Professional Documents
Culture Documents
Diagnosis of salivary gland disorders Non neoplastic pathology Metabolic conditions Infectious conditions Immunologic conditions Neoplastic pathology Postoperative complications
Non-neoplastic Disorders
Reactive conditions mucoceles and ranulas irradiation reactions sialolithiasis necrotizing sialometaplasia Infectious Nutrition disorders Medication reactions Immunologic disorders
Mucoceles
Most common reactive condition of the minor salivary glands Mucoceles form when trauma to excretory ducts of the minor glands allows the spillage of mucus into the surrounding connective tissue formation of painless, smooth surfaced, bluish lesions
The lower lip is the most frequent site followed by the buccal mucosa, the ventral surface of the tongue, the floor of the mouth, and the retromolar region Treatment: observation surgical excision
Ranulas
The result of blocked sublingual gland ducts Ranulas are unilateral, soft-tissue lesions, often with a bluish appearance. They vary in size and may cross the midline of the mouth and cause deviation of the tongue A mucosal extravasation that herniates the mylohyoid muscle is called a "plunging" ranula
Treatment of a Ranula Surgical excision of the involved gland and marsupialization Marsupialization: suturing its walls to an adjacent structure, leaving the packed cavity to close by granulation
Irradiation Reaction
A common side effect of tumoricidal doses of ionizing radiation is xerostomia Frequent sips of water and frequent mouth care are the most effective interventions for xerostomia Saliva substitutes (eg, mixed solutions of methylcellulose, glycerin, and saline) or pilocarpine hydrochloride may help these symptoms
Sialolithiasis
Middle-aged patients most frequently affected 85% of all salivary stones are located in the submandibular gland Patients with sialolithiasis typically complain of recurrent episodes of pain and swelling when the gland is stimulated to secrete, as when chewing food
Sialolithiasis
Treatment excision of salivary calculi from Wharton's duct (ie, sialolithotomy) and the administration of antibiotics for underlying salivary gland infections and/or excision of the entire submandibular gland
Necrotizing Sialometaplasia
Usually involves minor salivary glands Occurs secondary to vascular infarct due to smoking, trauma, DM, vascular disease, L/A Age range 23-66 yrs 1-4 cm ulceration resembles mucoepidermoid carcinoma and SCCA clinically and histologically Usually heal in 6-10 weeks
Nutrition Disorders
Nutrition disorders such as pellagra (ie, niacin deficiency), kwashiorkor (ie, protein deficiency), beriberi (ie, thiamine deficiency), and vitamin A deficiency are associated with parotid gland enlargement Malabsorption syndromes also can cause malnutrition and result in salivary gland dysfunction
Medication Reactions
Many medications (eg, amitriptyline, imipramine, nortriptyline, atropine, phenothiazine derivatives, antihistamines) decrease salivary flow and cause parotid enlargement
Metabolic Conditions
Patients with alcoholic cirrhosis often experience asymptomatic enlargements of their parotid glands, which are attributed to chronic protein deficiency Diabetes mellitus and hyperlipidemia cause fatty infiltrations that replace the functional parenchyma of the salivary glands and decrease the flow of saliva
Infectious Conditions
Mumps Cytomegalovirus (CMV), which is a DNA virus of the herpes family that is transmitted by human contact
Immunologic conditions
HIV may manifest with parotid gland enlargement and parotid lymphadenopathy often are observed in these immunocompromised patients.
Sjogren's syndrome
Autoimmune disorder characterized by a chronic inflammatory reaction of exocrine glands +/or systemic connective tissues Sjogren's syndrome includes any of the three findings: keratoconjunctivitis sicca (ie, dry eyes) ` salivary gland enlargement, and xerostomia vasculitis purpura hepatosplenomegally obstructive pulmonary disease anemia rheumatoid arthritis
Neoplasms
Salivary neoplasms generally present as painless, slow-growing masses Neoplasms of the major salivary glands usually are benign Neoplasms of the minor salivary glands usually are malignant Rapidly expanding salivary neoplasms that are associated with pain and neural dysfunction are more likely to be malignant
85% of salivary neoplasms arise in the parotid 10% in the submandibular gland 5% in the minor salivary glands Salivary neoplasms rarely occur in the sublingual glands
Complications
Xerostomia Hemorrhage Temporary facial nerve paralysis 15% Long-term facial nerve paralysis Frey's syndrome