Salivary gland

diseases
 SALIVARY GLAND APLASIA
Rare developmental anomaly
.absence of the one or all major salivary glands

Associated sometimes with other syndromes

Extraorally
The face has a normal appearance because the sites are filled in by fat or
connective tissue

Intraorally
xerostomia
The orifices of the missing glands are absent

TREATMENT
Saliva substitute
 MUMPS
Contagious viral infection commonly caused by Paramyxo virus
Rare by other viruses:
Influenza
Cytomegalovirus
Coxsackie virus A
HIV
Ebstein-Bar Virus

Most common cause of parotid gland swelling

of infections –parotid gland 70%–60

Submondibular gland involvement 10%

Direct contact or droplet infection

Affect any age

in winter and spring )Most common children 4-6 yrs(

: Symptoms

The incubation period (2-3 weeks)

:Prodromal symptoms
Headech , fever, malaise and abdominal pain first 3 days

:Acute stage
Unilateral or bilateral swelling of the salivary gland

Pain below the ear

Tenderness one or both parotid gland

Truisms and pain during eating

 :Complications

Rare
Orchitis lead to sterility of men
Ovaritis
Encephalitis and panceriatitis
diabetes mellitus
Senso-neural deafness

: Treatment
Resolve spontaneously in one week
Symptomatic (analgesics and antipyretic)
Soft diet and fluids
Rest
Isolation
Mumps is most contagious from one to two days before to five days after the onset
of infection in the salivary glands (parotitis)

MMR VACCINE
Recurrent Parotitis Of Childhood Juvenile recurrent parotitis

Recurrent parotitis of childhood ( 3-6) is an inflammatory condition of the parotid gland

Etiology : not known

Recurrent parotid inflammation with swelling and pain associated with fever which
 .usually lasts 2–7 days
occur every few months
Unilateral, or bilateral

Parotid swellings :smooth, soft to firm in consistency and tender

Treatment
Supportive
Hydration, gland massage
warm compresses, sialagogues, Analgesics

: Exclude
Sjogren's syndrome, lymphoma and HIV virus

Resolves spontaneously with puberty

 ACUTE BACTERIAL SIALODENTITIS
Acute inflammation in major or minor salivary glands due to infection

: ETIOLOGY
Bacterial infection from oral cavity (staphylococcus aureus and hemolytic
streptococcus and anaerobic bacteria

:Predisposing factors
Any condition lead to decrease saliva flow or obstruction
Xerostomia
Sjogren syndrome
Diabetes
salivary duct or gland stones
Idiopathic
Symptoms and Clinical features
Sudden onset of pain and swelling
Fever and malaise
USUALLY unilateral swelling
Pain of gland
Trismus

Hotness and redness of overlying skin

Purulent saliva
Redness and enlargement of duct orifice

:Treatment
Analgesics
Antibiotics (culture – amoxicillin-
clavulanate [Augmentin)
Massaging of gland to drain pus
 Chronic Bacterial Sialodentitis

Etiology
Recurrent infection due to Obstruction (stone or constriction ) of the
duct

Recurrent or low-grade swelling and tenderness (PAIN ) of the

affected gland, especially when eating

Swollen or firm gland

may appear normal on examination

Imaging (computed tomography or ultrasonography) may show calculus or

dilated duct
Sjogren's syndrome
Sjögren's syndrome is an autoimmune disease of salivary and lacrimal glands
and other tissues of the body
More common 40-60 yrs
female 90%

Etiology and pathogenesis

Autoimmune disease

Genetic (inherited) factors

Systemic disorder

10
I- Primary Sjogren syndrome (SICCA Syndrome )

Dry mouth and dry eyes are seen in the absence of connective tissue
disease
Less common

II- Secondary Sjogren syndrome

Dry mouth dry eyes with the connective tissue diseases and is more
common

Common connective tissue disorder are:

Rheumatoid arthritis -
Systemic lupus -
 A) Oral signs and symptoms

Dry mouth and erythematous mucosa

Dysphagia
Cracker sign
Caries
Candidiasis, angular stomatitis
Periodontal disease
Drying , fissuring ulceration of the tongue

Burning sensation
Abnormal taste and malodor

Recurrent parotid swelling

Smooth, Firm , Rarely Painful
Unilateral Or Bilateral
 B) Ocular Signs and
Symptoms
Keratoconjuctivitis sicca
Foreign body sensation
Inability to tear
photosensitivity

C) Others
Fatigue
Cough
Nausea
Connective tissue disease
,Kidney, muscle, nerve, liver
joints
Thyroid involvement
DIAGNOSIS
Dry mouth , dry eyes >3 months
Unstimulated salivary flow (1.5 ml in 15 minutes)
Schirmer test (≤ 5mm in 5 minutes)

Recurrent salivary gland swellings

Sjorgen Syndrome Lab Findings

Increase ESR

Autoantibodies
Positive anti-nuclear antibodies 
SS-A
SS-B

rheumatoid factor +/-

Parotid sialogram sialography
)”fruit-laden, branchless tree(

Histopathology

Minor salivary gland biopsy

Site of biopsy : lips (minor glands)

multiple lymphocytic foci
Complications
Bacterial infection of the parotid gland

Corneal ulceration

Primary biliary cirrhosis

Pulmonary Infection

Renal Failure

Lymphoma
 Treatment of Sjögren's syndrome

Sjögren's syndrome is not curable

Treatment directed to relieve of the effects of xerostomia and keratoconjunctivitis

Xerostomia Dryness of the eyes

Drinking fluids Artificial tears

Eye-lubricant ointments
pilocarpine Saliva stimulants, such as eyedrops Cyclosporine

Artificial saliva

Vitamin E

.Avoid drugs like anti-hypertensives, diuretics, anti-depressants

 Mucoceles Of Salivary Glands
Common lesion appear as Painless , smooth bluish dome-shaped mucosal swellings
that can range from 1 or 2 mm to several centimeters in size

Extravasation Mucocele
Not a true cyst because it lacks an epithelial lining
Trauma is the most common cause

Retention Mucocele
obstruction of a salivary gland duct
True cyst ,epithelial lining
 :Clinical features

Superficial lesions
Blue color, frequently traumatized causing them to drain and deflate

likely to recur and may develop surface ulceration

Deeper lesions
Diffuse, covered by normal-appearing mucosa without the distinctive blue color
The lesions vary in size over time

The lesion usually fluctuant, but some mucoceles feel firmer to palpation

Treatment
Short-lived lesions that rupture and heal by themselves
local surgical excision
To minimize the risk of recurrence, the surgeon should remove adjacent
minor salivary glands
The most frequent site is The lower lip

Buccal mucosa

The ventral surface of the tongue

The floor of the mouth

The retromolar region

.Mucocele on the posterior buccal mucosa

RANULAS
The result of blocked sublingual gland ducts-
Ranulas are unilateral, soft-tissue lesions, with a bluish appearance-
They vary in size and may cross the midline of the mouth and cause deviation -
of the tongue
A mucosal extravasation that herniates the mylohyoid muscle is called-
plunging" ranula"
 Treatment of a Ranula

Surgical excision of the lesion with involved gland

Marsupialization
suturing its walls to an adjacent structure, leaving the packed cavity to
close by granulation

Postsurgical complications

Recurrence
lingual nerve damage
Damage to Wharton’s duct
SALIVARY STONES

Salivary stones are composed of organic and

inorganic

: Salivary stones occur most commonly in

Submandibular glands (80%–90%)

Parotid (5%–15%)
Sublingual (2%–5%)

of submandibular stones are radio opaque% 80

Most parotid stones are radiolucent
The etiologic factors favoring salivary stone formation

factors favoring saliva retention -1

Irregularities in the duct system
Dehydration
Medications causing xerostomia such as diuretics
Neural diseases leads to decrease secretion

Bacterial chronic infection also promotes stone formation -2

High calcium concentration in saliva -3

The higher rate of stone formation in the submandibular gland is
:due to

The torturous course of Wharton’s duct -1

Position of the submandibular glands which lead them prone to stasis -2

The increased mucoid nature of the secretion -3

 :Symptoms depend on

The extent of salivary duct obstruction

The presence of secondary infection

Stasis of the saliva may lead to infection, fibrosis, and gland atrophy
Sialolithiasis without infectious sialadenitis
Patients complain of acute, colicky, periprandial pain
Pain due to swelling and pressure on capsule
Unilateral
Without discharge or overlying erythema
Intermittent swelling of the affected major salivary glad
.The involved gland is often enlarged and tender to palpation
.
.If partial obstruction occurs swelling may be mild with chronic painful
enlargement of the gland
 If secondery infection associated

The soft tissue adjacent to the salivary gland duct may be edematous and
inflamed

Systemic manifestations such as fever

Erythema or warmth in the overlying skin
Suppurative or nonsuppurative drainage

Other complications
Acute Sialadenitis
Ductal Stricture
Ductal Dilatation
Sinus tract, or ulceration may occur in the tissue covering the stone in chronic
cases
DIAGNOSIS
- :History
Painful swelling of the gland during meal
: Examination-
Saliva stimulator
Bimanual palpation
stone in the duct can be palpated - submandibular gland

Massage of the duct

Drainage of saliva from the duct can be seen when massage the parotid gland
Conventional Radiography

first-line to detect radio- opaque stones

Panoramic
Occlusal
Periapical radiographs

Oblique lateral films of the mandible

Antero-posterior views of the parotid region

 Radiograph - Radioopaque stone

Occlusal radiograph recommended to detect

submandibular stones

.Stones in the parotid gland can be more difficult to visualize for several reasons

Due to the superimposition of other anatomic structures

since only 20%–30% of parotid stones are radiopaque
: Sialography
Radiolucent stone

Sialography may be combined with therapeutic salivary interventional

procedures

limitations

Pain during and after the procedure

allergy to the contrast medium
Difficulty of ductal cannulation

The use of contrast sialography is contraindicated in acute sialadenitis

 TREATMENT
Small superficial stones near the orifice of duct
Hydration
Sialogogues
Milking & massage the gland
Shock wave therapy

large deep stones

Surgery -
sialendoscopy -
Is effective in multiple stones up to 4–5 mm in diameter especially those that lie
freely in the duct

:In case of secondary infection

Antibiotics ,antipyretics , Analgesics
XEROSTOMIA
Dry mouth : result from a decrease in the production of saliva

ETIOLOGY
DEVELOPMENTAL ORIGIN
Salivary gland aplasia

WATER /METABOLIC LOSS

Impaired fluid intake
diarrhea
.Local factors
Decrease mastication
Smoking
Mouth breathing

Radiation therapy
Medication Systemic diseases
Antihistaminic agents Auto immune diseases

Antidepressant Sjogren syndrome

.
Antihypertensive Diabetes mellitus

.Anticholinergic agent Sarcoidosis

Antiparkinson HIV infection

Psychogenic disorder
XEROSTOMIA

Clinical signs
.Oral mucosa appears dry, pale, or atrophic
.Tongue may atrophy of papillae with fissured and inflamed appearance
Difficulty in eating and swallowing food
.Dry, cracking lips, especially in the corners
Dry, burning mouth and throat
Difficulty with speech due to mouth soreness
Increased caries and periodontal disease
Fungal infections are common
Problems with denture wearing
.
Management of Xerostomia

: Preventive therapies
Supplemental fluoride; remineralizing solutions; optimal oral hygiene; non
cariogenic diet
: Symptomatic treatments
Water; oral rinses, gels, mouthwashes
minimize caffeine and alcohol
: Local or topical salivary stimulation
Sugar-free gums and mints
: Systemic salivary stimulation
cevimeline and pilocarpine
Treatment of underlying systemic disorders
Anti-inflammatory therapies to treat the Sjogren’s syndrome
 SIALORRHEA Hypersalivation

Description and
Excessive production of saliva and is the result of either
an increase in saliva production or decrease in salivary clearance

Etiology
idiopathic
local irritations, such as aphthous ulcers or ill-fitting oral prosthesis
Primary herpetic gingivostomatitis
Infant teething
Medications
Hyperhydration
Central nervous system mass
Heavy metal poisoning