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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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