,
we have to remove the whole parotid gland.
• radiotherapy may be advisable.

prognosis
• Generally, there is a good prognosis for low-grade
tumors, and a poor prognosis for high-grade
tumors.

It can arise de novo . CT scan is used to see the involved LNs. The patient is usually over the age of 50. They are hard . rapidly-growing . Men and women are equally affected. but not very rare. Tend to produce obvious clinical signs of malignancy at an early stage. In these conditions radical excision . or in a long-standing pleomorphic adenoma. FNA is necessary for diagnosis. and may infiltrate the surrounding tissues. block dissection of the neck . and radiotherapy may be necessary. .Carcinomas • • • • • • • • Carcinoma of the parotid gland is uncommon .

especially during movements of the jaw. • The patient may give a history of a preceding painless lump that has been present for many years. • The swelling is persistently painful . The pain may radiate to the ear and over the side of the face. .Carcinomas  Clinical presentation • The common complaint is of a rapidly enlarging swelling on the side of the face. • The patient may also complain of asymmetry of the mouth and difficulty in closing the eyes.

as it spreads in different directions . the patient will be unable to use the muscles of facial expression. hyperaemic and hot. • If the facial nerve is infiltrated . If the underlying skin is infiltrated it may be reddish-blue. the surface is smooth but irregular . and the edge is often indistinct. .Carcinomas  Examination • The tumor is basically a flattened hemisphere but . its shape becomes irregular. • The cervical LNs are likely to be enlarged and hard. • Its size increases inexorably . • There may be evidence of disseminated blood-borne metastases. • The mass is not very tender .

apart from the site. . and is diagnostic of carcinoma of the submandibular gland.Carcinomas • The physical features of the pleomorphic adenoma and carcinoma in the submandibular gland are identical to those of these tumors when they occur in the parotid gland . • Numbness of the anterior two-thirds of the tongue indicates infiltration of the lingual nerve .

Carcinomas .

– Facial numbness. – Frey’s syndrome. – Marginal mandibular nerve injury. – Sialocele. – Hypoglossal nerve injury. • Parotid gland: – Haematoma formation. – Transection of the facial nerve and permanent facial weakness. – Lingual nerve injury. – Transection of the nerve to the mylohyoid muscle producing submental skin anaesthesia. – Wound infection.Complications of Salivary gland excision • Submandibular gland: – Haematoma. – Temporary facial nerve weakness. . – Permanent numbness of the ear lobe associated with great auricular nerve transection. – Infection.

Sialocele .

Frey’s Syndrom e .

• Cervical node enlargement. .Clinical features of malignant salivary tumours • Facial nerve weakness. • Rapid enlargement of the swelling. • Induration and/or ulceration of the overlying skin.

controversial as it rarely alters surgical management. and its border can be imaged to highlight whether it is circumscribed and probably benign or diffuse. • Fine-needle aspiration biopsy is a safe alternative to open biopsy. The role of fine-needle aspiration biopsy is. there is no risk of seeding viable tumor cells.Investigation • Computerised tomography (CT) and MRI scanning are the most helpful techniques for imaging tumors arising in the major salivary glands. however. which is helpful in planning surgery. • Open surgical biopsy is contraindicated as this may seed the tumor into surrounding tissues. The scan will highlight the relationship of the tumor to other anatomical structures. provided the needle gauge does not exceed 18G. invasive and probably malignant. . The tumor is intrinsic to the gland. making it impossible to eradicate microscopic deposits of tumor cells (unless malignancy is suspected). There is evidence to suggest that.

• The main symptoms are pain and swelling beneath the jaw .Sialolithiasis • Submandibular gland is the most common site of salivary calculi. • Easily demonstrated by X-ray. • A salivary gland calculus is composed of cellular debris . or worsen . • Men and women are equally affected. caused by obstruction of Wharton’s duct. • Pain goes away before the swelling. and calcium and magnesium phosphates. before and during eating. • Most occur in middle-aged adults. mucous . • Very rarely . . the patient may notice discomfort and a swelling in the floor of the mouth. bacteria . • Both symptoms appear .

tumor . • Calculi within the duct may be removed through the floor of the mouth. or stricture. . • Calculi are radio-opaque . • When the gland gets infected . • Sialography is necessary to demonstrate the lumen of the ducts for stone . On the other hand .Sialolithiasis • Pressure on the gland may give foul tasting saliva (purulent saliva). • Acute & subacute infection may be the first indication of a stone. calculi within the gland need excision of the submandibular gland. it gives the features of cellulitis. can be seen on plain X-ray. • Persistent obstruction damages the gland making it harder and tender.

Sialolithiasis .