Salivary Gland Diseases
Salivary Glands Overview
Parotid
gland Sublingual
gland
Submandibular
gland
Salivary glands - Types
3 Major Salivary Glands
• Parotid
• Submandibular
• Sublingual
Plus many accessory glands in the lip and palatal
mucosa
SALIVA - Functions
Epithelial lubrication
PROTECTION
For tooth: Rinsing
Pellicle coat
ALIMENTARY Food approval: taste, texture
Mastication
MATERIALS
Digestion
Water
Swallowing Mucins (glycoproteins)
OTHER Vocalization Antibodies IgAs
Excretion ? Lysozyme
Amylase
Salivary Gland Diseases
Functional disorders
Obstructive disorders
Infectious disorders
Neoplastic disorders
Functional Disorders of the Salivary Glands
Functional Disorders of the Salivary Glands
Sialorrhea (Increase in saliva flow)
(i) Psychosis
(ii) mental retardation
(iii) certain neurological diseases
(iv) rabies
( v) mercery poisoning
Functional Disorders of the Salivary Glands
Xerostomia (Decrease in saliva flow)
(i) Mumps,
(ii) Sarcoidosis
(iii) Sjoegrens syndrome
(iv) Lupus
(v) post-irradiation treatment
Functional Disorders of the Salivary Glands
(Sjogren’s Syndrome)
Triad of dry eyes, dry mouth, dry joints
Autoimmune disorder
Lymphocytic infiltration of the salivary glands.
Functional Disorders of the Salivary Glands
Mucocele
– Secondary to trauma
– 70% occur in lower lip
– Excisional biopsy usually curative
Functional Disorders of the Salivary Glands
Ranula
– Sublingual salivary gland mucocele
– Treatment should include removal of Sublingual
gland
Obstructive Disorders of the Salivary Glands
Obstructive Disorders of the Salivary Glands
Obstruction to the flow of
saliva via the salivary duct
can occur due to the
presence of salivary gland
stone (Sialolith).
Obstruction can also
secondary to the stricture
(Narrowing) of the salivary
gland duct.
Obstructive Disorders of the Salivary Glands
Sialolithiasis (Salivary gland stone)
– 92% occur in submandibular gland
– 6% in parotid gland
– Multiple occurrence in same gland is common
Submandibular Gland - Sialolithiasis
Diagnosis
– Pain and sudden enlargement of gland while eating
- Palpation of stone in the submandibular duct
- Occlusal radiograph (80%)
- Sialogram
Submandibular Gland - Sialolithiasis
Treatment
Stone can be removed transorally if in the duct and
easily palpable
Submandibular Gland - Sialolithiasis
Treatment
Stone can be removed transorally if in the duct and
easily palpable
Submandibular Gland - Sialolithiasis
Treatment
– If the stone is inside the gland and therefore
damaging the gland, then the whole gland should
be removed under G.A.
Parotid Gland - Sialolithiasis
Diagnosis
– Based on history
– Swelling during meals
– Bimanual palpation of painful gland
– 40% non-radiopaque
– Most parotid stones are multiple
- Sialogram
Sialogram
A sialogram is a dye investigation of a salivary gland. It is
carried out to look in detail at the larger salivary glands,
namely the parotid or submandibular glands.
Advanced Radiographic Investigations
Plain and contrast-enhanced axial CT image of parotid
glands.
Diffuse enhancement of the left parotid gland ; sialadenitis
Parotid Gland - Sialolithiasis
Treatment
Stones in extraglandular portion of duct can be removed
transorally
Intraglandular stones removed from extraoral
approach by Superficial Parotidectomy.
Infectious Disorders of the Salivary Glands
Acute Sialadenitis - Infectious
Etiology
– Viral - ( Mumps)
– Bacterial
Viral- Acute Sialadenitis (Mumps)
Acute painful parotitis
Viral in aetiology
Self limiting
Bacterial - Acute Sialadenitis
Signs and symptoms
Swelling, xerostomia, failure of secretion with ascending infection
– (Staph aureus, Strep pyogenes, most common infective organism)
Painful swelling parotid gland, overlying skin red, shiny & tense, pus
from parotid duct
(if involving the parotid gland)
Bacterial - Acute Sialadenitis
Treatment
– Culture pus for Sensitivity
– Prescribe appropriate antibiotic
– Supportive therapy
• Fluids
• Heat
• Salivary stimulants
Bacterial - Chronic Sialadenitis
Chronic recurrent parotitis
– Occurs commonly in patients of 3-6 Years age
– Caused by Strep viridans
– May spontaneously heal during puberty
Necrotizing Sialometaplasia
Benign inflammatory condition
Usually involves the minor salivary gland of hard
palate
Will often simulate a malignant condition
No definite etiology
1-3 cm ulcer heals spontaneously
Neoplastic Disorders of the Salivary Glands
Salivary Gland Tumors
80 % occur in parotid gland
5-10 % occur in the sub-mandibular gland
1 % occur in sublingual gland
10-15% occur in the minor salivary glands
Benign Salivary Gland Tumors
Adenomas (Epithelial)
– Pleomorphic adenoma
– Monomorphic adenoma
– Adenolymphoma
– Oxyphilic adenoma
– Other types
Pleomorphic Adenoma (Mixed Tumor)
Commonest tumour (53% - 71%) of
the salivary glands
Tumor is slow growing, painless,
solitary, firm, smooth, moveable
without nerve involvement
Both mesenchymal/epithelial elements
Investigations include FNA, CT, MRI
Superficial parotidectomy is the
procedure that is commonly
performed.
Monomorphic adenoma
Characteristics
Consists of a single epithelial cell type with a
dense fibrous connective tissue capsule.
Two types
- Basal cell adenoma
- Canalicular adenoma
Warthins Tumor
Warthin’s tumour is also called as papillary cystadenoma
lymphomatosum)
6% - 10%
Benign, bilateral, parotid gland only
Older age group
Superficial location, therefore in most cases Superficial
parotidectomy is performed.
Malignant potential non existent
Malignant Tumours of the Salivary Glands
Malignant Tumours of the Salivary Glands
Locally aggressive in nature
Some grow along neural pathways, may access
skull base and brain eventually
Also lymphatic and haematogenous spread of
tumor
Incidence of Salivary Gland Malignancy
According to Site
Sublingual 70%
Submandibular 40%
Parotid 20 %
Clinical Classification of Malignant
Salivary gland Tumors
– (i) Mucoepidermoid tumor (high-grade)
– (ii) Carcinoma in pleomorphic adenoma
– (iv) Adenoid cyctic carcinoma
– (v) Acinic cell tumor
– (vi) Squamous cell carcinoma
Evaluation & Diagnosis of Malignant
Salivary gland Tumors
History & clinical examination, use TNM Classification to
stage the cancer
Sialography – of no value
CT scans and MRI
CT sialography for retromandibular
/ parapharayngeal lesions
Incisional biopsy is contraindicated
FNAC
Mucoepidermoid tumor
Commonest malignant tumour
50% of all salivary gland malignancies
Parotid involved in 40% - 50%
75% are low grade & have good prognosis
1 – 5 year survival 85%
High grade mucoepidermoid carcinomas invade locally,
spread regionally & distant metastasis.
5 year survival drops 30%
Carcinoma in pleomorphic adenoma
Mixed malignant tumour
Long standing pleomorphic adenoma
Older age group
Worse prognosis
Lymph node metastases 15%
Distant metastases 30%
5 year survival 40% - 50%
15% year survival 20%
Adenoid cystic carcinoma (Cylindroma)
Commonly involves submandibular (35% - 40%), only
7% of parotid malignancies
Slowly growing
Peri-neural invasion
30% lymph node metastasis,
50% distant metastasis
- 5 year survival 75%
- 10 year survival 30%
- 20 year survival 13%
Acinic cell carcinoma
Low grade
Slow growing
10% of malignant parotid tumour
Lymph node mets 10%
Aggressive tumours
Radical parotidectomy is necessary if parotid
gland is involved.
Squamous cell carcinoma of Salivary
glands
Infrequent occurrence 1% - 5%
May have skin infiltration
Total radical parotidectomy
Non-epithelial Salivary gland Tumors
Malignant lymphoma
Unclassified tumors
Clinical Classification of the Salivary gland
tumors based on Recurrence
Benign S.Gland tumor (seldom
recurrent)
– (i) Adenolymphoma (Warthins Tumor)
– (ii) Oxyphilic adenoma (Oncocytoma)
– (iii) Other types of Monomorphic adenoma
Clinical Classification of the Salivary gland
tumors based on Recurrence
Benign S.Gland tumor (often recurrent)
– (i) Pleomorphic adenoma (mixed tumor)
– (ii) Mucoepidermoid tumor ( low-grade)
– (iii) Acinic cell tumor (same)
