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ŽLIJEZDE SLINOVNICE. doc.dr.sc. Željka Roje Klinika za bolesti uha, nosa i grla s kirurgijom glave i vrata KBC Split. SEKRECIJA SLINE. Ukupno 1000 do 1500 ml u 24 sata 60% u parotidnim žlijezdama, 30% u submandibularnim, 5% u sublingvalnim i 5 % u malim žlijezdama

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Lijezde slinovnice

ŽLIJEZDE SLINOVNICE

doc.dr.sc. Željka Roje

Klinika za bolesti uha, nosa i grla s kirurgijom glave i vrata

KBC Split


Sekrecija sline
SEKRECIJA SLINE

  • Ukupno 1000 do 1500 ml u 24 sata

  • 60% u parotidnim žlijezdama, 30% u submandibularnim, 5% u sublingvalnim i 5 % u malim žlijezdama

  • Stvara se iz plazme procesima difuzije i osmoze između kapilara i acinusnih stanica


Sastav sline
SASTAV SLINE

  • 99,42% voda

  • 0,22% Kalcijev fosfat i karbonat

  • 0,14% amilaza


Funkcije sline
FUNKCIJE SLINE

  • Probavna (oblikovanje bolusa, amilaza)

  • Zaštitna općenito(lizozimi)

  • Zaštitna lokalno (obnova i održavanje cakline zuba, mehaničko čišćenje zubala)

  • “Epidemiološka”(virusi)

  • Posreduje u osjetu okusa

  • Sudjeluje u održavnju AB ravnoteže


Funkcionalni poreme aji slinjenja
FUNKCIONALNI POREMEĆAJI SLINJENJA

  • HIPOSALIVACIJA (HIPOPTIJALIZAM)

    • Smanjeno stvaranje sline

    • U kroničnim upalama, degenerativnim bolestima, nakon iradijacije, dehidracije, uporabe lijekova s antikolinergičnim učinkom (atropin), neuroleptika, sedativa, antihistaminika

    • Liječenje: palijativno

  • HIPERSALIVACIJA (PTIJALIZAM)

    • Nepoznate geneze

    • Liječenje: atropin, zračenje – male doze


Dijagnoza
DIJAGNOZA

  • Anamneza

  • Klinički pregled (palpacija, inspekcija)

  • Specijalne pretrage: sijalografija, scintigrafija

  • UZ, CT, NMR

  • Citološka punkcija




UPALE

  • Infectious parotitis

    • Acute bacterial parotitis: The patient reports progressive painful swelling of the gland and fever; chewing aggravates the pain.

    • Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement is present in most instances.

    • HIV parotitis: Nonpainful swelling of the gland occurs; otherwise, patient is asymptomatic.

    • Parotitis in tuberculosis: Chronic nontender swelling of one parotid gland occurs, or a lump is noted within the gland. Symptoms of tuberculosis are found in some cases.


Chronic punctate parotitis (chronic autoimmune parotitis)

Mikulicz disease: This is a historical disease only; it should not be diagnosed today.

Sjögren syndrome: Recurrent or chronic swelling of one or both parotid glands with no apparent cause is noted. It is frequently associated with autoimmune disease. Discomfort is modest in most cases and is related to dry mouth and eyes.

Lymphoepithelial lesion of Godwin: This is a historical category that is not used today.

UPALE


Diseases of uncertain etiology 

Recurrent parotitis of childhood: Repetitious episodes of unilateral or bilateral mumps like episodes in a young child are indicative.

Sarcoidosis: Chronic nontender swelling of parotid gland occurs.

Chronic nonspecific parotitis: Most commonly, patients experience episodes of painful parotid inflammation that last for hours to weeks with relative asymptomatic periods between. Pain varies from mild to incapacitating.

UPALE




SIJALOLITIJAZA

Ca fosfat 74%

Ca karbonat 11%

ostalo



Tumori1
TUMORI

  • Najčešći u parotidi

  • Što je žlijezda manja šansa da se radi o malignom tumoru je veća!


TERAPIJA

kirurgija

radioterapija


Kirurgija
KIRURGIJA

  • Superficijalna parotidektomija

  • Totalna parotidektomija

  • TP s disekcijom vrata

  • TP sa žrtvovanjem ličnog živca (ev. rekonstrukcija živca)