SEMINAR ON

DISORDERS OF
SALIVARY GLANDS.

CLASSIFICATION OF SALIVARY
GLAND DISORDERS
A) Developmental disorders
Aberrancy
Aplasia & Hypoplasia
Hyperplasia
Atresia
Accessory ducts
Diverticuli
Congenital fistula

B) Functional disorders
Sialorrhoea
Xerostomia
C) Obstructive disorders
Sialolithiasis
Mucus plug
Stricture & stenosis
Foreign bodies
Extra ductal causes

D) Cyst
Mucocele
Ranula
E) Asymptomatic enlargement
Sialosis
Allergic
Associated with malnutrition and
alcoholism

F) Infection
Viral
Bacterial
Mycotic
G) Autoimmune disorders
Sjogrens syndrome
Mikuliczs disease
Uveoparotid fever
Recurrent non specific parotitis

Developmental anomalies
Aberrant salivary glands
An aberrant or ectopic is salivary gland
tissue that develops at a site where it is not
normally found.
Clinical features
Site cervical region near the parotid gland
or body of mandible.
Posterior to first molar
Clinical significance
Site for development of retention cyst or
neoplasm

Aplasia & hypoplasia

It is congenitally absence of salivary gland.
Aplasia occurs in combination with congenital
anomalies.
Hypoplasia in patient with Melkersen Rosenthal
syndrome.
Clinical features
One or group of glands missing unilaterally or
bilaterally.
Xerostomia
Dental caries
Early loss of teeth
Dry & smooth oral mucosa
Cracking & Fissuring at corner of mouth.
Management Good oral hygiene.

Hyperplasia
Cause- Hormonal
Metabolic
Clinical features
Site minor salivary glands of palate.
Asymptomatic when surface firm,sessile
& normal in color.
Management
Excision for microscopic examination.

Accesory ducts
Most common developmental anomoli.
Site- superior and anterior to normal
stensons duct orifice.
Atresia
Congenital occlusion or absence of one
or two major salivary gland ducts.
Site- submandibular duct in floor of
mouth.
Causes severe xerostomia.

Diverticuli
Small pouches or outpocketing of
ductal system of one of the major
salivary glands.

Congenital fistula
Sinus tract form either in crease behind
the pinna or in front of tragus.
Management
Complete surgical excision of sinus
tract.

Functional disorders
Sialorrhoea or ptyalism
It is increase salivary secretion.
Stimulation of parasympathetic causes
profuse secretion of watery saliva.
Etiology
Drugs like sialogogues
Local factors ANUG,erythema multiforme
Systemic like paralysis
Misc. like metal poisoning

Clinical features
Drooling from mouth
Lip chapping
Infection from constant exposure to saliva
Cheek scarring.
Management
Oral motor draining
Biofeed
Removal of local factors
Anti cholinergic drugs (atropine sulphate
0.4 mg in adults
.01 mg / kg in children upto 0.4
Surgery

Xerostomia
Dryness of mouth.
Etiology
Radiation induced
Drug induced
Nutritional
Clinical features
Dry leathery tongue
Increase thirst
Difficulty in speech, swallowing & eating dry food
Burning sensation
Blurred vision
Fissuring of tongue.
Management
Preventive therapy
Symptomatic treatment
Topical salivary stimulation
Systemic salivary stimulation
Bromhexiene 8mg T.D.S. adult
4mg B.D. children

Obstructive disorders
Sialolithiasis
Salivary gland stone or salivary gland calculus within major &
minor salivary gland.
Clinical features
Site Submandibular 83%
Parotid
10%
Sublingual
7%
Severe pain
Swelling during meals
Pus from duct orifice
Inflammatory reaction to surrounding soft tissue
Overlying mucosa may ulcerate along calculus to extend into
oral floor
Radiographically almost radio opaque, oval shape & with
multiple layers of calcification, smooth borders.

Management
Manual manipulation of stone within duct.
If in submandibular duct then incision is made
directly over it.
If in gland then excision is done
Antibiotics if acute infection is present.

Mucus plug
Incompletely mineralized sialolithes.

Hard mass

Minor salivary gland sialolith

Strictures & stenosis

Etiology
Irritation
Acute trauma
Tumour
Types
Papillary obstruction
Duct obstruction
Management
Saline rinses
Salivary gland massage
Ductoplasty

Foreign Bodies
Tooth brush bristles
Tooth picks
Spikes of wheat
Finger nails
Extraductal causes
Muscle pressure
Tumors
Enlarged lymph nodes
Denture flanges associated with the
primary salivary duct.

Cysts of salivary gland

Mucocele
Swelling caused by pooling of saliva at site of injured minor
salivary gland.
Types
Mucous extravasation cyst
Mucous retention cyst
Clinical features
Site inner aspect of lower lip, palate, cheek,tongue,floor of
mouth.
Painless swelling which is frequently recurrent develops at
meal time and drains simultaneously at intervals.
Shape round or oval & smooth.
Consistency soft or hard depend upon tension of fluid.

Blue pigmented nodule

Superficial vesicle like

Exophytic lesion

Nodule

Management
Complete excision of cyst under L.A.
Injection steroid & cryosurgery.

Ranula
It is used for the mucoceles occurring in the
floor of the mouth in association with ducts of
sub mandibular or sub lingual glands
Types
Superficial
Plunging
Clinical features
Site floor of mouth on side of frenulum
Unilateral bluish swelling
Shape spherical or dome shaped only top
visible

Fluctuation & Transillumination

positive brilliantly translucent
On aspiration sticky clear fluid
Slowly enlarging swelling on side of floor
of big ranula may cause difficulty in
speech or eating.
Plunging ranula
when intra buccal ranula has cervical
prolongation it is called deep or plunging
ranula.
It is located along post border of
mylohyoid muscles in submandibular
region.

Management
Surgical excision including portion of
surrounding tissue.
Partial excision & marsupilization.

Blue pigmented swelling

Ranula

Plunging Ranula

Viral
Infections
Mumps
Contagious viral infection caused by para myxo virus
Clinical features
Unilateral & bilateral swelling of salivary gland
Fever, malaise, anorexia.
Tender & pain on eating sore food
Involved gland continues to enlarge for 2-3 days &
comes back to normal.
Complication
oophritis, orchitis, meningitis, encephalitis.
Management
Self limiting
MMR vaccine
Systemic corticosteroids

Unilateral

Bilateral
Parotid enlargement

Bacterial Infection
Acute bacterial sialadenitis (acute supprative parotitis)
Causes
Staph aureus
Staph viridans
Clinical features
Site- unilateral involvement of parotid
Fever
Pain at angle of jaw
Elevation of ear lobule
Cervical lymphadenopathy

Management
Oral hygiene
Soft diet
I.V. fluids
Parentral antibodies active against pencillin resistence staphylococcus
Surgical drainage of affected gland

Acute bacterial sialadenitis

Mycotic Infections
Actinomycosis
Cause
A.Israliae
Types
Primary ascending canalicular
inflammation. Infection penetrates from
mouth into gland and affects it entirely.
Secondary when transferred to gland
from tissue surrounding, non tender,
non fluctuant indurated lesion with
formation of multiple fistulae with
discharge of sulphur granules.

Autoimmune Disorders
Sjorgens syndrome
Chronic inflammatory disease that
predominantly affects salivary, lacrimal &
other exocrine glands
It was first described by HENNIK SJOGREN
in 1933.
Types
primary dry eyes, dry mouth.
secondary dry eyes , dry mouth ,
collagen disorders
usually rheumatoid
arthritis & SLE.

Dry & Fissured Tongue

Benign Lymphoepithelial Lesion

Clinical Features
Middle aged and female are commonly infected
Xerostomia
Soreness and difficulty in controlling dentures
Pus from duct
Difficulty in eating and unpleasant taste
Unilateral and bilateral enlargement of parotid gland
Frothy saliva
Severe dental caries
Depapillation of tongue
Dry eyes
Vaginal dryness
Connective tissue disorder
Enlargement of lymph nodes
Radiographic Findings
Snow storm appearance
In some cases cherry blossom appearance
MANAGEMENT
SYMTOMATIC TREATMENT
Occular lubricant- artificial tears coating methyl cellulose
Saliva substitute
Oral hygiene
Surgery for enlargement of glands

MIKULICZS DISEASE
Symmetric or bilateral chronic painless enlargement
of lacrimal or salivary gland has inflammatory
characteristics.
Clinical Features
Women in middle and later life
Site- unilateral or bilateral enlargement of parotid or
submandibular gland
Fever
Upper respiratory tract infection
Occasional pain
Xerostomia
Diffuse poorly outline and enlargement of gland
Management
Surgical excision

Investigations
Non-invasive investigations
Radiographs
Computerized Tomography
Ultrasound scanning
Magnetic resonance imaging
Single Photon emission Computed Tomography
Invasive Investigations
Biopsy
Fine needle Aspiration cytology
Sialography

SIALOGRAPHY
It is a specialized radiographic view of
salivary gland taken by introduction of
soluble contrast material into the ductal
system. The radiographs are called
Sialographs.
Indications
Detection of sialoliths, calculus, foreign
bodies.
Evaluation of extend of irreversible ductal
damage.
Detection/diagnosis of recurrent swelling &
inflammatory process.

Evaluation of diverticula's, strictures and

fistulae.
Tumor location & size.
Selection of a site for biopsy.
Outline the plane of facial nerve.
Residual stone/tumor, fistulae &
stenosis.
Contraindications
Acute infection of salivary gland.
Allergic reaction to any radio opaque
material to be used.
Thyroid disorders.

Phases
Filling phase
Emptying phase
Parenchyma phase
Agents used
Contrast media
X-ray film
Contrast media (Ideal requisites)
Physiologic properties similar to saliva.
Miscibility with saliva.
Absence of systemic/local toxicity.
Low surface tension & low viscosity.
Easy elimination.

Types of contrast media

Water soluble - Hyopaque
Fat soluble - Lipidol
Sialographic appearance
Normal
Calculus
Inflammation/blockage (Sialadenitis)
Strictures
Sjogrens syndrome
Tumors

Sialadenitis

Large calcified stone

Sjogrens syndrome

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