Salivary Gland Diseases Salivary Glands Overview Parotid gland

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Salivary Gland Diseases

Salivary Gland Diseases

Salivary Glands Overview Parotid gland Sublingual gland Submandibular gland

Salivary Glands Overview Parotid gland Sublingual gland Submandibular gland

Salivary glands - Types 3 Major Salivary Glands • Parotid • Submandibular • Sublingual

Salivary glands - Types 3 Major Salivary Glands • Parotid • Submandibular • Sublingual Plus many accessory glands in the lip and palatal mucosa

SALIVA - Functions PROTECTION Epithelial lubrication For tooth: Rinsing ALIMENTARY Pellicle coat Food approval:

SALIVA - Functions PROTECTION Epithelial lubrication For tooth: Rinsing ALIMENTARY Pellicle coat Food approval: taste, texture Mastication Vocalization MATERIALS Water Mucins (glycoproteins) Antibodies Ig. As Excretion ? Lysozyme Digestion Swallowing OTHER Amylase

Salivary Gland Diseases l Functional disorders l Obstructive disorders l Infectious disorders l Neoplastic

Salivary Gland Diseases l Functional disorders l Obstructive disorders l Infectious disorders l Neoplastic disorders

Functional Disorders of the Salivary Glands

Functional Disorders of the Salivary Glands

Functional Disorders of the Salivary Glands Sialorrhea (Increase in saliva flow) (i) Psychosis (ii)

Functional Disorders of the Salivary Glands Sialorrhea (Increase in saliva flow) (i) Psychosis (ii) mental retardation (iii) certain neurological diseases (iv) rabies ( v) mercery poisoning

Functional Disorders of the Salivary Glands Xerostomia (Decrease in saliva flow) (ii) (iii) (iv)

Functional Disorders of the Salivary Glands Xerostomia (Decrease in saliva flow) (ii) (iii) (iv) (v) Mumps, Sarcoidosis Sjoegrens syndrome Lupus post-irradiation treatment

Functional Disorders of the Salivary Glands (Sjogren’s Syndrome) l Triad of dry eyes, dry

Functional Disorders of the Salivary Glands (Sjogren’s Syndrome) l Triad of dry eyes, dry mouth, dry joints l Autoimmune disorder l Lymphocytic infiltration of the salivary glands.

Functional Disorders of the Salivary Glands Mucocele – Secondary to trauma – 70% occur

Functional Disorders of the Salivary Glands Mucocele – Secondary to trauma – 70% occur in lower lip – Excisional biopsy usually curative

Functional Disorders of the Salivary Glands Ranula – Sublingual salivary gland mucocele – Treatment

Functional Disorders of the Salivary Glands Ranula – Sublingual salivary gland mucocele – Treatment should include removal of Sublingual gland

Obstructive Disorders of the Salivary Glands

Obstructive Disorders of the Salivary Glands

Obstructive Disorders of the Salivary Glands l Obstruction to the flow of saliva via

Obstructive Disorders of the Salivary Glands l Obstruction to the flow of saliva via the salivary duct can occur due to the presence of salivary gland stone (Sialolith). l Obstruction can also secondary to the stricture (Narrowing) of the salivary gland duct.

Obstructive Disorders of the Salivary Glands Sialolithiasis (Salivary gland stone) – 92% occur in

Obstructive Disorders of the Salivary Glands Sialolithiasis (Salivary gland stone) – 92% occur in submandibular gland – 6% in parotid gland – Multiple occurrence in same gland is common

Submandibular Gland - Sialolithiasis Diagnosis – - Pain and sudden enlargement of gland while

Submandibular Gland - Sialolithiasis Diagnosis – - Pain and sudden enlargement of gland while eating Palpation of stone in the submandibular duct Occlusal radiograph (80%) Sialogram

Submandibular Gland - Sialolithiasis Treatment Stone can be removed transorally if in the duct

Submandibular Gland - Sialolithiasis Treatment Stone can be removed transorally if in the duct and easily palpable

Submandibular Gland - Sialolithiasis Treatment Stone can be removed transorally if in the duct

Submandibular Gland - Sialolithiasis Treatment Stone can be removed transorally if in the duct and easily palpable

Submandibular Gland - Sialolithiasis Treatment – If the stone is inside the gland therefore

Submandibular Gland - Sialolithiasis Treatment – If the stone is inside the gland therefore damaging the gland, then the whole gland should be removed under G. A.

Parotid Gland - Sialolithiasis Diagnosis – – – - Based on history Swelling during

Parotid Gland - Sialolithiasis Diagnosis – – – - Based on history Swelling during meals Bimanual palpation of painful gland 40% non-radiopaque Most parotid stones are multiple Sialogram

Sialogram A sialogram is a dye investigation of a salivary gland. It is carried

Sialogram A sialogram is a dye investigation of a salivary gland. It is carried out to look in detail at the larger salivary glands, namely the parotid or submandibular glands.

Advanced Radiographic Investigations l Plain and contrast-enhanced axial CT image of parotid glands. l

Advanced Radiographic Investigations l Plain and contrast-enhanced axial CT image of parotid glands. l Diffuse enhancement of the left parotid gland ; sialadenitis

Parotid Gland - Sialolithiasis Treatment Stones in extraglandular portion of duct can be removed

Parotid Gland - Sialolithiasis Treatment Stones in extraglandular portion of duct can be removed transorally Intraglandular stones removed from extraoral approach by Superficial Parotidectomy.

Infectious Disorders of the Salivary Glands

Infectious Disorders of the Salivary Glands

Acute Sialadenitis - Infectious Etiology – Viral - ( Mumps) – Bacterial

Acute Sialadenitis - Infectious Etiology – Viral - ( Mumps) – Bacterial

Viral- Acute Sialadenitis (Mumps) l Acute l Viral l Self painful parotitis in aetiology

Viral- Acute Sialadenitis (Mumps) l Acute l Viral l Self painful parotitis in aetiology limiting

Bacterial - Acute Sialadenitis Signs and symptoms l Swelling, xerostomia, failure of secretion with

Bacterial - Acute Sialadenitis Signs and symptoms l Swelling, xerostomia, failure of secretion with ascending infection – (Staph aureus, Strep pyogenes, most common infective organism) l Painful swelling parotid gland, overlying skin red, shiny & tense, pus from parotid duct (if involving the parotid gland)

Bacterial - Acute Sialadenitis l Treatment – Culture pus for Sensitivity – Prescribe appropriate

Bacterial - Acute Sialadenitis l Treatment – Culture pus for Sensitivity – Prescribe appropriate antibiotic – Supportive therapy • Fluids • Heat • Salivary stimulants

Bacterial - Chronic Sialadenitis l Chronic recurrent parotitis – Occurs commonly in patients of

Bacterial - Chronic Sialadenitis l Chronic recurrent parotitis – Occurs commonly in patients of 3 -6 Years age – Caused by Strep viridans – May spontaneously heal during puberty

Necrotizing Sialometaplasia l l l Benign inflammatory condition Usually involves the minor salivary gland

Necrotizing Sialometaplasia l l l Benign inflammatory condition Usually involves the minor salivary gland of hard palate Will often simulate a malignant condition No definite etiology 1 -3 cm ulcer heals spontaneously

Neoplastic Disorders of the Salivary Glands

Neoplastic Disorders of the Salivary Glands

Salivary Gland Tumors l 80 % occur in parotid gland l 5 -10 %

Salivary Gland Tumors l 80 % occur in parotid gland l 5 -10 % occur in the sub-mandibular gland l 1 % occur in sublingual gland l 10 -15% occur in the minor salivary glands

Benign Salivary Gland Tumors l Adenomas (Epithelial) – Pleomorphic adenoma – Monomorphic adenoma –

Benign Salivary Gland Tumors l Adenomas (Epithelial) – Pleomorphic adenoma – Monomorphic adenoma – Adenolymphoma – Oxyphilic adenoma – Other types

Pleomorphic Adenoma (Mixed Tumor) Commonest tumour (53% - 71%) of the salivary glands Tumor

Pleomorphic Adenoma (Mixed Tumor) Commonest tumour (53% - 71%) of the salivary glands Tumor is slow growing, painless, solitary, firm, smooth, moveable without nerve involvement Both mesenchymal/epithelial elements Investigations include FNA, CT, MRI Superficial parotidectomy is the procedure that is commonly performed.

Monomorphic adenoma l Characteristics Consists of a single epithelial cell type with a dense

Monomorphic adenoma l Characteristics Consists of a single epithelial cell type with a dense fibrous connective tissue capsule. l Two types - Basal cell adenoma - Canalicular adenoma

Warthins Tumor l Warthin’s tumour is also called as papillary cystadenoma lymphomatosum) l 6%

Warthins Tumor l Warthin’s tumour is also called as papillary cystadenoma lymphomatosum) l 6% - 10% l Benign, bilateral, parotid gland only l Older age group l Superficial location, therefore in most cases Superficial parotidectomy is performed. l Malignant potential non existent

Malignant Tumours of the Salivary Glands

Malignant Tumours of the Salivary Glands

Malignant Tumours of the Salivary Glands l Locally aggressive in nature l Some grow

Malignant Tumours of the Salivary Glands l Locally aggressive in nature l Some grow along neural pathways, may access skull base and brain eventually l Also lymphatic and haematogenous spread of tumor

Incidence of Salivary Gland Malignancy According to Site l Sublingual 70% l Submandibular l

Incidence of Salivary Gland Malignancy According to Site l Sublingual 70% l Submandibular l Parotid 20 % 40%

Clinical Classification of Malignant Salivary gland Tumors – (i) Mucoepidermoid tumor (high-grade) – (ii)

Clinical Classification of Malignant Salivary gland Tumors – (i) Mucoepidermoid tumor (high-grade) – (ii) Carcinoma in pleomorphic adenoma – (iv) Adenoid cyctic carcinoma – (v) Acinic cell tumor – (vi) Squamous cell carcinoma

Evaluation & Diagnosis of Malignant Salivary gland Tumors l History & clinical examination, use

Evaluation & Diagnosis of Malignant Salivary gland Tumors l History & clinical examination, use TNM Classification to stage the cancer l Sialography – of no value l CT scans and MRI l CT sialography for retromandibular / parapharayngeal lesions l Incisional biopsy is contraindicated l FNAC

Mucoepidermoid tumor l Commonest malignant tumour l 50% of all salivary gland malignancies l

Mucoepidermoid tumor l Commonest malignant tumour l 50% of all salivary gland malignancies l Parotid involved in 40% - 50% 75% are low grade & have good prognosis l 1 – 5 year survival 85% l l High grade mucoepidermoid carcinomas invade locally, spread regionally & distant metastasis. l 5 year survival drops 30%

Carcinoma in pleomorphic adenoma l l l l Mixed malignant tumour Long standing pleomorphic

Carcinoma in pleomorphic adenoma l l l l Mixed malignant tumour Long standing pleomorphic adenoma Older age group Worse prognosis Lymph node metastases 15% Distant metastases 30% 5 year survival 40% - 50% 15% year survival 20%

Adenoid cystic carcinoma (Cylindroma) l Commonly involves submandibular (35% - 40%), only 7% of

Adenoid cystic carcinoma (Cylindroma) l Commonly involves submandibular (35% - 40%), only 7% of parotid malignancies l Slowly growing l Peri-neural invasion l 30% lymph node metastasis, l 50% distant metastasis - 5 year survival 75% - 10 year survival 30% - 20 year survival 13%

Acinic cell carcinoma l Low grade l Slow growing l 10% of malignant parotid

Acinic cell carcinoma l Low grade l Slow growing l 10% of malignant parotid tumour l Lymph node mets 10% l Aggressive tumours l Radical parotidectomy is necessary if parotid gland is involved.

Squamous cell carcinoma of Salivary glands l Infrequent occurrence 1% - 5% l May

Squamous cell carcinoma of Salivary glands l Infrequent occurrence 1% - 5% l May have skin infiltration l Total radical parotidectomy

Non-epithelial Salivary gland Tumors l Malignant lymphoma l Unclassified tumors

Non-epithelial Salivary gland Tumors l Malignant lymphoma l Unclassified tumors

Clinical Classification of the Salivary gland tumors based on Recurrence l Benign S. Gland

Clinical Classification of the Salivary gland tumors based on Recurrence l Benign S. Gland tumor (seldom recurrent) – (i) Adenolymphoma (Warthins Tumor) – (ii) Oxyphilic adenoma (Oncocytoma) – (iii) Other types of Monomorphic adenoma

Clinical Classification of the Salivary gland tumors based on Recurrence l Benign S. Gland

Clinical Classification of the Salivary gland tumors based on Recurrence l Benign S. Gland tumor (often recurrent) – (i) Pleomorphic adenoma (mixed tumor) – (ii) Mucoepidermoid tumor ( low-grade) – (iii) Acinic cell tumor (same)