Obstructive and inflammatory disorders

Obstructive And Inflammatory DisordersAhmed Ali Salman Ahmed 20102050236SialolithiasisSynonyms: Calculus and salivary stones.

Diseases mechanism: Formation of calcified obstruction within the salivary duct leading to infection.Usually one gland is involved (mostly Wharton's duct).

Clinical features: Intermittent swelling, pain with eating and signs of infection.Imaging features:

Radiopaque or radiolucent depending on degree of calcification.Radiolucent appears as ductal filling void and is referred as mucous plugs. Radiopaque plain radiograph radiolucent sialographySialography is not used if a radiopaque stone has been shown in the distal portion of the duct.

Occlusal film. Sialogram

Posteroanterior skull view of the parotid Posteroanterior skull view of sialogramLateral view

Axial CBCT Lateral CBCT Differential diagnosis: Phlebolith(has radiolucent centre).Calcified lymph nodes(cauliflower shape).Tonsillar sialolith(multiple and inferior to the occlusal plane).

Treatment: sialagogues to stimulate secretion, removed by surgery, total excision.Bacterial sialadenitisSynonyms: Parotitis and submandibulitis.

Disease mechanism: Acute or chronic bacterial infection as a result of reduced salivary secretions (mostly parotid).

Clinical features: Unilateralacute phase(redness, swelling, tenderness, malaise and expression of pus from saliva) If not treated chronic phase(fibrosis and scar).Imaging features: sialography is contraindicated in acute phase why?

Treatment:conservative(sialagogues, oral hygiene, AB)Not cured conservatively :excision

Contrast enhanced CT image showing enlarged left parotid gland.SialodochitisSynonym: Ductal sialadenitis.

Disease mechanism and imaging features:Inflammation of ductal system of salivary glands.In chronic phases interstitial fibrosis leading to sausage string appearance(alternating strictures and dilations)Common in both parotid and submandibular salivary glands pic above.

Treatment: Same as sialadenitis.Autoimmune sialadenitisSynonyms: Myoepithelial sialadenitis, Autoimmune sialosis, Benign lymphoepithelial lesion, Sjogren syndrome

Disease mechanism: Group of disorders affect the salivary gland and share an autosensetivity (different developmental stages of the same immunologic mechanisms)

Clinical features:

Primary SS:Xerostomia.Exophthalmia Secondary SS: XerostomiaExophthalmiaCT disease

40-60 y.o.

90-95% female prevalence.

Imaging features: Sialography is helpful in the diagnosis and staging of autoimmune disorders.

Early stage: globular sialectases(spherical collections 1-2mm of contrast agent evenly distributed throughout the gland, normal main duct).

Conventional sialography, lateral projection. Late stage: cavitary sialectases(irregular collections>2mm of contrast agent not uniformly distributed throughout the gland, dilatation of main duct).

End stage: complete destruction of the gland.

Treatment: Xerostomia: salivary stimulants, increase fluid intake.Exophthalmia: artificial tears.CT disease.