ENT lecture!

7/26/2019 ENT lecture!

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Salivary GlandsDisorders



Anatomical Considerations

Twosubmandibular

Two Parotid Two sublingual

> 400 minor

salivary glands



Minor salivary glands

These lie ust undermucosa!

Distributed over li"s#

chee$s# "alate# %loor o%mouth & retro'molararea!

Also a""ear in u""er

aerodigestive tract Contribute (0) o% total

salivary volume!



Sublingual Salivary glands

This is the smallest o% themaor salivary glands!

The almond sha"ed gland lies ust dee" to the %loor o% mouth

mucosa between the mandible& Genioglossus muscle! *t is bounded in%eriorly by the

Mylohyoid muscle Sublingual gland has no true

%ascial ca"sule! *t lac$s a single dominant duct!

*nstead# it is drained bya""ro+imately (0 small ducts,the Ducts o% -ivinus.



Submandibular Gland

This gland lies in thesubmandibular triangle%ormed by the anterior and"osterior bellies o% the

Digastric muscle and thein%erior margin o% themandible!

The gland %orms a /C

around the anterior margino% the Mylohyoid muscle#which divides the gland intoa su"er%icial and dee" lobe!

http://radiographics.rsna.org/content/26/3/745/F16.large.jpg



Submandibular Gland11

2hartons duct em"tiesinto the intraoral cavitylateral to the lingual

%renulum on the anterior%loor o% mouth

http://210.44.214.13/HISTOPATH/opatho/SG/073bb.htm



Parotid Gland

The "arotid gland re"resents thelargest salivary gland

The %ollowing lists theboundaries o% the "arotidcom"artment3

Su"erior border 5 6ygomaPosterior border 5 7+ternalAuditory Canal*n%erior border 5 StyloidProcess# Styloid Processmusculature# *nternal CarotidArtery# 8ugular 9einsAnterior border 5 a diagonalline drawn %rom the6ygomatic root to the 7AC



Parotid Gland11

:0) o% the gland overliesthe Masseter andmandible! The remaining

;0) o% the gland ,theretromandibular "ortion

This "ortion o% the glandlies in the PrestyloidCom"artment o% thePara"haryngeal s"ace

http://en.academic.ru/pictures/enwiki/71/Gray1024.png



Parotid Gland11

Stensens duct arises %rom theanterior border o% the Parotidand "arallels the 6ygomaticarch# (!< cm in%erior to the

in%erior margin o% the arch! *t runs su"er%icial to the

masseter muscle# then turnsmedially =0 degrees to "ierce

the uccinator muscle at thelevel o% the second ma+illarymolar where it o"ens onto theoral cavity!



Parotid Gland11

Cranial ?erve 9** divides it into ;surgical @ones ,the su"er%icial anddee" lobes.!

A%ter e+iting the %oramen# it turnslaterally to enter the gland at its

"osterior margin! The nerve then branches at the Pes

Anserinus ,gooses %oot.a""ro+imately (! cm %rom thestylomastoid %oramen! The nervethen gives rise to ; divisions3

(.Tem"ero%acial ,u""er. ;.Cervico%acial ,lower.



Parotid Gland11

Bollowed by <terminalbranches3

(.Tem"oral ;.6ygomatic .uccal

4.MarginalMandibular <.Cervical



Bunctions o% saliva include the%ollowing3

*t has a cleansing action on the teeth *t moistens and lubricates %ood during mastication

and swallowing *t dissolves certain molecules so that %ood can be

tasted *t begins the chemical digestion o% starches through

the action o% amylase# which brea$s down"olysaccharides into disaccharides!

The saliva %rom the "arotid gland is a rather thin#

watery %luid# but the saliva %rom the sublingual andthe submandibular glands contains mucus and ismuch thic$er!



Disorders o% minor salivary Glands

7+travasation Cysts

Bollow trauma

MSG with in lowerli"

9isible "ain%ulswelling

Some resolves"ontaneously orreuire surgery




MSG tumours are rarebut =0) aremalignant

Common sites include ""er li"

Palate

-etromolar regions

-are sites arenoseEP?SEPharyn+




enign tumours "resent as"ainless slow growingswellings# overlying

ulceration is rare! Malignant tumours have

%irmer consistency andhave ulceration at later

stage

http://screening.iarc.fr/atlasoral_detail.php?flag=1&lang=1&Id=B8000002&cat=B8

http://screening.iarc.fr/atlasoral_detail.php?flag=1&lang=1&Id=B8000001&cat=B8




enign tumors o% "alate F (cm in si@eare removed by e+cisional bio"sy

2hen si@e larger than ( cm "riorincisional bio"sy is done

Malignant tumors are managed bye+cision which may involve low'level

or total ma+illectomy and immediatereconstruction



Disorders o% sublingual salivaryGlands

Problems are rare

Minor mucous retention cysts

Plunging ranula is a retentioncyst that tunnels dee"

?early all tumours aremalignant



Plunging ranula

-are %orm o% retention cyst

May arise %rom SMES SG

Mucous collects aroundgland

Penetrates Mylohyoidmuscle to enter nec$

So%t "ainless %luctuantdumb'bell sha"ed swelling

Surgical e+cision via nec$



Disorders o% sublingual salivaryGlands

Tumours are rare

=0) are malignant

2ide e+cision and simultaneous nec$dissection



Disorders o% submandibular salivaryGlands

Acute sialadenitis 9iral ,Mum"s.

acterial secondary to in%ection

More Common Secondary to obstruction

Poor ca"acity to recover

Des"ite control with Ab+

chronicity %ollows and reuiressurgical e+cision



Chronic Sialadenitis

Commonly due to obstruction%ollowing stone %ormation

:0) salivary stones occur in SMSG

High mucous content

Acute "ain%ul swelling ra"idly"reci"itated by eating & resolveswithin ('; hours

7nlarged bimanually "al"able SMG

Marsu"lisationE7+cision

http://www.wpsmith-surgeon.co.uk/services/services.htm



Tumors o% Submandibular SalivaryGlands

ncommon# slow growing# "ainless Inly <0) are benign 7ven malignant tumours can be slow

growing Pain is not a reliable %eature *nvestigations3

CTEM-* B?AC ?o o"en bio"sy



Management

Small & encased within ca"suleintraca"sular e+cision

arge benign tumors5 su"rahyoide+cision

Malignant tumours reuireconcomitant nec$ dissection



Disorders o% "arotid Glands

Common causes o% "arotid swelling3 Mum"s

Acute bacterial sialadenitis in dehydratedelderly "atients

Acute bacterial "arotitis

Ibstructive "arotitis3 causes swelling at

meal time



Parotid Tumours

Most Common is "leomor"hic adenoma,:0'=0).

ow grade Tumors li$e acinic cell carcinoma

are not distinguishable %rom benign High grade Tumours grow ra"idly# are o%ten

"ain%ul and have nodal metastasis

CTEM-* are use%ul

B?AC better than o"en bio"sy

T+ should be e+cised & not enucleated



Classi%ication o% Parotid Tumours

Adenoma

Pleomor"hic

Monomor"hic ,2arthins Tumour. Carcinoma

ow grade ,Acinic cellEAdenoid

cystic. High grade ,AdenocarcinomaESCC.



Management

Su"er%icial"arotidectomymost common

"rocedure -adical"arotidectomy is"er%ormed %or"atients clearhistologicalevidence o% highgrade malignancy



Tumour li$e lesions

Sialadenosis Diabetes

Alcoholism

7ndocrine disorders

Pregnancy

ulimia



Sogren Syndrome

Autoimmune condition causing"rogressive degeneration o% salivaryand lachrymal glands

The oral as"ects o% "rimarySogrenJs syndrome consist o%mucosal atro"hy ,:0) to =<).#salivary gland enlargementa""ro+imately 0 ).#

The oral mani%estations may include+erostomia with or without salivarygland enlargement# candidiasis#dental caries and taste dys%unction!



*nvestigations

Sialometry

Sialogra"hy

Scintigra"hy a radioactive tracer is given by

vein that is subseuently ta$en u" by thesalivary glands and gradually eliminatedwithin the salivary %luid

Sialochemistry

ltrasonogram

abial or minor salivary gland bio"sy



Management

Sym"tomatic

Brom the systemic drug treatmentstand"oint# immunosu""ressive thera"y in

the %orm o% corticosteroids or cytoto+icdrugs have "roven e%%ective# in "articularwhen sym"toms are severe! A drug $nownas Plauenil has also "roven to be hel"%ul in

some cases with o"en uestions remainingas to the role o% al"ha inter%eron andnonsteroidal anti'in%lammatory drugs!

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