DISEASES OF SALIVARY GLANDS. By. Professor Dr / Heba Ahmed Farag.
II-INFECTIOUS:. A. Bacterial:. I- DEVELOPMENTAL: Aplasia; Atresia; Abberancy.
Aplasia: Absence of one or more major salivary glands..
Complete absence of one or more major salivary glands..
Atresia. A congenital absence or occlusion of one or more ducts of the major salivary glands. It may result from degeneration or failure of canalization of the more proximal part of the epithelial salivary gland after the distal part has differentiated into salivary gland tissue. Clinical significance : Xerostomia..
Abberancy Latent bone cyst. Stafne’ bone cyst – Latent bone cyst Developmental lingual submandibular salivary gland inclusion cyst. Ectopic Condition due to presence of normal salivary gland tissue in the mandible. It is cyst like lesion and considered a developmental condition due to entrapment of part of submandibular salivary gland inside the body of the mandible. Connected to the main gland with a stalk..
Abberancy Latent bone cyst. Discovered by routine X-ray. Unilocular RL below the inferior alveolar canal.
Abberancy Latent bone cyst.
ACUTE SUPPURATIVE PAROTITIS. Most affected salivary gland parotid gland. Causes as a sequel to abdominal surgery , mainly due to postoperative dehydration (which causes secondary Xerostomia), and poor oral hygiene..
The micro-organisms responsible: - Staph ylococcus aureus . - Staphylococcus pyogenes . - Streptococcus viridans . - Pneumococci ..
Clinical Features: - Rapid painful swelling of the affected gland - Uplifting of the lobe of the ear - Low grade fever - Elevated erythrocyte sedimentation rate - Leucocytosis, - General malaise and headache. - The overlying skin is reddened ,.
- Trismus may be present, - Oedema may spread to involve the cheek, periorbital region and neck. - A purulent discharge may be expressed from the duct of the affected gland by digital pressure..
Pathologically. catarrhal inflammation. purulent inflammation.
Prognosis - In the past , when the condition was common, it frequently ended fatally . - The fatal outcome, however, was mainly due to the poor general condition of the patients rather than to the severity of the parotitis itself. - Nowadays , due to the improved care of patients and the use of antibiotics , the condition ends in resolution ..
Chronic Sialadenitis. This is usually a combination of ascending infection and dilatation of the small ducts of the gland..
Küttner’s tumour is a rare disease, which mimics malignancy.
Recurrent Parotitis. -children of up to 12 years of age, > adults. - Only one or both glands may suffer, simultaneously or at different times. - The swelling often starts at a mealtime and may persist from half an hour to several days..
- There is a feeling of tension and pain, and the swelling is firm and smooth but not hot. - The mouth is dry during an attack, and the saliva is clear..
The condition may actually be a form of chronic parotitis with acute exacerbations..
-Mumps is an acute, contagious viral disease. - The virus is a member of the paramyxovirus group which also includes the parainfluenza , measles and the NewCastle disease viruses. - respiratory droplet infection. Age : 15 years..
Epidemics occur at all seasons but are slightly more frequent in late winter and spring . The virus has been isolated from saliva as long as 6 days before and up to 9 days after appearance of salivary gland swelling. - Life long immunity usually follows clinical or subclinical infection although second infections have been documented..
-The ear lobe is pushed upwards and outwards, and the angle of the mandible is no longer visible. - The swelling slowly subsides within 3-7 days..
- Less commonly, the sublingual glands are affected , usually bilaterally, the swelling being evident in the submental region and in the floor of the mouth. - A maculopapular erythematous rash, most prominent on the trunk , occurs infrequently..
Complications. -Meningoencephalitis: This occurs in 10% of patients..
Diagnosis The diagnosis of mumps is usually apparent from symptoms and physical examination. The blood picture shows leucopaenia with relative lymphocytosis. serum amylase is common. - Definitive diagnosis depends upon isolation of the virus from saliva, urine , spinal fluid or blood ..
Obstructive Lesions Sialolithiasis(salivary calculus).
- submandibular > parotid glands. 40:1 - They may also occur in the sublingual and minor salivary glands,. - Calcium phosphates and carbonates comprise the major inorganic Component. - Mucopolysaccharides, cholesterol and uric acid are usually also present. - Adults > children..
- Males > females. - The stone or stones may be in the gland, in the duct or in both. - radiopaque on an occlusal x-ray film. . -round if small but oval if large. - edentulous patients < - ducts> -obstruction and -infection of the gland in whose duct it lies..
Histologically - A decalcified stone is seen to consist of an amorphous,concentrically laminated material. - This surrounds a core of micro-organisms or a foreign body.
DEGENERATIVE DISEASE OF SALIVARY GLANDS. - Autoimmune response is a condition in which an individual's primary defence mechanism is directed against his own tissues..
Such a reaction is associated with the production of circulating antibodies that affect specific tissues and organs..
SJOGREN'S SYNDROME. Sjogren’s syndrome is an autoimmune disease resulting from immunologically mediated destruction of lacrimal and salivary glands..
1-Primary form: It occurs as an isolated disorder also known as the sicca syndrome..
-middle-aged females > - decreased salivary and lacrimal function. - arthritic symptoms are the most frequent initial complaint of patients..
- Keratoconjunctivitis sicca gritty burning sensation of the eyes. Redness, photophobia and discharge are also noted..
-Dryness of the skin with pruritis and scaling. -Fatigue. Persistent major salivary gland swelling. May have multiple organ system involvement or other connective tissue disease as lupus erythematosus, polyarteritis nodosa, scleroderma as well as rheumatoid arthritis..
- The dentist may be the first to suspect Sjogren’s syndrome because of the noticeable oral changes in these patients. -From post-mortem studies, infection, malignant lymphoma , renal failure and hepatic failure are likely causes of death in Sjogren’s syndrome.
In established cases the oral mucosa the following is seen:.
The tongue is typically red, the papillae characteristically atrophy -dorsum becomes lobulated with a cobblestone appearance ..
-Beefy red appearance..
Dental changes: Caries: root and incisal caries. Plaque accumulates -rapidly progressive dental caries..
Some patients experience tooth erosion. -Sjogren’s syndrome does not appear to increase the risk of periodontal disease..
Radiographic Features Sialography typically shows: Dilatation and feathering of minor ducts. - Snow flake pattern indicating the escape of the contrast medium from the minor duct into the parenchyma..
- Punctate cavitatory defect filled with radiopaque contrast medium producing cherry blossom or fruit-laden tree appearance ..
Histopathologic Features: - atrophy of the acinar tissue associated with infiltration by lymphocytes that may or may not form follicles with germinal centres. -lymphocytic infiltration may be sparse and adipose replacement marked..
- The acinar atrophy is usually associated with proliferative activity of ductal cells forming so-called epimyoepithelial islands, though these may be present in about half the cases..
The histopathological changes of the oral mucosa in Sjogren's syndrome:.
Diagnosis. patient presents with xerostomia and salivary gland swelling:.