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SALIVARY GLAND DISEASES

SALIVARY GLAND DISEASES

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SALIVARY GLAND DISEASES

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  1. SALIVARY GLAND DISEASES omr

  2. Introduction

  3. Classification of salivary glands: • According to size. • Major :- Parotid / Submandibular /Sublingual • Minor :- Lingual / buccal / labial / palatine / glossopalatine • According to nature of secretion. • Serous :- Parotid • Mucous :- Sublingual / minor • Mixed :- Submandibular / minor • According to location of the opening of duct. • Into vestibule :- Parotid / minor • Into oral cavity proper :- Submandibular / Sublingual / minor

  4. Embryology • 6th-8th Weeks of Gestation • Parotid • First to develop • Last to become encapsulated • Autonomic Nervous System Crucial

  5. Embryology

  6. Anatomy: Parotid Gland • Wedge shaped with 5 processes • 3 Superficial • 2 Deep • Parotid Compartment • Superior – Zygoma • Posterior – EAC • Inferior – Styloid, ICA, Jugular Veins

  7. Anatomy: Parotid Gland • 80% overlies Masseter & Mandible • 20% Retromandibular • Stylomandibular Tunnel, Isthmus of Parotid • Tail of Parotid

  8. Anatomy: Parotid Gland • Parapharyngeal Space • Prestyloid Compartment • Poststyloid Compartment (Paragangliomas)

  9. Anatomy: Parotid Gland • Stensen’s Duct • Arises from anterior border • 1.5 cm inferior to Zygomatic arch • Pierces Buccinator at 2nd Molar • 4-6 cm in length • 5 mm in diameter

  10. Anatomy: Parotid Gland • Parotid Capsule • Superficial layer Deep Cervical Fascia • Superficial layer • Deep layer

  11. Anatomy: Parotid Gland • CN VII • 2 Surgical zones • 3 Motor branches immediately • Pes Anserinus – 1.3 cm • Temperofacial Division • Cervicofacial Division • 5 Terminal branches

  12. Anatomy: Parotid Gland

  13. Anatomy: Parotid Gland • Localization of CN VII • Tragal pointer • Tympanomastoid suture • Posterior belly Digastric • Styloid process • Retrograde dissection • Mastoidectomy

  14. Anatomy: Parotid Gland • Great Auricular nerve • Auriculotemporal nerve • Superficial Temporal vessels • Frey’s Syndrome

  15. Anatomy: Parotid Gland • Neural compartment • VII, Great Auricular, Auriculotemporal • Venous compartment • Retromandibular vein • Arterial compartment • Superficial Temporal/Transverse Facial

  16. Anatomy: Parotid Gland • Lymphatics • Paraparotid & Intraparotid nodes • Superficial & Deep Cervical nodes

  17. Anatomy: Submandibular Gland • The ‘Submaxilla’ • Submandibular Triangle • Mylohyoid ‘C’ • Marginal Mandibular branch • Capsule from superficial layer of Deep Cervical fascia

  18. Anatomy: Submandibular Gland • Wharton’s duct • Exits medial surface • Between Mylohyoid & Hyoglossus • 5 cm in length • Lingual nerve & CN XII

  19. Anatomy: Submandibular Gland

  20. Anatomy: Submandibular Gland • Innervation • Superior Cervical Ganglion (symp) • Submandibular Ganglion (para) • Artery: Submental branch of Facial a. • Vein: Anterior Facial vn. • Lymphatics: Deep Cervical and Jugular chains • Facial artery nodes

  21. Anatomy: Sublingual Gland • Between Mandible & Genioglossus • No capsule • Ducts of Rivinus +/- Bartholin’s duct • Sialogram not possible • Innervation: Same as Submandibular • Artery/Vein: Sublingual branch of Lingual & Submental branch of Facial • Lymphatics: Submandibular nodes

  22. Anatomy: Sublingual Gland

  23. Anatomy: Minor Salivary Glands • 600-1,000 • Simple ducts • Buccal, Labial, Palatal, Lingual • Tumor sites: Palate, upper lip, cheek • Lingual & Palatine nn.

  24. INVESTIGATIONS: • IMAGING • Radiography • Sialography • CT scan • MRI • Ultrasound Contd..

  25. 2. PATHOLOGY • Aspiration cytology & biopsy for definitive diagnosis • Frozen section • Histochemistry • Immunohistochemistry • Electron microscophy Contd..

  26. 3. FUNCTIONAL TESTS • Flow rates & sialochemistry 4. TESTS FOR RELATED / CONTRIBUTORY SYSTEMIC DISEASE • Bacteriology • Haematology • Autoantibody studies Contd..

  27. Imaging • CT – Inflammatory • MR – Tumor • Children: U/S & MR • NO sialogram during active infection • Parotid is fatty

  28. Microanatomy • The Secretory Unit • Acinus (serous, mucous, mixed) • Myoepithelial cells • Intercalated duct • Striated duct • Excretory duct

  29. Microanatomy • Striated & Intercalated ducts well developed in serous, NOT mucous glands • Striated duct: HCO3 into, Cl from lumen • Intercalated duct: K into lumen, Na from lumen, producing hypotonic fluid • Excretory ducts do NOT modify saliva

  30. Microanatomy

  31. Microanatomy • The Bicellular Theory • Intercalated duct • Excretory duct • The Multicellular Theory

  32. Microanatomy • Parotid: serous & fatty • Submandibular: mixed serous • Sublingual: mixed mucous • Stroma: Plasma cells

  33. Microanatomy

  34. Microanatomy

  35. Saliva • 600 to 700 ml (upto 1.5 L) per 24 hours. • PH is 6.7 (6.2 – 7.6) • Contribution of various glands: • Parotid:- 60 – 65% • Submandibular:- 20 – 30% • Sublingual:- 2 – 5% • Minor glands:- 6 – 7%

  36. Composition of saliva: • Water :- 94.0 – 99.5% • Solids :- 6.0% (unstimulated), 0.5% (stimulated) • organic constituents:-urea, uric acid, glucose, aminoacid, lactate, fatty acids, proteins like amylase, peroxidase, lysosyme, IgA, IgM, IgG. • inorganic constituents:- Ca, Mg, F, HCO3, K, Na, Cl, NH4. • gases:- CO2, N2, O2. • constituents from oral cavity:- desquamative epithelial cells, bacteria.

  37. Digestion (Amylase, Lipase) Antibacterial (Lysozyme, IgA, Peroxidase, FLOW) Mineralization Protective Pellicle Inhibition of dental caries Water balance Lubrication action Taste of food Buffering action Hygienic action Function of Saliva

  38. Factors influencing salivary secretion: • Taste and smell • Mechanical stimulation of oral mucosa and gingiva • Mastication of food • Chemical irritation of oral mucosa & stomach • Distension / irritation of oesophagus • Pregnancy

  39. Causes of salivary gland dysfunction: • Drugs (anticholinergic, antihistamine, antihypertensive) • Radiation theraphy • Oncologic chemotheraphy • Psychological factors • Systemic diseases • Malnutrition and neoplasms

  40. Clinical features: • Commonly present as an asymptomatic mass • Pain – infection/ hemorrhage/ infected cyst • Malignant lesions are also symtomless unless involves the nerves • Nasal obstruction – tumor involves paranasal sinuses / nose • Xerostomia

  41. Salivary hypofunction • Candidiasis • Lichen Planus • Burning Mouth • Aphthous ulcers • Dental caries • Xerostomia not reliable

  42. XEROSTOMIA • Causes; • Depression / chronic anxiety • Dehydration • Drugs • Diseases

  43. XEROSTOMIA • Clinical features; • Dry mouth • Salivary froath adhering to mucosa • Rapid dental decay • Adherence of food debris to teeth • Soreness / halitosis

  44. XEROSTOMIA • MANAGEMENT • Preventive theraphy • Symptomatic treatment • Local or topical salivary stimulation • Systemic salivary stimulation

  45. Effects of Aging • Total salivary flow independent of age • Acinar cells degenerate with age • Submandibular gland more sensitive to metabolic/physiologic change • Unstimulated salivary flow more greatly affected by physiologic changes

  46. DEVELOPMENTAL APLASIA / HYPOPLASIA ACCESSORY SALIVARY DUCTS DIVERTICULI DARIER’S DISEASE ACQUIRED REACTIVE LESIONS INFECTIONS METABOLIC CONDITIONS ASSOCIATED IMMUNE DEFECTS NEOPLASMS CLASSIFICATION OF DISEASES

  47. BENIGN Pleomorphic adenoma Monomorphic adenoma Ductal papilloma MALIGNANT Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma Salivary duct carcinoma Squamus cell carcinoma Basal cell adenocarcinoma Adenocarcinoma NEOPLASMS

  48. CONCLUSION

  49. THANK YOU