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DR.LINDA MAHER
SALIVARY GLANDS
group of glands that secretes saliva
CLASSIFIED INTO :
1\MAJOR SALIVARY GLANDS
1 -parotid glands
2 -submandibular glands
3 -sublingual glands
2\MINOR SALIVARY GLANDS
more than 400 small glands scattered all around the
oral cavity(except the Gingiva and anterior palate)
 Parotid gland: secretes watery (serous) saliva rich in
enzymes
 The peripheral branches of the facial nerve(CN VII) are
intimately associated with the parotid gland.
 Stenson’s duct(on the buccal mucosa opposite to the
maxillary second molar)
 Submandibular gland: serous and mucinous saliva
 Wharton’s duct(in the floor of the mouth on both sides of
tongue frenulum )
 Sublingual gland: secretes viscous saliva
 Multiple small ducts
Stinson's duct
Wharton's duct
(3)Sublingual fold with multiple
sublingual gland openings
MINOR SALIVARY GLANDS
 They lie just under mucosa.
 Distributed over lips, cheeks ,posterior
palate , floor of mouth & retro-molar area.
 Contribute 10% of total salivary volume.
SALIVA
 Healthy person secretes about
( 750-1500 ml of saliva / day)
 FUNCTION OF SALIVA:
 1\It facilitates swallowing
 2\It keeps the mouth moist & aids speech
 3\It serves as a solvent for molecules which
stimulate the taste buds
 4\It cleans the mouth, gum, & teeth.
 5\It contains digestive enzymes
 DIAGNOSTIC USES OF SALIVA:
 1\The Use of Saliva Testing for Hormones
 2\monitor drug use
 3\screen for various diseases.
 4\check for the presence of antibodies to the
HIV virus.
saliva is becoming a preferable diagnostic aid
because it is the easiest to collect.
(1)OBSTRUCTIVE
(2)FUNCTIONAL
DISORDERS
OF
SALIVARY
GLANDS
(3)INFECTIVE
(4)CYSTS AND
TUMORS
1\OBSTRUCTIVE SALIVARY
GLAND DISEASE
 Any Disease that causes obstruction of the
ductal system of salivary glands.
 Tow major causes:
 1-salivary calculi(stone)
 2-duct strictures
1\Salivary calculi
 a stone can form in a salivary gland or duct
 80% of salivary calculi form in the submandibular gland
 CLINICAL FEATURES:
 Usually the calculi are unilateral
 1-The classical symptom is pain when the smell or taste of
food stimulates salivary secretion.
 2-ductal obstruction may lead to infection , pain and
swelling of the gland
 3-the stone can be seen and palpated in the floor of the
mouth or can be deeply located and seen only in
radiograph
 DIAGNOSIS:
 Sialography
 MANAGEMENT:
 Removal of the calculi by
 1\milking and manipulation out of the orifice
 2\surgical incision
2\salivary duct strictures
 Strictures means Narrowing of the duct or
papilla of a gland
 Mainly seen in the parotid gland
 AETIOLOGY:
 Chronic trauma(E.G. from projecting clasps
or faulty restorations )leading to fibrosis
 CLINICAL FEATURES:
 Same as salivary calculi
 (pin and swelling during meal time-can be infected
causing further painful swellings)
 DIAGNOSIS:
 Sialography
 TREATMENT:
 Removal of the cause
 Dilation of the duct by bougies
2\FUNCTIONAL DISORDERS
 Disorders of saliva production
 Can be :
 1\sialorrhea (increase salivary production)
 2\xerostomia or dry mouth (decrease
salivary production)
1\sialorrhea
 Increase saliva production also known as hyper
salivation
 It is not a significant complain as any excess
saliva can readily be swallowed.
 AETIOLOGY:
 1\local reflex to oral infections or ulcerations or
new dentures
 2\nausea
 3\false sialorhea(normal salivary flow with lack of
neuromuscular control that leads to drooling)
2\Xerostomia (dry mouth)
 Reduction in saliva production
 AETIOLOGY:
 1\ORGANIC CAUSE:(sjogren’s syndrome-
irradiation)
 2\FUNCTIONAL CAUSE:(dehydrationpersistent diarrhea and vomiting –
hemorrhage)
 3\SOME DRUGS
SJOGREN’S SYNDROME
 1\PRIMARY SJOGREN’S SYNDROME:
Combination of dry mouth and dry eye
 2\SECONDARY SJOGREN’S SYNDROME
Combination of dry mouth ,dry eye
associated with rheumatoid arthritis
 AETIOLOGY:
 Sjogren's syndrome is an auto immune
disease
 CLINICAL FEATURES:
 ORAL MANIFISTATIONS:
 1\The oral mucosa becomes dry ,often red
shiny.
 2\The tongue is red and the dorsum
becomes lobulated
 3\Calculus accumulation and rapidly
progressive dental caries
 Oral effects of low salivary
production:
 1\discomfort
 2\difficulties with eating or swallowing
 3\disturbed taste sensation
 4\disturbance of speech
 5\predisposition to infections
 OCULAR MANIFISTATIONS:
 1\failure of tear secretion
 2\inflammations in the eye
 3\risk of vision loss
 DIAGNOSIS:
 1\low salivary flow rate
 2\labial salivary gland biopsy
 3\antibody screen
 TREATMENT:
 Salivary gland damage is irreversible
 Treat dry mouth with artificial saliva
substitutes and frequent drinking of water
 Maintain good oral hygiene and caries
control
3\INFECTIVE SALIVARY GLAND
DISORDERS (SIALADENITIS)
 CAN BE BACTERIAL,VIRAL OR FUNGAL
 THE MOST COMMON INFECTIVE
DISEASES OF THE SALIVARY GLANDS:
 1\mumps
 2\suppurative parotitis
1\mumps
 Highly infectious salivary gland disease that causes painful
swelling of the parotid gland and some times other glands.
 AETIOLOGY:
 Paramixovirus (mumps virus)
 CLINICAL FEATURES:
 1\affect mainly children
 2\headache , malaise ,fever and painful swelling of the
parotids
 3\permanent nerve damage may occur
 4\after one infection the immunity is long lasting
 DIAGNOSIS:
 Usually obvious from clinical manifestation
 Antibody screen
 MANAGEMENNT:
 Symptomatic treatment (analgesics-
antipyretics)
 Supportive treatment (bed rest –fluid
intake-warm or cold compress to the
swollen glands to reduce the pain)
2\suppurative parotitis
 It is a bacterial infection of one or both parotid glands
 AETIOLOGY:
 Staphylococcus aureus bacterial species
 Mostly seen in patients with severe xerostomia
 CLINICAL FEATURES:




Pain on one or both parotid glands
Swelling , redness and tenderness
Pus exudates from the parotid duct
If not treated may lead to abscess formation with fever
and malaise.
 DIAGNOSIS:
Culture and sensitivity testing for the pus.
 TREATMENT:
antibiotics
4\CYSTS AND TUMORS
A)CYSTS OF SALIVARY GLANDS
 MUCOCELES:
 The most common type of salivary cysts
 Affects minor salivary glands
 AETIOLOGY:
 Extravasations of saliva as result of damage to the
duct of the salivary gland
 It is not a true cyst as it has no epithelial lining
 CLINICAL FEATURES:
 Mucoceles most often form in the lower lip
but occasionally on the buccal mucosa or
floor of the mouth (mucoceles in the floor
of the mouth is named ranula)
 Appear as rounded fleshy swelling about
1cm in diameter
 Then it become cystic ,hemispherical and
bluish due to thin wall
mucocele
ranula
 TREATMENT:
 Surgical excision of the cyst with the
underlying minor gland
B)TUMORS OF SALIVARY GLANDS
 70% of salivary glands tumors develop in
parotid gland and few affect the
submandibular gland. Sublingual tumors are
very rare.
 AETIOLOGY:
 Unknown but can result from irradiation to the
head and neck region
CLASSIFICATION OF SALIVARY GLAND
TUMORS:
S.G TUMORS
EPETHELIAL
BENIGN
MALIGNANT
)ADENOMA(
)CARCINOMA(
NONEPETHELIAL
SARCOMA
LYMPHOMA
TYPICAL CLINICAL FEATURES OF
SALIVARY GLAND TUMORS
BENIGN
MALIGNANT
 1-slowly growing
 1-fast growing and
 2-soft or rubbery in
painful
 2-hard consistency
 3-may ulcerate and
invade bone
 4-cause cranial nerve
palsies(dysfunction of
the nerve affected)
consistency
 3-do not ulcerate
 4-no associated
nerve signs
Pleomorphic adenoma(benign)
Adenocarcinoma(malignant
Pleomorphic adenoma(benign)
Lymphoma(malignant)
 DIAGNOSIS:
 MRI or CT-SCAN
 Biopsy and histological examination
 TRETMENT:
 1\surgical excision for both malignant and
benign tumors
 2\if the tumor is malignant chemotherapy is
indicated after excision
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