Salivary Gland Diseases

SALIVARY GLAND DISEASES
Introduction
The saliva plays a very important role in oral health.
The salivary hypo function causes less effective
lubrication of oral mucosa and less defensive activity that
might lead to opportunistic infections.
The causes of salivary gland enlargement are
inflammatory conditions (mumps, recurrent parotiditis,
Sjogren`s syndrome) neoplasms, duct stricture, sialosis.
Most common salivary gland diseases

Acute ascending bacterial sialadenitis
Chronic bacterial sialadenitis
Mumps
Recurrent parotiditis of childhood
Duct obstruction
Sialolithiasis
Mucocele
Necrotizing sialometaplasia
Sialosis
Salivary gland neoplasms
Sjogren`s syndrome
ACUTE BACTERIAL ASCENDING SIALADENITIS

Definition : sialadenitis due to bacterial infection ascending
from the oral cavity
Incidence :Rare
Age mainly affected :Older adults
Sex mainly affected : M=F
Aetiology :the parotid glands are most commonly affected by
ascending sialadenitis which may be seen :
1) After radiotherapy to the head and neck

2) In Sjogren,s syndrome
3) Occasionaly following gastrointestinal surgery , because of
dehydration and dry mouth
Clinical features :the disease present with
1) Painful and tender enlargement of one salivary gland only
2) The overlying skin possibly reddened
3) Pus exuding from the salivary duct orifice
4) Trismus
5) Cervical lymphadenopathy
6) pyrexia
Diagnosis : Clinical
Management :
1) Antimicrobial therapy
2) Analgesia
3) Surgical drainage is needed where fluctuation is present
4) Hydration must be ensured
5) Salivation should be stimulated
CHRONIC BACTERIAL SIALADENITIS

Definition : Chronic infection of a salivary gland
Incidence :Rare
Etiology : May develop after acute sialadenitis particularly if
inappropriate antibiotics are used .
Clinical features :
1) The affected salivary gland is chronically swollen
2) Gland often not tender
3) No systemic features of infection
Diagnosis : Clinical and radiography
Management : surgical excision is often needed but occasionally

the duct is ligated
MUMPS
Definition : An acute infectious disease which principally
affects the parotid salivary glands
Incidence : Common
Age mainly affected : Children
Etiology :Infection with an RNA paramyxovirus , the mumps
virus ,and others
Clinical features :1) Protiditis

2) Trismus
3) Fever and malaise
Extrasalivary manifestations may include :
1)Inflammation of the testes or ovaries
2)Meningitis or meningoencephalitis
3)Deafness
Diagnosis , Clinically and :

1) A four-fold rise in serum antibody titres
2) Raised levels of serum amylases or lipases
Management :_ There is no specific antiviral
_ Treatment is symptomatic
RECURRENT PAROTITIS OF CHILDHOOD

Definition; Recurrent unilateral inflammation of parotid gland
with duct dilation
Incidence : Uncommon
Age mainly affected : Children & Adolescents
Sex mainly affected : M>F
Etiology; Most cases are due to congenital dilation of the ducts.
Duct dilation appears in sialography.
Clinically: Unilateral paroxysmal parotid enlargement (2-3

weeks) with simultaneous regression. It might appear alternating
with the other side. Mild pain.
Diagnosis : Clinical
Management : No specific treatment is available or required .
Repeated courses of antimicrobials are often used but usually
the condition resolves after puberty .
DUCT OBSTRUCTION
Definition : Obstruction to salivary duct is usually due to an
internal blockage from a stone ( calculus ) , mainly seen in the
submandibular duct .
Age mainly affected : Adults
Aetiology : Calculi caused by stasis , strictures , mucus plugs or
neoplasms.
Clinical features :1)Salivary gland swelling especially with

meal.
2) Lack of swelling at other times
Diagnosis : 1) Clinically
2)Plain radiographs
3) Sialography
Management : Obstructions are overcome by surgical removal
of the obstruction , lithotripsy or duct dilation
SIALOLITHIASIS
Definition : Calculus , usually in salivary duct
Etiology : Possibly salivary stasis
Clinical features :
1) Usually affect the submandibular duct
2) May present with pain , and swelling of , the gland
particularly around mealtimes
3) Are sometimes asymptomatic
4) Are usually yellow or white and can sometimes be seen in
the duct
5) May be palpable
6) Are commonly radiopaque
Diagnosis : Radiography , sialography if necessary
Management: Surgical or lithotripsy removal of obstruction
MUCOCELE
Definition : A cystic space filled with mucinous material
Incidence : Common
Age mainly affected :From childhood
Aetiology : Rupture of the duct of a minor salivary gland
Clinical features :Mucoceles appear as dome-shaped ,

translucent whitish-blue cystic lesions , papules or nodules
.There are three main types :
1) Extravasation mucocele
2) Mucocele of the retention type
3) Superficial mucocele
4) Mucous extravasation cyst (mucocele): due to escape of
mucous into the approximate tissuse. This is the most
commonly seen mucocele & mostly in the lower lip.
5) Mucous retention cyst (mucocele): in the floor of the
mouth & called RANULA. It occurs unilateral.
6) Superfacial mucocele: due to mucous escape into
submucosa. It looks like vesicolobullous lesions.
Diagnosis : We must ensure that the lesion is not salivary gland
tumour
Management : 1) Superficial mucoceles usually resolve
spontaneously
2) The other mucoceles can be excised but
they also respond well to cryosurgery.
NECROTISING SIALOMETAPLASIA
Definition : Benign self-limiting inflammatory salivary disorder
Incidence : Rare
Age mainly affected : Adults, 5th decade
Aetiology : Unknown
Clinical features :
1) Initially an asymptomatic swelling
2) Of sudden onset
3) In the palate, any oral tissue may be affected
4) Followed by painful solitary ulceration
5) Self-limiting , healing over 5 to 8 weeks
Diagnosis :_ Clinical features
_ Biopsy
Management : This is a self-limiting condition but may take 1-2
months to heal completely
SIALOSIS , (SILADENOSIS)
Definition : Sialosis is bilaterally symmetrical painless
enlargement of salivary glands .
Age mainly affected : Adults
Aetiology : 1) Alcholism
2)Endocrine conditions
3)Nutritional disorders
4)Drugs
Clinical features :
1) Salivary gland swelling
2) No xerostomia
3) No trismus
4) No fever
Diagnosis :
1) The daignosis of sialosis is one of exclusion
2) Blood examination for antibody
3) Salivary biopsy is not usually needed
4) Salivary gland function is normal
5) Sialography is likely to show enlargement salivary glands
6) Sialochemistry
Management: No specific treatment is available

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SALIVARY GLAND DISEASES

Most common salivary gland diseases

ACUTE BACTERIAL ASCENDING SIALADENITIS

1) After radiotherapy to the head and neck

CHRONIC BACTERIAL SIALADENITIS

Management : surgical excision is often needed but occasionally

Clinical features :1) Protiditis

Diagnosis , Clinically and :

RECURRENT PAROTITIS OF CHILDHOOD

Clinically: Unilateral paroxysmal parotid enlargement (2-3

Clinical features :1)Salivary gland swelling especially with

Clinical features :Mucoceles appear as dome-shaped ,

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