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DISEASES OF SALIVARY GLANDS. By. Professor Dr / Heba Ahmed Farag. 

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II-INFECTIOUS:. A. Bacterial:. I- DEVELOPMENTAL: Aplasia; Atresia; Abberancy. 

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2. Specific: a. Tuberculosis b. Actinomycosis c. Sarcoidosis

I- DEVELOPMENTAL: Aplasia;   Atresia;   Abberancy

1. Mumps            2. Cytomegalic inclusion disease

Aplasia: Absence of one or more major salivary glands.. 

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Aplasia: Absence of one or more major salivary glands.

Complete absence of one or more major salivary glands.. 

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Complete absence of one or more major salivary glands.

It results from failure of the terminal cells of a developing gland bud to differentiate into acinar tissue.

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.. 

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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.. 

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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. 

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Discovered by routine X-ray. Unilocular RL  below  the inferior alveolar canal

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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.. 

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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.

Predisposing factors: - Debility - Drugs that cause xerostomia.  (e.g. tricyclic antidepressant treatment)

The micro-organisms responsible: - Staph ylococcus aureus . - Staphylococcus pyogenes . - Streptococcus viridans . - Pneumococci .. 

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The micro-organisms responsible:   -  Staph ylococcus  aureus . - Staphylococcus  pyogenes . - Streptococcus  viridans . -  Pneumococci .

-The infection is usually an  ascending  one, with the organisms reaching the gland from the oral cavity  through the duct. - Very rarely the organisms may reach the gland via the blood stream.

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 ,. 

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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.. 

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-  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. 

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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 .. 

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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.. 

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This is usually a combination of ascending infection and dilatation of the small ducts of the gland.

Most cases show dilatation without stricture.

Parotid inflammation may be bilateral, and sometimes the submandibular glands may be affected as well.

Küttner’s tumour is a rare disease, which mimics malignancy. 

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histopathologic features: - hyperplasia  of  ductal epithelium , - periductal chronic inflammatory cell ( lymphocytic )  infiltration . - acinar atrophy - fibrosis  leading to disappearance of the acini.

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.. 

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-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.. 

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- 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.

-  Sialography   often reveals  some dilatation of the ducts , even between attacks,

The condition may actually be a form of chronic parotitis with acute exacerbations.. 

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The condition may actually be a form of chronic parotitis with acute exacerbations.

pseudocystic dilations of interlobular ducts.

-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.. 

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-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.. 

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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.. 

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-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.

-One parotid  gland usually  swells a day or two before the other , but swelling limited to one gland is not uncommon. - The swollen area is tender and  painful.

- 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.. 

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- 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.

-  Redness  and swelling around the  opening of the parotid  duct are common

Complications. -Meningoencephalitis: This occurs in 10% of patients.. 

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-Meningoencephalitis: This occurs in 10% of patients.

Orchitis: Rarely occurs in prepubescent boys but is common in adolescents and adults.

- Oophoritis: This presents by pelvic pain.

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 .. 

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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). 

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Obstructive Lesions Sialolithiasis(salivary calculus)

Etiology: form around a colony of: - Microorganisms glands. - Foreign bodies - Desquamated epithelial cells

- 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.. 

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- 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.. 

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- 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. 

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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.. 

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- 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.. 

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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.. 

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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.. 

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1-Primary form: It occurs as an isolated disorder also known as the sicca syndrome.

cause more severe oral and ocular changes and has a higher risk of lymphomatous change than secondary.

Image showing symptoms of Sjogrens syndrome, dry eyes and mouth.

-middle-aged females > - decreased salivary and lacrimal function. - arthritic symptoms are the most frequent initial complaint of patients.. 

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Sjogren's triad includes: - kerato-conjunctivitis sicca, - xerostomia, - rheumatoid arthritis.

-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.. 

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- 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.. 

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-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. 

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- 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:. 

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In established cases the oral mucosa the following is seen:

Difficulty in swallowing and mastication and speech.

The oral mucous membranes appear dry, smooth and glazed.

The tongue is typically red, the papillae characteristically atrophy -dorsum becomes lobulated with a cobblestone appearance .. 

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- The lips become chapped and angular cheilitis develops.

The tongue is typically red, the papillae characteristically atrophy  -dorsum becomes lobulated with a cobblestone appearance .

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Dental changes: Caries: root and incisal caries. Plaque accumulates -rapidly progressive dental caries.. 

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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.. 

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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.. 

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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 .. 

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- 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.. 

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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.. 

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- 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:. 

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The histopathological changes of the oral mucosa in Sjogren's syndrome:

Diagnosis. patient presents with xerostomia and salivary gland swelling:. 

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patient presents with xerostomia and salivary gland swelling:

-Careful  clinical  examination . Stimulated parotid  salivary flow rates  are measured. Labia l salivary gland  biopsy  . -  Sialography .

Salivary Gland -1 Recorded__