Post on 02-Nov-2014
description
DR BASAVARAJ T BHAGAWATI, SBBDC GZBD
Salivary gland D’S
CLASSIFICATION:DEVELOPMENTALINFLAMMATARYCYSTICAUTOIMMUNENEOPLASTIC
CLASSIFICATION
Developmental 1.Hypoplasia/
aplasia Aberrent s.
gland[ectopic] Accessary s. gland Diverticuli
Inflammatary diseases
Viral:mumps, CMV HIV
Bacterial:Acute B. SialadenitisChronic B.
Sialadenitis
S.G. DISEASES
CYSTIC MUCOCELE RANULA AUTOIMMUNE MUKULICZ D’S SJOGREN’S
SYNDROME
NEOPLASTIC
BENIGN TUMOURS
MALIGNANT TUMOURS
Omdr-2011
SG-3
Symptom –xerostomia Pt c/o dryness of oral mucosal surfaces/
reduced oral fluids Difficulty in chewing,swallowing and
speaking Burning mouth/ mucosa-aggrevates
on eating spicy and coarse food Pain in the mucosal surfaces
Sg-3
Medical history:present/past h/o Radiotherapy to head & neck
tumours Medications-tricyclic
atidepressents,sedative,antihistamines
dryness in the eyes,throat and vagina
clinical examination
Cracked lips,corrugated -buccal mucosa Lipstick sign:presence of shed epithelial
cells on labial sufaces of max. Anteriors teeth
Tongue blade sign:hold the tongue blade against the buccal mucosa and mucosa is adhered to tongue blade as the blade is lifted away
Enlargement of salivary glands
Saliva collection
Stimulated saliva sample
Unstimulated saliva samples
methods
Draining methods spitting method Suction method absorbent
methods
Suction method Saliva is collected by using suction tip
or saliva ejectors for defined time period Absorbent method:uses pre weighed
gauge sponge for a set of time period
Saliva secreation can be stimulated by applying 2% citric acid on the tip of the tongue
Methods-indidual/specific sg Parotid gland saliva collected by
placing carlosons-crittenden collectors over the ductal orifices
submandibular and sublingual gland saliva collected by alginate held collector called segregator
Saliva samples-
Stimulated – saliva:less than 1ml/min –abnormally low
Unstimulated –saliva:less than 0.1ml/ min abnormally low
salivry glnd imaging
Plain film radiography Sialography Ultrasonagraphy Radionuclide imaging/scintigraphy C T M R I
SALIVARY FLOW OVER A 24 HOUR PERIOD
MUMPS
Viral infection of salivary gland caused by paramyxo virus
Infects SG s, Gonads, CNS PAROTID commonly affected
MUMPS [c/f]
Age:2nd deacde peak incidece
CL. Presentation; Prodromal
symptoms like fever,malaise anorexia and tenderness at the angle of the jaw.
Parotid swelling may be the first indication in many cases
swollen parotid may extend from ear to lower part of the mandibular ramus displacing ear upwards&outwards
MUMPS[C/F]
Bilateral parotitis is common but one gland swells 1-2 days after the other
Edema of the skin over the gland and red,inflamed ductal orifice
DIAGNOSIS:History/Cl. Exmn. Negative h/o mumps in the past&vaccine
Investigation: 1.Antibody titres:4fold increased.2. Serum amylase levels increased
Mumps
Treatment:supportive
analgesics&antipyretic
Preventive vaccine:
MMRSystemicsteriods:Orchitis
COMPLICATIONS MENINGITIS ENCEPHALITIS ORCHITIS PANCRETITS MYOCARDITIS
Ac Bacterial S’itis
Clinical features:Age:adults mean-70yrsParotid gland
commonly affected,unilateral
Syptoms:sudden on set of pain at the angle of the jaw& which increases on eating
Other sympoms ;Fever
Clinical exmn reveals a tender enlarged gland & overlaying skin warm &red
Diagnosis is confirmed by collection of purulent material from the ductal orifice
Acute Bacterial sailadenitis Acute infection of salivary gland
bacteria Bacterial strains:staphylococcus
Aureus and streptococcus viradans Predisposing Factors:1. Dehydration that reduces salivary
flow
Acute Bacterial sailadenitis Investigations
Culture of purulent material collected from duct.[gram stain]
Blood: leukocytosis
Treatment:antibiotics
[Parentaral] amoxycillin+cloxacillin[250mg+250mg]Metronidazole[400mg]Fluid balanceOral hygineSurgical drianage
Chronic sialadenitis
Chronic infection of SG’s
Bacterial strains step.viridans E coli,proteus C/f :children
&young adults affected.
Parotids commonly affected
Syptoms:pain at the angle
Purulent discharge from ductal orfice
Antibiotics resolve the infection but recurrence is noted
Recurrences lead to fibrosis of gland
Treatment
ANTIBIOTICS [after culture /gram’stian]
Fluid balance Other modalities:INTRADUCTAL
ANTIBIOTICS –Erythromycin/ tetracyclines
Mucocele
Mucocele is a swelling caused by pooling of saliva at the site of injured or obstructed minor salivary gland duct
Mucocele are classified as 1.Mucous retention M. 2.Extravasation M.
Mucocele
Mucous retntion M.is caused by obstruction of minor salivary gland duct
Extravasation mucocele occurs because of laceration of of minor salivary gland duct
Mucocele[C/F]
Clinical appearance depends on location of the lesion.
R.M. is common on the palate/floor mouth
EV.M. is seen on lips where trauma is common
Super ficial lesions are vesicles containig mucin
Bluish in colour and on rupturing they release mucin
Size vary from 3-4mm to 1cm in diameter
Deep lesions well defined and covered by normal mucosa
Ranula
Ranula is Mucocele which occurs on the floor mouth because of trauma to the sublingual gland duct.
Slow growing lesion causing difficulty in mastication.
Types :
Super ficial
Deep
Ranula
Superficial Ranula-superficial to mylohyoid muscle
Deep ranula:deep to mylohyoid muscle [plunging R.]
Treatment Deep R./Recurrent R.
Surgical excisionOther modalities
Large lesions:Marsupalization
Intralesional steriods
Sialoliths [s.calculi] Sialolith are calcified and organic matter
that form within the secreatory system of the
of major salivary gland
Composition Hydroxyappetite crystal
Octocalcium phosphateTraces of Mg,, Cl, K,Carbon&ammonium
sialoliths
Etiology /p. factors [Debatable]1. Inflammation2. Drugs [anticholenergic
medications,antihistamines]3. Defects in calcium and phospharous
metabolism
SIALOLITH Sialoliths are common in the
submandibular gland duct, because……..
Anatomical course of wharton’s duct has sharp curves which may trap mucin/calculus
High mucin level of the gland may trap foreign bodies &debris
Calcium content is higher in the saliva of sub.mand. Gland
Flow rate of the saliva is slower than parotid Dependent position of the gland increases
chances of stasis of saliva
SIALOLITH
Clinical features: Intermittent swelling in the region of major salivary gland that enlarges during eating and resolves later
Pain because of the back up saliva behind the stone
Stasis of saliva may lead to infection /fibrosis /atropy of the gland
Sinus /fistula and ulceration in chronic cases
They may be palpable if they are at periphery of the duct
They are circumscribed &firm to hard masses
SIALOLITH[Investigations]
OCCLUSAL RADIOGRAPH:
SUB.MAND. GLAND /SUBLINGUAL
PA View/OPG: PAROTIDS
Modern imaging
SIALOGRAPHY,CT SCAN,ULTRASOUND
SIALOGRAPHY
It is a radiographic technique where in a radiographic contrast agent is infused into the ductal system of major salivary gland and imaged with plain films,fluroscopy or CT Scan.
SIALOGRAPHY
INDICATIONS: Sialoliths Chronic infection Tumours of SG gland Autoimmune d’s;
sjogren’s syndrome For extrinsic/intrinsic
masses in gland
CONTRA INDICATIONS:
Acute infections Allergy to
contrast agents
SIALOGRAPHY
INDICATIONS: Sialoliths Chronic infection Tumours of SG gland Autoimmune d’s;
sjogren’s syndrome For extrinsic/intrinsic
masses in gland
CONTRA INDICATIONS:
Acute infections Allergy to
contrast agents
SIALOGRAPHY
CONTRAST AGENTS:
WATER SOLUBLE LIPID SOLUBLE
Water soluble:Advantages:a]Good flow rate b] Less painfulDIS
advantages;absorbed by duct :poor contrast
Lipid soluble;ADV.good contrast. Not absorbed by duct
DISadvantages:painful infusions:poor flow rate
SIALOGRAPHYprocedure 1.Ductal orifice
located and dilated by lacrimal probe
2.Cannula is passed into ductal orifice
3.Syringe is inserted into the cannula andd slowly solution is infused
PAROTID:0.75-1.5ml
SUB.MAND:0.5-1ml 4.Infusions done
with fluroscopic mionitoring5.Images are taken3.phases
Ductal phaseGlandular phaseSecreatary phse
THANK U
Ptyalism
Hypersalivation (also called ptyalism[1] and sialorrhea[2]) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.[3
Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.
Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).[4]
Contents [show
Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.
Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling
Conditions-ptyalism
Rabies Gastroesophageal r
eflux disease,
Pregnancy Pancreatitis Liver disease Serotonin syndrom
e Mouth ulcers Oral Infections
Medications that can cause overproduction of saliva include:[3]
clozapine pilocarpine Ketamine TOXINS:
mercury copper
DECREASED –CLEARANCE-SALIVA Infections : tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps.jaw fracture/TMJ dislocationRadiation Therapy
Neurological disorders:
myasthenia gravis, Parkinson's disease, Multiple System Atrophy, , bilateral facial nerve palsy and hypoglossal nerve palsy.
Management
. Removal of cause Antihistamine or atropine sulphate
Self-contained saliva test kit for use at the point of care that will target markers for periodontal diseases, caries, infectious diseases, pancreatic cancer, diabetes, salivary gland diseases, renal diseases, steroids and inflammatory markers for cardiovascular and pulmonary diseasesDetermining hormone