NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS Wednesday March

NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS Wednesday, March 3, 2021 1

Benign Salivary Diseases �Infectious Acute Chronic �Inflammatory Autoimmune Granulomatous �Sialolithiasis Wednesday, March 3, 2021 w. Cystic Congenital n. Acquired n w. Other w. Sialorrhea w. Sialadenosis w. Rare 2

Viral Parotitis(Mumps) �Paramyxovirus – A RNA virus �Droplet infection/fomites �Children of school going age & �Incubation period: 2 -3 weeks �Patient is infective even before young adults the onset of clinical manifestations and remains so 7 -10 days after the swelling subsides �Virus excreted through nasal, salivary & urinary secretions Wednesday, March 3, 2021 3

Clinical features Symptoms – fever, malaise, headache in 1/3 rd, painful swelling of parotids – 70% bilateral. Occasionally submandibular glands affected Tense, firm swelling - lasts for a week Other features: Orchitis, Ophritis, Pancreatitis, aseptic meningitis, thyroiditis, myocarditis, nephritis, arthritis Unilateral SNHL/sudden loss Wednesday, March 3, 2021 4

Diagnosis �Clinical diagnosis �Serum & urinary amylase are raised �Raised serum Ig. M & Ig. G by day 5 Wednesday, March 3, 2021 5

Treatment �Good hydration �Rest �Analgesics �Cold & hot compression �MMR vaccination by 15 months Wednesday, March 3, 2021 6

Acute Bacterial Sialadenitis � 2 mechanical factors: Retrograde contamination of the salivary gland duct & parenchymal tissue by bacteria Stasis of salivary flow through ducts & parenchyma Wednesday, March 3, 2021 7

Predisposing factors �Systemic dehydration �Major surgical procedures �HIV Infections �Systemic diseases like Diabetes, renal failure, Sjogren’s syndrome, hepatic failure �Mechanical obstruction to the duct �Bacteriology: Staph aureus Wednesday, March 3, 2021 8

Clinical features �Sudden onset �Pain & enlargement of the affected gland �Tender, erythematous, indurated swelling over the parotid, aggravated by jaw movements �Fever & malaise �Stenson’s duct swollen & red with discharging pus on pressure Wednesday, March 3, 2021 9

Diagnosis �Clinical diagnosis �Leucocytosis with neutrophelia �Serum amylase normal Wednesday, March 3, 2021 10

Treatment �Treat the underlying cause �IV antibiotics �Adequate hydration �Proper oral hygiene �Surgical drainage if required Wednesday, March 3, 2021 11

Chronic recurrent Sialadenitis �Recurrent acute attacks of infection involving parotid gland �Symptoms: Mildly painful, recurrent parotid enlargement – aggravated by eating 80% develop xerostomia �O/E: Palpable enlargement with scanty saliva on palpation Will have acute picture during flare-ups Wednesday, March 3, 2021 12

Chronic Sialadenitis �Radiology: Sialography – prominent sialectasia, filling defects due to debris, stenosis �Treatment: Treatment of acute attack with antibiotics Remove any calculus Periodic ductal dilation, duct ligation, irradiation, gland excision Wednesday, March 3, 2021 13

Acute Suppurative Parotitis of Infancy Unique to newborns – 40% of affected are premature Usually in parotid Bacteriology: Staph. aureus Streptococci, E. coli, Pseudomonas aeriginosa, Moroxella catarrhalis Treatment: Hydration IV antibiotics Usually resolves within one week Wednesday, March 3, 2021 14

Recurrent Parotitis of Childhood Second most common salivary disorder in children Infections occur every 2 -3 months, last days to 2 weeks often resolve at puberty Symptoms: and Recurrent acute/subacute swelling of parotid with fever and malaise – usually unilateral Asymptomatic between episodes Diagnosis: History USG to rule out new presentation of Sjögren’s syndrome (2 -4 mm round hypoechoic areas in superficial lobes) Wednesday, March 3, 2021 15

Recurrent Parotitis of Childhood Etiology: Congenital malformation – congenital sialectases predispose to bacterial colonization Recurrent ascending infection with mucus plug formation Immune deficiency Treatment: Antibiotics with each episode (wait out infections until “burns out” at puberty) Conservative measures Parotid duct dilation to break-up mucus plugs Rarely parotid duct ligation Wednesday, March 3, 2021 16

Sialectasis �Dilatation of the ductal system �Aetiology: congenital/Associated with Sjogren’s syndrome �Stasis of secretions & infection �CF: similar to chronic recurrent sialadenitis, can be differentiated by sialography which shows punctate/globular/cavitary types of dilatation Wednesday, March 3, 2021 17

Granulomatous diseases �Tuberculosis �Sarcoidosis �Actinomycosis Wednesday, March 3, 2021 18

Tuberculosis �Uncommon �Unilateral parotid swelling �Spread of infection from the teeth & tonsil �Two forms: Acute inflammatory/Chronic granulomatous �May present with fistula �Excision/Anti tubercular treatment Wednesday, March 3, 2021 19

Sarcoidosis �Heerfordt’s syndrome(Uveoparotid fever) – Uveitis, chorioretinitis, facial paralysis & Parotid enlargement � 20 -30 years �Fever, malaise, weakness, nausea & night sweats �Diagnosis: Kveim’s test �Treatment: Steroids, symptomatic Wednesday, March 3, 2021 20

Actinomycosis �Uncommon �Acute abscess with sinus formation discharging sulphur like granules �Indolent swelling over the parotid �Surgical drainage �Penicillin/tetracyclin Wednesday, March 3, 2021 21

Sialolithiasis Occur most commonly in submandibular glands (80 – 90%%) More alkaline p. H Higher viscosity mucoid secretions Anti-gravity flow through long duct Uric acid stones in gout occur primarily in parotids Composition: Calcium phosphate as hydroxyapitite Carbohydrate and amino acid matrix Uric acid in gout Etiology: Infection alters protein composition of mucin – encourages calcium precipitation – prevalent in chronic sialadenitis Duct stenosis/secretion stasis encourage stone formation Wednesday, March 3, 2021 22

Sialolithiasis Symptoms: Intermittent pain/swelling - exacerbated by eating Symptoms can resolve between meals Range from discomfort to cellulitis to purulent secretions Diagnosis: Usually can palpate stone in FOM Plain films will show submandibular stones 80 -90% Only 10% for parotid stones Sialography – nearly 100% sensitive, allows evaluation of gland anatomy/parenchyma also Contraindicated in acute infection Wednesday, March 3, 2021 23

Sialolithiasis Wednesday, March 3, 2021 24

Sialolithiasis Treatment: Spontaneous extrusion with sialagogues Proximal stones can be milked from duct after dilation Local anesthesia and I&D of Warthin’s duct with stone removal Higher risk of stenosis if I&D of parotid duct, must place stent Gland excision if stone is in parenchyma Failure to remove stones leads to abscess formation, duct stricture, chronic sialadenitis, gland destruction Wednesday, March 3, 2021 25

Sjogren’s Syndrome �Second most common autoimmune disorder after rheumatoid arthritis �Primary/Secondary Wednesday, March 3, 2021 26

Primary �Mikulicz’s disease / Benign lymphoepithelial disease �Xerostomia & Xero-opthalmia �Involves both the sexes Wednesday, March 3, 2021 27

Secondary �Keratoconjunctivitis sicca �Xerostomia �Rheumatoid arthritis �Bilateral parotid swelling �More common in females �Diagnosis: Raised ESR, + RH factor, +antinuclear antibodies, biopsy from lower lip �Treatment: Symptomatic, NSAID, Steroids Wednesday, March 3, 2021 28