SALIVARY GLAND DISEASES

Dr.Syed Alam Zeb

• There are four main salivary glands: two submandibular glands two parotid glands There also two sublingual glands and >400

minor salivary glands.

SUBLINUAL GLANDS

• Paired set of salivary glands, lying in the anterior part of the floor of the mouth.

• Each gland has numerous excretory ducts which open either directly in to the oral cavity or indirectly via ducts that drain in to the submandibular duct.

Disorders of Sublingual glands

• Problems are rare.• Minor mucous retention cysts may need

surgery.• Plunging ranula is a retention cyst that tunnels

deep.• Nearly all tumours are malignant.

Ranula and plunging Ranula

• Ranula. This term is only applied to a mucous retention cyst of the sublingual gland.

Characteristic ‘frog’s belly’ swelling. Can resolve spontaneously. Surgically the cyst should be excised along

with the sublingual gland.

ranula

ranula

• Plunging Ranula. Mucous retention cyst that can arise from both the sublingual and submandibular glands.

Patient presents with a swelling in the submental or submandibular region that is dumbell shaped, soft, fluctuant and painless.

Diagnosed with US/MRI. Treatment is excision.

SUBMANDIBULAR GLAND

• Paired salivary glands,encapsulated, has superficial and deep parts. Anteriorly related to facial vessels.

• The lingual, hypoglossal and marginal mandibular branch of facial nerve are in closed relation.

• Drained by the wharton’s duct in to the floor of the mouth.

DISORDERS OF SUBMANDIBULAR GLAND

• DEVELOPMENTAL DISORDERS: congenital absence duct atresia ectopic/ aberrant gland tissue

• INFLAMMATORY DISORDERS Sialadenitis which may be acute, chronic or acute on chronic, caused by either bacteria or virus.

• CHRONIC SUBMANDIBULAR SIALADENITIS: This is caused by a stone formation in the duct. There is acute painful swelling, precipitated by eating and resolves spontaneously in 1-2 hrs after meals. On examination the gland is enlarged, firm and tender. Pus may be seen coming out of the duct.

• Management : if the stone is in part of the duct anterior to the point where it is crossing the lingual nerve, remove it by a direct incision over the stone and do not stitch the wound in the duct. if the stone is in the posterior part, excise the whole gland and ligate the duct.

• Complications of submandibular gland surgery. haematoma wound infection marginal mandibular nerve injury lingual nerve injury hypoglossal nerve injury

• Submandibular gland tumours : 50% tumours are malignant. Do FNAC not open biopsy where tumor is suspected. CT and MRI help to know the extent of the disease. Treatment is surgical excision.

PAROTID GLAND

• The gland is divided in to superficial and deep parts by the facial nerve.

• Structures passing through the parotid gland are important: facial nerve branches of external carotid artery retromandibular vein intraparotid lymph nodes.

Common causes of Parotid swelling: Viral infections..mumps. Bacterial infections, acute are idiopathic while chronic

are due to obstruction. Sjogners syndrome HIV associated Tumours

Sialolithiasis ..stone formation:

• much rarer than submandibular

• usually radiolucent • sialography is needed to identify them

• removed surgically by exposing the duct and

cutting down on to the stone.

• Tumours of the parotid gland: Classification

Adenomas: 1.pleomorphic adenoma is the most common tumour. 2.warthins tumour

Carcinomas: 1.Adenocarcinoma 2.Sqamous cell Carcinoma 3.Acinic cell ca.

• Classification cont: Non-epithelial tumours like haemangioma Lymphomas Secondary tumours Cysts unclassified

• Investigations for parotid tumours:

FNAC CT MRI

Superficial Parotidectomy: this is the most common procedure for parotid gland pathology.

‘lazy S’ incision. facial nerve is identified

the whole superficial parotid gland is removed, not just enucleation of the tumour.

• Complications of parotid surgery.• Haematoma formation.• Infection.• Facial nerve damage.• Numbness of the ear lobe due to division of

the greater auricular nerve.• Frey syndrome.