Diseases of salivary gland
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Transcript of Diseases of salivary gland
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DISEASES OF SALIVARY GLAND
NUR AINA BINTI AB KADIR
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INTRODUCTION Anatomy of salivary gland Non-neoplastic Neoplastic
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PAROTID GLAND the
sternocleidomastoid muscle behind;
the ramus of mandible in front;
superiorly, the base of the trench is formed by the external acoustic meatus and the posterior aspect of the zygomatic arch.
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SUBMANDIBULAR GLAND elongate
submandibular glands are smaller than the parotid glands, but larger than the sublingual glands.
Each is hook shaped
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SUBLINGUAL GLAND Smallest Each is almond
shape Lateral to the
submandibular duct and associated lingual nerve in the floor of the oral cavity
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INNERVATIONS
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NON-NEOPLASTIC DISORDERS
Mumps (viral parotitis)
Acute suppurative
parotitis
Chronic recurrent
sialadenitis
Sialectasis
Granulomatous disease
Salivary calculi
Sjogren’s syndrome
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Paramyxovirus Droplets
infection, fomities Children IP: 2-3 weeks(7-
23 days) Excreted through:
salivary, nasal and urinary
Orchitis Ophritis Pancreatitis Aseptic meningitis Unilateral
sensorineural hearing loss
Thyroiditis, myocarditis, nephritis, arthritis
COMPLICATIONS
INTRODUCTION
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MUMPS (VIRAL PAROTITIS)CLINICAL FEATURES
Fever(103’F) Malaise Anorexia muscular pain Unilateral parotid
swelling Other gland also Subside- 1 week
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Serum, urinary amylase- 1 week
Serology IgG,IgM: ASAP, after
10-14 days of illness IgG : past exposure,
rise more than 4x recent infection(presence of IgM)
IgM : day 5(100%)
• Proper hydration• Rest• Analgesics• Cold/hot
compresses• Avoid food:
encourages salivary flow
TREATMENT
DIAGNOSIS
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PREVENTION
Maternal immunity- 1 year
MMR vaccine: 15 months
Older children, adolescents, adults: monoclonal mumps/MMR vaccine
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INTRODUCTIONS Elderly,
debilitated, dehydrated patient
Predisposing factor: dry mouth
Staphy. Aureus Route: from
mouth Stensen’s duct(SD)
CLINICAL FEATURES Sudden onset Severe pain Enlargement of
gland Movements of
jaw- pain Opening of the
SD swollen,red, discharging pus
Febrile, toxaemic
ACUTE SUPPURATIVE PAROTITIS
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WBC: leucocytosis+ increase in polymorphs
Blood culture Pus collection
Appropriate antibiotics
Adequate hydration
Measures to promote salivary flow
Oral hygiene Surgical drainage
TREATMENTS
INVESTIGATIONS
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parotid gland recurrent bacterial infection
Acute: enlarged, tender, pus
Between acute episodes: firm, slightly enlarged
Culture: staph/strep
Sialography: normal duct system
TREATMENT: Similar to ABS Between attacks:
keep good oral hygiene, avoid drugs which dry oral mucosa
sialogogues: promote salivation
CHRONIC RECURRENT SIALADENITIS
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Dilatation of the ductal system stasis of secretions infection
Clinically: ~ CRS sialography
Different degrees: Punctuate,
globular, cavitary
May be Congenital Granulomatous
disease Autoimmune
disease (Sjogren’s syndrome)
SIALECTASIS
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Tuberculosis •Parenchyma/LN, non tender mass•Overlying skin undergoes necrosisfistula•Surgical excision, ATT
Sarcoidosis •Uveoparotid fever•Fever, enlargement of the parotid&lacrimal gland, chorioretinitis, cranial nerve palsies
Actino-mycosis •Uncommon, acute abscess with sinus formation discharging sulfur-like granule/indolent swelling•Surgical drainage, large doses of penicillin/tetracycline
GRANULOMATOUS DISEASE
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Forms in the ducts of SM/ parotid
Deposition of calcium phosphate on the organic matrix of mucin or cellular debris
Ducts/parenchyma TREATMENT
Peripheral: removes intaorally
Hilum/parenchyma: excision of the gland
Intermittent swelling
Pain Stone:visible/
palpated 80%(radio-
opaque): X-rays Radiolucent:
sialography
SALIVARY CALCULICLINICAL FEATURES
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Xerostomia Xeropthalmia Involvement:
salivary(P), lacrimal glands
Both sexes -equal Aka
Benign lymphoepithelial lesion of parotid
Mikulicz’s disease
Keratoconjuctivitis sicca (lacrimal gland)
Xerostomia(salivary, minor mucous gland of oral cavity)
Autoimmune CT disorder
Bilateral swelling 90%: female
SJOGREN’S SYNDROME(SICCA SYNDROME)
PRIMARY SECONDARY
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DIAGNOSISHistory, physical
examinationSchirmer’s testBiopsy of lower
lipSS-A and SS-B
antibodies : DIAGNOSIS
Raised ESRPositive
rheumatoid factor & antinuclear antibodies
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Epithelial or mesenchymal tissues Higher in larger size of glandsbenign 80% in parotid, 50-60% in
submandibular and 25% in minor salivary glands
Malignant features : rapid growth, restricted mobility, fixity of overlying skin, pain and facial nerve involvement
NEOPLASM OF SALIVARY GLAND
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BENIGN TUMOURS
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PLEOMORPHIC ADENOMA Most common P,SM, other minor
SG P: tail Slow-growing
tumour, quite large initially
3rd/4th decade of life
Female “mixed tumor”
Stroma: mucoid, fibroid,vascular, myxochondroid/ chondroid
TREATMENT Surgical excision+
normal gland tissue
Parotid: superficial parotidectomy
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ADENOLYMPHOMA (PAPILLARY CYSTADENOMA LYMPHOMATOSUM,
WARTHIN TUMOUR) 5th-7th decade Male:female (5:1) Tail of parotid Bilateral- 10% Multiple Rounded,
encapsulated tumor, at times cystic, mucoid/brownish fluid
Histologically: epithelial, lymphoid
TREATMENT: Superficial
parotidectomy
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ONCOCYTOMA(OXYPHIL ADENOMA)
Acidophilic cells (oncocytes)
<1% of all SG tumour
Elderly Not grow>5cm Superficial lobe of
P Benign: cystic Malignant also
seen
Increased uptake of technetium-99
TREATMENT Superficial
parotidectomy
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HEMANGIOMAS Most common benign
tumor in children Females Discovered at birth Grows rapidly in the
neonatal period, involute spontaneously
50%: coexist with cutaneous hemangiomas
Soft,painless increase in size with crying/straining
Overlying skin: bluish discoloration
Not regress spontaneously surgical excision
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LYMPHANGIOMAS Less common May involve P &
SM Soft, cystic Not regress
spontaneously surgical excision
Rare: lipoma, neurofibroma
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MALIGNANT TUMOUR
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MUCOEPIDERMOID Slow growing but
can invade facial nerve
Histologically: area of mucin-producing cells, squamous cells
Behaviour: Minor SG: akin to
adenoid cystic carcinoma
Major SG: pleomorphic adenoma
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ADENOID CYSTIC CARCINOMA (CYLINDROMA)
Slow growing Infiltrates widely into
the tissue planes and muscles
Also: perineural spaces, lypmphatics pain and VII nerve paralysis
Metastases: lymh nodes Distant: lung, brain,
bone Local recurrences after
surgical is common, as late as 10-20 years
TREATMENT: Radical
parotidectomy +largest cuff of grossly normal tissue around the boundaries
Radical neck not done unless nodal metastases
Postoperative radiation: margin of resected specimen are not free of tumour
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ACINIC CELL CARCINOMA Low grade tumor Similar to a
benign mixed tumour
Small, firm, movable, encapsulated tumor, sometimes bilateral
Metastases: RARE
Conservative approach of superficial/total parotidectomy is adopted
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ADENOCARCINOMA Minor SG Highly aggressive
locally Distant
metastases
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MALIGNANT MIXED TUMOUR Carcinoma
developing in pre-existing benign mixed tumor
A “de-novo” tumour Shorter history Rapid growth, pain
developing in benign tumour malignant
TREATMENT Radical
parotidectomy Facial nerve
sacrificed grafted immediately
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SQUAMOUS CELL CARCINOMA Rapidly growing
tumour Infiltratespain,
ulcerates through skin Metastasize to neck
nodes Radical parotidectomy
+ cuff of muscle,a portion of mandible, temporal bone, involved skin
+ radical neck: nodal metastases
Followed by postoperative radiation to primary site& the neck
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UNDIFFERENTIATED CARCINOMA Rare Aggressive Tendency to
spread rapidly Pain Fixed to skin,
ulcerates
Facial paralysis Cervical node
metastases
TREATMENT Wide excision Radical neck Post-operative
radiation
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Rare Systemic disease May occasionally
be a primary tumour
TREATMENT: Same with other
lymphomas
Rarely other sarcomas Rhabdomyosarco
ma may arise from the parotid
SARCOMALYMPHOMA
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FREY’S SYNDROME(GUSTATORY SWEATING
Complication of parotid surgery several months after surgery
Sweating, flushing of the preauricular skin during mastication-social embarrassment
d/t: aberrant innervation of sweat glands by parasympathetic secretomotor fibres- destined for the P
TREATMENT: Reassurance Tympanic neurectomy
which intercepts these PS fibres at the level of middle ear
Place sheet of fascia lata between the skin & the underlying fat, to prevent secretomotor fibers reaching the sweat gland
SC infiltration of botulinum toxin
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DISEASES OF EAR, NOSE, AND THROAT & HEAD AND NECK SURGERY BY PL DHINGRA, 6TH EDITION, PAGE 231-236
GRAY’S ANATOMY FOR STUDENTS, BY RICHARD L DRAKE, 3YH EDITION
REFERENCES