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Diseases of salivary glands (Inflammatory diseases (Sialadenitis) (causes,…
Diseases of salivary glands
Inflammatory diseases (Sialadenitis)
causes
viral
Acute Viral Sialadenitis (MUMPS)
diffuse, painfull, acute swelling of the parotid glan
the duct orifices are reddened, the secretions are nonpurulent
mild fever is present
one parotid gland is affected initialy, followed several days later by swelling of the lymph nodes, the opposide parotid gland
supportive treatment (analgesics, increased fluid intake, salivary stimulation e.g lemon drops
Complications: meningoencephalitis with permanent cranial nerve deficits, orchitis, labirynthitis, deafness.
Cytomegalovirus, Coxsackievirus, parainfluenza, HIV
autoimmune
Benign lymphoepithelial lesion ( Sjogren syndrome)
CONSISTS OF:
##
myoepithelial sialadenitis (xerostomia),
keratoconjunctivitis sicca (decreased lacrimation)
rheumatoid-type disorder (rheumatoid arthritis, lupus erythomatosus, polymyositis, scleroderma)
formation of antibodies against antigens of the salivary duct epithelium.
gradual decline in saliva production
develop
sicca syndrom
(oral dryness, infections of the oral cavity, dental caries)
affects women
50- 60 years of age.
both parotid glands are diffusely swollen with little pain
xerostomia
DIAGNOSIS: ##
•Nonspecific signs of inflamation (elevated ESR)
•Detection of parotid antibodies (Cytoplasmic antibodies Against excrectory-duct epithelium)
•„Leafless tree” pattern on sialography
•Incisional biopsy from the lips
TREATMENT ##
Usually supportive treatment is enough
Oral saliva substitutes, eye drops
3x5mg/day pilocarpine to stimulate salivation
Immunosupressant therapy is indicated Only in rheumatic disease
ionizing radiation
bacterial
Acute Bacterial Sialadenitis
(accute suppurative sialadenitis)
affects the parotid gland in dehydrated patients, Submandibular affected as a result of sialolithiasis
painful, diffuse swelling; the skin may be reddend; fluctuation
excretory duct orifices are red and swollen; turbid fluid or pus can be present.
trismus may be present
*management: antibiotics, analgesics, hydratation, salivary stimulation, good oral higiene
If an abscess developes, the gland should be incised.
Chronic recurrent Parotitis
mostly in childern
very painful swelling
the saliva is milky, granular or pure pus, tastes salty
tismus is present
between the recurrences the patient is symptom free
mostly unilateral or alternating (rarely bilateral)
treatment - same as in case of accute bacterial parotitis
Symptoms
##
Acute inflammation
rapid onset of
pain
swelling of the gland
xerostomy
duct
orifices are red and swollen
trismus
Chronic inflammation
little or
no pain
discreet swelling of the gland
- little or no xerostomy
**- duct orifice intact
**- no trismus
Accute sialadenitis
viral (Mumps)
cytomegalovirus
coxackievirus, echovirus
acute bacterial
Chronic sialadenitis
chronic recurrent parotitis
chronic sclerosing sialadenitis of the submandibular gland (Kuttner tumor) *
myoepithelial sialadenitis (benign lymphoepithelial lesion).
radiation sialadenitis
Sjogren syndrom
Noninflammatory
Sialolithiasis (Salivary stone disease)
##
formation in the excrectory duct of a salivary gland
Adults (30-40 yoa), males
LOCATION
: ##
70-80% of stones occur in the submandibular gland,
about 20% in the parotid gland.
60-70% of stones are located in the main duc
Salivary stone
result from the secondary calcification of „plugs”
that form from enriched organic salivary contents (mucins)
SYMPTOMS
: Eating and gustatory stimuli incite a swelling of the gland; often accompanied by severe pain („
salivary stone colic
”)
DIAGNOSIS
:
Can be palpable in the duct system of the submandibular gland
USG – reveals dilatation of the duct system with typical acustic shadows
Sialography
TREATMENT
:
1 Whith distal stones – incise the excrectory duct, extract the stone,
suture the duct epithelium to the mucosa (marsupialisation)
2 Intragladular stones – excision of the submandibular gland
3 Stones in the duct – removal by sialendoscopy
Sialadenosis
##
symmetrical swelling of the major salivary glands caused by a systemic, unknown cause.
parotid gland is most commonly affected
occur in association with:
• Chronic alcoholism
• Vitamin deficiencies
• Diabetes mellitus
• Protein deficiency
• Anorexia nervosa
SYMPTOMS:
Painless, symmetrical swelling that is unrelated to eating
Injuries
sharp or blunt injuries most commonly affect the parotid gland.
It is important to distinguish injuries to the glandular parenchyma alone
from injuries involving the excrectory dust system or facial nerve
BLEEDING
DUCT INJURIES
Microsurgical end-to-end anastomosis should be performed over plastic catheter
Suture the duct stump to the mucosa creating A neo-ostium
FACIAL NERVE INJURIES Immediate or early treatment – suturing the nerve
Matar