SALIVARY

GLAND DISORDER
Pembimbing : dr. Gardika, Sp.B
Disusun oleh : Lisye Konny
 IntroducGon

Major: Minor:
2 paroGd glands. Sublingual.
2submandibular gland MulGple minor glands
Anatomy
 ParoGd Gland
Important structure that run through the
paroGd gland:
Branch of facial nerve
Terminal branch of external caroGd artery
(maxillary and supercial temporal artery)
Retromandibular vein (posterior facial)
IntraparoGd lymph node.
 ParoGd Duct
Stensens duct = 5 cm long
Open opposite the second upper molar tooth
 Submandibular Gland
Paired of gland located below the mandible
on either side
Supercial and deep lobes
Warthons duct drained submandibular gland
and opens into anterior oor of mouth.
 Sublingual Gland

Lie on the superior surface of the mylohyoid

muscle and are separated from the oral cavity
by a thin layer of mucosa.

The ducts of the sublingual glands are called
bartholins duct
 Minor Salivary Gland
About 450 lie under the mucosa
They are distributed in the mucosa of the lips,
cheeks, palate, oor of mouth & retromolar
area
Also appear in oropharyanx, larynx & trachea
Disorders of Sublingual Salivary Gland
Cyst
ExtravasaGon cyst result
from trauma to
overlying mucosa

Ranula
ExtravasaGon cyst that
arises from sublingual
gland
Disorders of Sublingual Salivary Gland
Plunging Ranula
Mucus retenGon cyst
arise from both
sublingual &
submandibular.
Mucus collects around
the gland & penetrates
the mylohyoid
diaphragm to enter the
neck.
 Disorders of minor salivary Glands

MSG tumours are rare but

90% are malignant
Common sites include
Upper lip
Palate
Retromolar regions
Rare sites are nose/PNS/
Pharynx
 Disorders of minor salivary Glands

Benign tumours present as

painless slow growing swellings,
overlying ulceraGon is rare.
If <1 cm removed by excisional
biopsy, otherwise incisional biopsy

Malignant tumours have rmer

consistency and have ulceraGon at
later stage. Management may
involve low-level or total
maxillectomy and reconstrcucGon.
 Disorders of ParoGd Gland
Developmental
Inammatory disorders
ObstrucGve
Neoplasma
 Developmental
Agenesis
Duct atresia
Congenital stula formaGon
 Inammatory

Acute sialadeniGs
Chronic sialadeniGs

EGology
Bacterial
Viral


 Viral- Acute SialadeniGs (Mumps)
Acute painful paroGGs
Viral in aeGology
Self limiGng
 Bacterial - Acute SialadeniGs
Signs and symptoms

Swelling, xerostomia, failure of secreGon with ascending infecGon
(Staph aureus, Strep pyogenes, most common infecGve organism)

Painful swelling paroGd gland, overlying skin red, shiny & tense, pus
from paroGd duct
(if involving the paroGd gland)
 Bacterial - Acute SialadeniGs
Treatment

Culture pus for SensiGvity
Prescribe appropriate anGbioGc
SupporGve therapy
Fluids
Heat
Salivary sGmulants
 Bacterial - Chronic SialadeniGs

Chronic recurrent paroGGs

Occurs commonly in paGents of 3-6 Years age
Caused by Strep viridans
May spontaneously heal during puberty
 Further ExaminaGon

Plain and contrast-enhanced axial CT image of paroGd glands.

Diuse enhancement of the leg paroGd gland : sialadeniGs

 Sjogren Syndrome
Autoimmune condiGon causing progressive
degeneraGon of salivary and lachrymal glands
The oral aspects of primary Sjogren's
syndrome consist of mucosal atrophy (80% to
95%), salivary gland enlargement
approximately 30 %),
The oral manifestaGons may include
xerostomia with or without salivary gland
enlargement, candidiasis, dental caries and
taste dysfuncGon.
 ObstrucGon

Sialolithiasis
Based on history,
Swelling during meals,
Bimanual palpaGon of painful gland,
40% non radiopaque
Mostly mulGple
Sialogram
 Sialogram

A sialogram is a dye invesGgaGon of a salivary gland. It is
carried out to look in detail at the larger salivary glands,
namely the paroGd or submandibular glands.
 Neoplasma
Most Common is pleomorphic adenoma (80-90%)
Low grade Tumors like acinic cell carcinoma are not
disGnguishable from benign
High grade Tumours grow rapidly, are ogen painful and
have nodal metastasis
CT/MRI are useful
FNAC beler than open biopsy
Tx should be excised & not enucleated
 Neoplasma

80 % occur in paroGd gland

5-10 % occur in the sub-mandibular gland

1 % occur in sublingual gland

10-15% occur in the minor salivary glands
 ClassicaGon of ParoGd Tumours
Adenoma
Pleomorphic
Monomorphic (Warthins Tumour)
Carcinoma
Low grade (Acinic cell/Adenoid cysGc)
High grade (Adenocarcinoma/SCC)
Pleomorphic Adenoma (Mixed Tumor)
Commonest tumour (53% - 71%) of the
salivary glands

Tumor is slow growing, painless, solitary,
rm, smooth, moveable without nerve
involvement

Both mesenchymal/epithelial elements

InvesGgaGons include FNA, CT, MRI

Supercial paroGdectomy is the
procedure that is commonly performed.
 Monomorphic adenoma

CharacterisGcs
Consists of a single epithelial cell type with a dense
brous connecGve Gssue capsule.

Two types
- Basal cell adenoma
- Canalicular adenoma
 Warthins Tumor
Warthins tumour is also
called as papillary
cystadenoma
lymphomatosum)
6% - 10%
Benign, bilateral, paroGd
gland only
Older age group
Supercial locaGon,
therefore in most cases
Supercial paroGdectomy
is performed.
Malignant potenGal non
existent

 Management

Supercial paroGdectomy
most common procedure
Radical paroGdectomy is
performed for paGents clear
histological evidence of high
grade malignancy

Type of ParoGdectomy
Type of ParoGdectomy
THE END