Salivary Glands

diseases
Ashjan AL-Rashidi
Esraa Halawah
Mariam AL-Mansour
Fatemah Bughaiss

Salivary Glands
We have Major and minor salivary
glands .
The major are : parotid gland ,
submandibular gland and sublingual
gland.
Both major and minor salivary glands
maybe involved pathologically , but
the major accounts more.

Salivary gland diseases

Salivary gland diseases are divided
into three categories according to
processes :
1. inflammatory disorders.
2. non-inflammatory disorders.
3. space occupying masses :
A. cystic.
B. neoplastic ( benign or malignant

Salivary gland disease

The inflammatory diseases can
be :
A. acute or chronic.
B. secondary to ductal obstruction
( sialoliths ) or infections.
C. secondary to trauma or
neoplasms.

Salivary glands disease

The clinical signs and
symptoms of salivary glands
disorders are :
1. swelling.
2. pain.
3. altered salivary glands.

Differential diagnosis
of salivary glands
enlargement

Applied diagnostic imaging

The diagnostic imaging is

very important to
differentiate , distinguish ,
identify and localize the
salivary gland diseases.

Intra-oral radiograph
These are an intra-oral
peri-apical and occlusal
radiograph for the
mandible showing
sialolith in the anterior
two thirds of the
submandibular duct
(whartons duct).

Extra-oral radiograph
This is an extra-oral radiograph
projection that has been taken
with over-the-shoulder
occlusal technique showing
a sialolith in posterior part of
whartons duct.

Extra-oral radiograph
These are panoramic
radiographs :
A. this panoramic radiograph
shows submandibular
sialolith near the antegonial
notch of the mandible and
superior to hyoid bone.

Extra-oral radiographs

B. this
panoramic
radiograph
shows parotid
sialolith
superimposed
over the
condyler neck.

Conventional sialography

These are sialography

of normal parotid
gland showing
opacification all the
way to the terminal
ducts and acini :
A. ant. Post.
projection.

Conventional sialography
B. lateral projection.

Conventional sialography

These are conv.

Sialography of a
submandibular g.
imaged with cone
beam computed
tomography
(CBCT) :
A. axial view.

Conventional sialography
B. lateral view.

CBCT image
These are CBCT
imaging of a
submandibular
sialolith :
Coronal , axial
and 3D views.

CT image
These are CT
image with soft
tissue algorithm
demonstrates
bilat.
enlargement of
the parotid
glands :
Axial view.

CT image
Coronal view.

MDCT image
This an axial bone
algorithm MDCT
image shows a
sialolith in the
submandibular
whartons duct.

obstructive and inflammatory

disorders (1. sialolithiasis)
disease mechanism :

it is the formation of a
calcified obstruction within
the salivary duct.

the submandibular gland and

Wharton's duct ( 83% of

obstructive and inflammatory

disorders (1. sialolithiasis)
clinical features :
1. swelling.
2. pain with eating.
3. signs of infection.

obstructive and inflammatory

disorders (1. sialolithiasis)
imaging features :

it depends on the degree of

calcification, it may appears :
a. radiopaque or radiolucent.
b. varies from long cigar shapes
to oval round shapes.

* sialography is helpful in locating

obstructions *

1. sialolithiasis

obstructive and inflammatory

disorders (1. sialolithiasis)
treatment :
1. it is done by stimulating the
secretion through the use of
sialagogues.

2. If the discharge does not

occur , then sialolith maybe
removed by surgery.

obstructive and inflammatory

disorders( 2. bacterial sialadenitis )
disease mechanism :
it is an acute or chronic bacterial infxn of the
terminal acini or parenchyma of the salivary
glands.

a. acute type:
-parotid gland is the most affected.
- as a result of reduced salivary secretion o&
retrograde by oral flora.

b. chronic type:
-maybea consequence of an untreated acute
sialadenitis.
-mayaffect any of the major glands ( mostly
parotid ).

obstructive and inflammatory

disorders( 2. bacterial sialadenitis )
clinical features :

1. unilat & it occur at any age.

a. inacutecases :
- swelling , redness , tenderness and malaise.
- enlarged regional lymph nodes and suppuration.

b. inchronic cases :
- pus expression.
- pain during salivary stimulation.

obstructive and inflammatory

disorders( 2. bacterial sialadenitis )
imaging features :

-sialography is contra-indicated in acute cases!

however , sialography is good for chronic infxns.

-MDCT will show the abscess cavities.

-US will distinguish between diffuse infl. and

suppuration.
and will detect sialolith greater than 2 mm.

-MRI is an alternative when the sialography is contraindicated.

2. bacterial sialadenitis

obstructive and inflammatory

disorders( 2. bacterial sialadenitis )
treatment :

1. oral hygiene , local massage , fluid

intake , oral sialagogues.
2. antibiotic.
3. partial or total surgical excision.

obstructive and inflammatory

disorders ( 3. sialodochitis )
disease mechanism :

it is an inflammatory of the ductal system of the

salivary glands.

dilation of the involved ductal system.

in chronic cases ,fibrosis may showcausing

obstructions.

common in both the submandibular and the

parotid gland.

obstructive and inflammatory

disorders ( 3. sialodochitis )
imaging features :

sialectasia is prominent manifestationof

sialodochitis on sialography.

if fibrosis develops , it will appear as a sausagestring.

treatment :

similar to that describe to sialadenitis.

3. sialodochitis

Autoimmune sialadenitis
Synonym : it include
myoepithelial sialadenitis
Sjogren syndrome
Benign lymphoepithial lesion
Disease mechanism : defferent
devolopmental stage of the same
immunologic mechanism

Clinical feature
Range from reccurent painless
swelling of S.G to enlarge of
lacremal gland
glandular swelling may
accompained by :
- xerostomia ,exophthalmic
( primary sjogran syndrom )
Subsequently by C.T disease such as
: rheumatoid arithritis , systamic

Diagnosis
Made on the basic of any 2 of the
3 feature :
1- Dry mouth
2- Dry eyes
3- rheumatoid disease
common in : Adult (40-60 years )
Female 95%
Non hodgkin lymphoma

Imaging Feature:

sialograph is helpful in diagnosis

and staging of autoimmune disease
*Early stage
*Disease progress
*End stage

D/D :

- Chronic bacterial granulomatous in infection

- Multiple parotid cyst associated with HIV

*Diffuse cervical lymphadenopathy is

common in HIV
uncommon in sjogran syndrome

Treatment :

- Relive symptom
- The underlyining rheumatoid
condition are treated with :
*Antiinflammatory agent
*corticosteriod
* Immunosuppressive therapeutic
agent

Non Inflammatory Disorder

1- Sialadenosis
2- Cystic Lesions
3- Benign tumers : Benign Mixed Tumor
Warthin Tumor
Hemangioma
4- malignant tumers :
Mucoepidermoid Carcinoma
Malignant Mixed Tumor

Disease mechansim :
-non-neoplastic
-non-inflammatory enlargment of
primary parotid gland

Related to:
Metabolic and secretory disease

Associated with :
-vitamin and protein deficiencies
- neurologic disorders

Clinical Feature :

enlargment of S.G

Imaging Feature :
enlargment of the effected S.G and the
duct are splayed

Treatment :
- Identify the cause of the
metabolic and secretory disorder
- Conservative treatment :
-local massage
- increased fluid intake
- use of oral sialagogoues

Cystic lesion
Disease Mechanism :
-rare
-unlateral
-conginital or acquired
-intraglandular or extraglandular

Clinical Feature :
*palpable *must be distinguished from neoplasia

Imaging Feature
-cystic mass may indirectly visualized
on sialography only by the displacement
of the duct arch around them.
-its appear well circumscribed
- low density area when examined on CT
-high signal area on MRI but do not
enhance after administration of
gadolinium

Treatment

- typically surgical involving :

local or total excision of the gland

Extravasation has pseudocyst:

lack an epithelial lying and result from duct rupture
*Ranulas: are retention cyst result from obstruction of
sublingual duct
*Multicentric parotid cyst associated with HIV
*Bengin lymphoepithelial lesion of human
immunodeficiency syndrome

BENIGN TUMOR
Disease mechanism :
Prevalence < 0.003% of population .
It's 3% all tumors in body .
Benign and low -grade malignancy >
high-grade malignancy .
chance of being benign varies directly
with size .

parotid gland 80%

Treatment:
major salivary glands is surgical
removal .

Imaging feature:
Benign and low -grade malignancy are
1. Well-defined margin
(especially MDCT & MRI)
2. Ball in hand appearance ( MRI )

PLEOMORPHIC ADENOMA
(BINGHN MIXED TUMOR )

Disease mechanism :
Arising from the ductal epithelium of
major and minor salivary glands

Clinical features :
1.
2.
3.
4.
5.
6.

75% of all salivary gland tumors .

Fifth decade .
Female > male .
Slow-growing , Unilateral , Encapsulated , Asymptotic .
50% recurrence after excision
15% malignant transformation

parotid gland 80%

submandibular gland
4%

Imaging features:
In MDCT
1.sharply circumscribed
2. Round homogeneous lesion
3. Higher density
4. Calcifications within tumor

WARTHIN'S TUMORS
( PAPILLARY CYSTADENOMA LYMPHOMATOSUM
ADENOLYMPHOMA
LYMPHOMATOUS ADENOMA )

Disease mechanism :
arising from proliferating salivary ducts
trapped in lymph nodes during
embryogenesis .

Clinical features :
1.second most common benign tumors .
2. 2-6% of parotid tumor and found in the
inferior lobe .
3. More in men older than 40 years .
4. Slow-growing , Painless .
4. Rond-to-avoid mass .
5.Unilateral or bilateral

Imaging Features.
MDCT and MRI are preferred
techniques
1. Similer to benign mixed tumor .
2.either soft tissue or cystic density
(on MDCT).
3. heterogeneous and may
hemorrhagic foci (on MRI) .

Hemangioma
( vascular nevus )

Diseae Mechanism :
Arising from proliferating endothelial cells
(congenital hemangioma) and vascular
malformation

Clinical Feature:
1. Most frequently occurring non-epithelial
salivary gland neoplasm (especially during
infancy and childhood)
2. 85% in parotid gland .
3. 50% Hemangioma
4. Unilateral , asymptomatic
5. 2:1 female:male .

Treatment
is local excision if it's not undergo
spontaneous remission .

Imaging Features:
1. Phleboliths .
2. the ducts of the gland may be displaced
curving about the mass ( sialography )
3. hemangioma ( MDCT especially when
intravenous contrast enhancement is used )
4. has a signal similar to that of adjacent
muscle on TI-weighted images and a very
high signal on T2-weighted images (MRI)

Malignant Tumors
Dieese Mechanisms:
1. 20% of the parotid gland tumors
2. 50-60% of submandibular tumors
3. 90% of sublingual tumors
4. 60-75% of minor salivary gand tumors

Treatment Management
1. major salivary glands is typically
surgical.
2. Radiation therapy
3. Chemotherapy

Imaging Features :
1. variable and it's related to the
grade , aggressiveness ,
location and type of tumor.
2. ill-defined .
3. invasion of djacent soft tissues .
4. destruction of adjacent osseous
structure .

Mucoepidermoid carcinoma

Diseae Mechanism :
variable admixture of epidermoid and mucous
cells arising from the ductal epithelium of the
salivary glands .

Clinical features:
1. the most common malignant salivary gland tumor .
2. more than half occur in the major salivary glands (parotid
gland) .
3. the rest are found in the minor glands (palate).
4. fifth decade of life.
5. females > male
6. Low-grade tumors : mobile , slowly growing , painless , 1-4 cm
in
diameter , rarely metastasis and the prognosis is good.
7. high- grade tumors : immobile , painful , paralysis , ill-defined
margins , metastasis by blood and lymph recurrence in half of
patients after excision and the prognosis is poor .

Imaging Features :
1.Low-grade tumors :
*not apparent unless destructive changes to adjacent osseous
structures have occurred
*Presentations similar to benign salivary tumors.
* may lobulated or irregularly sharply circumscribed appearance ( in contrast-enhanced
MDCT and MRI)

2. high-grade tumors :
irregular margins , ill-defined form (MDCT or MRI)
3. irregular homogeneous mass , slightly more dense than the glandular tissues (MRI)
4. Homogeneous low signal intensity (dark) on TI-weighted images, but T2-weighted images
are more
heterogeneous and intense (brighter) ( MRI).

Other Malignant and

Metastatic :
1. adenoid cystic carcinomas (minor
salivary glands).
2. Adenocarcinoma
3. acinic cell carcinoma
4. primary lymphoma
5. squamous cell carcinoma

Clinical features:
1. Pain, paresthesia, and paralysis in high-grade
Tumors
2. Tumor spread may be by direct invasion or
metastatic
3. Metastasis lesions in the parotid gland are more
common because of the extensive lymphatic and
circulatory components
*the lymphatic system include: squamous cell
carcinoma, lymphoma, and melanoma

Imaging Features.
The presentation similar to
high-grade mucoepidermoid
carcinoma