salivary diseases

8/7/2019 salivary diseases

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Dr. Saleh Al Salamah


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1. Introduction

2. Evaluation of Salivary Disease

3. Inflammatory Diseases

4. Salivary Gland Stones (Sialolithiasis)

5. Salivary Retentions Cysts and Mucous

Cysts

6. Salivary Fistulas and Sialoceles

7. Salivary Gland Tumors

8. Rare Autoimmune Diseases

9. Salivary Diseases in Childhood

1. Introduction

2. Evaluation of Salivary Disease

3. Inflammatory Diseases

4. Salivary Gland Stones (Sialolithiasis)

5. Salivary Retentions Cysts and Mucous

Cysts

6. Salivary Fistulas and Sialoceles

7. Salivary Gland Tumors

8. Rare Autoimmune Diseases

9. Salivary Diseases in Childhood

Diseases of theDiseases of the

SALIVARY GLAND:SALIVARY GLAND:

Diseases of theDiseases of the

SALIVARY GLAND:SALIVARY GLAND:


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INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION

a) Major groups of salivary glands which

are consists three major glands, theparotid, submandular and sublingual

glands. The parotid produces

mucous secretions. The parotid and

submandular glands each drain intothe mouth in a single long duct.

Where as the sublingual glands drain

via many small ducts.

a) Major groups of salivary glands which

are consists three major glands, theparotid, submandular and sublingual

glands. The parotid produces

mucous secretions. The parotid and

submandular glands each drain intothe mouth in a single long duct.

Where as the sublingual glands drain

via many small ducts.

There are Major and Minor groups ofSalivary Glands:

There are Major and Minor groups ofSalivary Glands:


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b) Minor groups of salivary glandsmay be found in the lips, cheeks,

tongue, floor of the mouth, palate,larynx, trachea and tonsils andlacrymal gland. And all are liableto undergo the same pathologicalchange as the major groups.

b) Minor groups of salivary glandsmay be found in the lips, cheeks,

tongue, floor of the mouth, palate,larynx, trachea and tonsils andlacrymal gland. And all are liableto undergo the same pathologicalchange as the major groups.


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The Salivary glands secrets saliva

which contains the enzyme amylase

(protein of molecular wt. 50,000.

Containing calcium which splitsstarch and glycogen into maltose) all

the secretory activity is regulated

mainly by parasympathetic nerves.

The Salivary glands secrets saliva

which contains the enzyme amylase

(protein of molecular wt. 50,000.

Containing calcium which splitsstarch and glycogen into maltose) all

the secretory activity is regulated

mainly by parasympathetic nerves.

FUNCTIONS:FUNCTIONS:FUNCTIONS:FUNCTIONS:

The total salivary secretion is between

1,000 ml 1,500 ml daily and is almost

all the result of stimulation.

The total salivary secretion is between

1,000 ml 1,500 ml daily and is almost

all the result of stimulation.


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DeficiencyDeficiency oof the saliva cause dry

mouth (xerostormia)

eg: Dehydration, Sjogrens syndrome,

atropine which blocks the action of

parasympathetic nerves on theglands.

DeficiencyDeficiency oof the saliva cause dry

mouth (xerostormia)

eg

: Dehydration, Sjogrens syndrome,

atropine which blocks the action of

parasympathetic nerves on theglands.

DeficiencyDeficiencyDeficiency

Deficiency


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Evaluation of theEvaluation of the

SALIVARY GLANDSSALIVARY GLANDS Diseases:Diseases:

Evaluation of theEvaluation of the

SALIVARY GLANDSSALIVARY GLANDS Diseases:Diseases:

a. History: Age, pain, swelling, duration etc..

b. Clinical Examination: (Position (site), colour,temperature, tenderness, shape, surface. Edge,

composition, relation, lymphatic drainage.c. Investigations:

I. Blood (CBC), Hb, Urea and Electrolytes, BloodSugar etc..

II. Constituents of saliva in inflammatory diseases.The sodium increased while the phosphate

level is decreased. The albumin usually very lowbut increased in Sjogrens diseases, also

antibodies can be demonstrated.

a. History: Age, pain, swelling, duration etc..

b. Clinical Examination: (Position (site), colour,temperature, tenderness, shape, surface. Edge,

composition, relation, lymphatic drainage.c. Investigations:

I. Blood (CBC), Hb, Urea and Electrolytes, BloodSugar etc..

II. Constituents of saliva in inflammatory diseases.The sodium increased while the phosphate

level is decreased. The albumin usually very lowbut increased in Sjogrens diseases, also

antibodies can be demonstrated. Contd.


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III. Radiology:

a)a) PlainPlain XX--rayray ( (2020%% ofof salivarysalivary

calculicalculi areare nonnon--opaqueopaque toto XX--

rays)rays)

b)b) SialogramSialogram

Radiology is helpful in the diagnosis of;

CalculiCalculi

DegreeDegree ofof glandularglandular damagedamage ininobstructionobstruction

DuctDuct stricturesstrictures

DuctDuct fistulasfistulas andand sialocelessialoceles

III. Radiology:

a)a) PlainPlain XX--rayray ( (2020%% ofof salivarysalivary

calculicalculi areare nonnon--opaqueopaque toto XX--

rays)rays)

b)b) SialogramSialogram

Radiology is helpful in the diagnosis of;

CalculiCalculi

DegreeDegree ofof glandularglandular damagedamage ininobstructionobstruction

DuctDuct stricturesstrictures

DuctDuct fistulasfistulas andand sialocelessialoceles Contd.


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IV. Ultrasound distinguishes solid tumourfrom the rare cyst and sialocales.

VV.. Radio Isotopes: Tc 99 warthins tumours

may take up more of the isotopes andappear as (hot) lesion. Carcinoma take

up very little and appear cold.

VI. C AT scanning has definite place in theassessment of deep parotid tumours.

IV. Ultrasound distinguishes solid tumourfrom the rare cyst and sialocales.

VV.. Radio Isotopes: Tc 99 warthins tumours

may take up more of the isotopes andappear as (hot) lesion. Carcinoma take

up very little and appear cold.

VI. C AT scanning has definite place in theassessment of deep parotid tumours.


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Acute bacterial sialadenitis

Chronic sialadenitis

Recurrent sialadenitis

Mumps

Post operative usually parotid

Autoimmune diseases

Acute bacterial sialadenitis

Chronic sialadenitis

Recurrent sialadenitis

Mumps

Post operative usually parotid

Autoimmune diseases

Inflammatory diseases of theInflammatory diseases of thesalivary glands:salivary glands:Inflammatory diseases of theInflammatory diseases of thesalivary glands:salivary glands:


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Acute Bacterial Sialadenitis:Acute Bacterial Sialadenitis:Acute Bacterial Sialadenitis:Acute Bacterial Sialadenitis:

This condition is now uncommonalmost always occurring in elderly

or debilitated patients with poor oral

hygiene.

Dehydrations and reduced salivary

flow encourage ascending infection.

The parotid gland is usuallyinvolved the result is painful,

unilateral swelling accompanied by

trismus, pyrexia and tachycardia.

This condition is now uncommonalmost always occurring in elderly

or debilitated patients with poor oral

hygiene.

Dehydrations and reduced salivary

flow encourage ascending infection.

The parotid gland is usuallyinvolved the result is painful,

unilateral swelling accompanied by

trismus, pyrexia and tachycardia.


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On Examination:On Examination:On Examination:On Examination:

The parotid gland is tender and diffuselyenlarged and purulent discharge can beseen oozing (or can be milked) from theparotid duct orifice (Stensen duct).

The parotid gland is tender and diffuselyenlarged and purulent discharge can beseen oozing (or can be milked) from theparotid duct orifice (Stensen duct).

TREATMENT:TREATMENT:TREATMENT:TREATMENT:

a. Parenteral antibiotics.

b. If parotid abscess has alreadyformed surgical drainage should be

performed.

a. Parenteral antibiotics.

b. If parotid abscess has alreadyformed surgical drainage should be

performed.


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Prolonged obstruction of major

salivary gland by ductal calculus

causes chronic inflammation of the

gland.

The glandular secretory element,

progressively atrophy and are

replaced by fibrous and adiposetissues.

Prolonged obstruction of major

salivary gland by ductal calculus

causes chronic inflammation of the

gland.

The glandular secretory element,

progressively atrophy and are

replaced by fibrous and adiposetissues.

CHRONIC SIALADENITISCHRONIC SIALADENITISCHRONIC SIALADENITISCHRONIC SIALADENITIS


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The ducts system becomes dilated,fibrotic and infiltrated by chronicinflammatory cells.

Chronic Sialadenitis and salivary calculiusually involved the submandibular gland.The submandibular gland swollen and theremay be purulent discharge from the duct.T

he swelling is made worse by takingfood.

TREATMENT: by removing the ductobstruction. Antibiotics may be necessary.

The ducts system becomes dilated,fibrotic and infiltrated by chronicinflammatory cells.

Chronic Sialadenitis and salivary calculiusually involved the submandibular gland.The submandibular gland swollen and theremay be purulent discharge from the duct.T

he swelling is made worse by takingfood.

TREATMENT: by removing the ductobstruction. Antibiotics may be necessary.

ChronicChronic SialadenitisSialadenitis (contd)(contd)ChronicChronic SialadenitisSialadenitis (contd)(contd)


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Uncommon condition which

may occur at any age.

UsuallyUsually affectsaffects thethe parotidparotid glandsglands areare

subject toto recurrentrecurrent attacksattacks ofof painpain andand

swellingswelling causedcaused byby combinationcombination ofof

obstructionobstruction andand infectioninfection ofof thethe glandsglands..

Uncommon condition which

may occur at any age.

UsuallyUsually affectsaffects thethe parotidparotid glandsglands areare

subject toto recurrentrecurrent attacksattacks ofof painpain andand

swellingswelling causedcaused byby combinationcombination ofof

obstructionobstruction andand infectioninfection ofof thethe glandsglands..

RECURRENT SIALADENITISRECURRENT SIALADENITISRECURRENT SIALADENITISRECURRENT SIALADENITIS


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There may be an associated dilatation

of the duct system and alveoli of theglands with terminal sacculation

(Sialectasis) associated with

strictures of the duct or stones.

These changes best demonstrated byperforming Sialogram.

There may be an associated dilatation

of the duct system and alveoli of theglands with terminal sacculation

(Sialectasis) associated with

strictures of the duct or stones.

These changes best demonstrated byperforming Sialogram.

RECURRENT SIALADENITISRECURRENT SIALADENITIS

(contd)(contd)

RECURRENT SIALADENITISRECURRENT SIALADENITIS

(contd)(contd)


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TreatmentTreatment::

aa.. Antibiotics with careful attention to oral

hygiene..bb.. Associated strictures is treated with

dilatation.

cc.. If stones present these must be removed.

bb.. Intractable causes may required surgical

removal of the gland.

TreatmentTreatment::

aa.. Antibiotics with careful attention to oral

hygiene..bb.. Associated strictures is treated with

dilatation.

cc.. If stones present these must be removed.

bb.. Intractable causes may required surgical

removal of the gland.

RECURRENT SIALADENITISRECURRENT SIALADENITISRECURRENT SIALADENITISRECURRENT SIALADENITIS


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Viral infectious disease attackthe parotid gland mainlyincubation period (17-21days)which is usually bilateral usuallyoccur in children. Fever, painfulswelling and difficulty in

mastication.

Viral infectious disease attackthe parotid gland mainlyincubation period (17-21days)which is usually bilateral usuallyoccur in children. Fever, painfulswelling and difficulty in

mastication.

MUMPSMUMPSMUMPSMUMPS


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* Mumps is interest to the Surgeon for

the following reasons:

* Occasional cause of acute orchitisespecially when mumps occurs inadolescent or young adults pain andswelling in the testicle occur 7-10 daysafter the onset of parotid and may leadto testicular atrophy.

TREATMENT: by rest and sedation.

* Mumps is interest to the Surgeon for

the following reasons:

* Occasional cause of acute orchitisespecially when mumps occurs inadolescent or young adults pain andswelling in the testicle occur 7-10 daysafter the onset of parotid and may leadto testicular atrophy.

TREATMENT: by rest and sedation.

MUMPSMUMPS(contd)(contd)

MUMPSMUMPS(contd)(contd)


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** Ascending infection of the parotid glandvia its duct may occur after major surgicalprocedures.

AetiologicalAetiological factorsfactors includeinclude dentaldental sepsis,sepsis,dehydrationdehydration..

TheThe presencepresence ofof nasogastricnasogastric tubetube forforprolongedprolonged periodperiod andand poorpoor oraloral hygienehygiene..

ClinicallyClinically therethere isis swellingswelling andand painpain inin oneone ororbothboth parotidparotid glandgland andand therethere maymay bebe dischargedischargefromfrom thethe ductduct..

** Ascending infection of the parotid glandvia its duct may occur after major surgicalprocedures.

AetiologicalAetiological factorsfactors includeinclude dentaldental sepsis,sepsis,dehydrationdehydration..

TheThe presencepresence ofof nasogastricnasogastric tubetube forforprolongedprolonged periodperiod andand poorpoor oraloral hygienehygiene..

ClinicallyClinically therethere isis swellingswelling andand painpain inin oneone ororbothboth parotidparotid glandgland andand therethere maymay bebe dischargedischargefromfrom thethe ductduct..

POST OPERATIVE PAROTITISPOST OPERATIVE PAROTITISPOST OPERATIVE PAROTITISPOST OPERATIVE PAROTITIS


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TREATMENT: (Rare nowadays) However :

a. Prophylaxis important and elimination of

the above etiological factors.

b. Patient must be kept fully hydrated the

flow encourage suckling, sweets or

chewing gums.

c. Antibiotic therapy.

d. Occasionally surgical drainage required.

TREATMENT: (Rare nowadays) However :

a. Prophylaxis important and elimination of

the above etiological factors.

b. Patient must be kept fully hydrated the

flow encourage suckling, sweets or

chewing gums.

c. Antibiotic therapy.

d. Occasionally surgical drainage required.

POST OPERATIVE PAROTITISPOST OPERATIVE PAROTITISPOST OPERATIVE PAROTITISPOST OPERATIVE PAROTITIS


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I. Parotid calculus is rare and difficult to

diagnose since the stone is so small

that it cannot be demonstrated by

radiography and sialography is usually

necessary.

II. Submandibular calculus: verycommon being more than 50 times

than parotid this is due to:

I. Parotid calculus is rare and difficult to

diagnose since the stone is so small

that it cannot be demonstrated by

radiography and sialography is usually

necessary.

II. Submandibular calculus: verycommon being more than 50 times

than parotid this is due to:

SALIVARY GLAND STONESSALIVARY GLAND STONES

(SIALOLITHIASIS)(SIALOLITHIASIS)




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a. The secretion of the gland is thick andviscid as compared to watery secretionof the parotid.

b. The upward course of thesubmandibular duct does not provideadequate drainage.

c. The duct orifice lies in the floor of themouth where foreign bodies may lodgeinto it and provide nucleus for stoneformation.

a. The secretion of the gland is thick andviscid as compared to watery secretionof the parotid.

b. The upward course of thesubmandibular duct does not provideadequate drainage.

c. The duct orifice lies in the floor of themouth where foreign bodies may lodgeinto it and provide nucleus for stoneformation.






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ClinicalClinical FeaturesFeatures::

Patient complaint recurrent attacks of pain andswelling in the region of the gland during meals.

Occasionally present with acute or chronicbacterial infection (Sialadenitis).

OnOn ExaminationExamination::

** The gland is enlarged and firm and tender .

** If the stone lies in the duct it can be felt oreven seen in the floor of the mouth.

ClinicalClinical FeaturesFeatures::

Patient complaint recurrent attacks of pain andswelling in the region of the gland during meals.

Occasionally present with acute or chronicbacterial infection (Sialadenitis).

OnOn ExaminationExamination::

** The gland is enlarged and firm and tender .

** If the stone lies in the duct it can be felt oreven seen in the floor of the mouth.






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Large retention cysts sometimes develop in the floor of the

mouth. They reach several centimeters in diameter and areknown as Ranulae.

RANULAERANULAE:: Typically appear as blue-grey dome likeswelling beneath the tongue in the floor of the mouth.

They are more common seen in neonates and children.

It may burst spontaneously discharging it content andcollapsing.

They are painless and can recurr.

TREATMENTTREATMENT:: Marsupialisations with de-roofingthe cyst so that it opens into the floor of themouth.

Large retention cysts sometimes develop in the floor of the

mouth. They reach several centimeters in diameter and areknown as Ranulae.

RANULAERANULAE:: Typically appear as blue-grey dome likeswelling beneath the tongue in the floor of the mouth.

They are more common seen in neonates and children.

It may burst spontaneously discharging it content andcollapsing.

They are painless and can recurr.

TREATMENTTREATMENT:: Marsupialisations with de-roofingthe cyst so that it opens into the floor of themouth.

Salivary Retention Cysts:Salivary Retention Cysts:Salivary Retention Cysts:Salivary Retention Cysts:

Note: They are painless and can recuNote: They are painless and can recu


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SALIVARY MUCOUS CYSTS:SALIVARY MUCOUS CYSTS:SALIVARY MUCOUS CYSTS:SALIVARY MUCOUS CYSTS:

They are arising from minor

mucous secreting gland in thelower lip. They sometimes

spontaneously disappear but

excision is the treatment.

They are arising from minor

mucous secreting gland in thelower lip. They sometimes

spontaneously disappear but

excision is the treatment.


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Submandular fistulas uncommon

(rare) and always arises in thegland

Submandular fistulas uncommon

(rare) and always arises in thegland

SALIVARY FISTULAS:SALIVARY FISTULAS:SALIVARY FISTULAS:SALIVARY FISTULAS:

TREATMENTTREATMENT:: byby excisionexcision ofof thethe glandglandTREATMENTTREATMENT:: byby excisionexcision ofof thethe glandgland


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May follow penetrating wound orincision of parotid abscess.

It may arise from the main duct or from the

ductules within the gland

May follow penetrating wound orincision of parotid abscess.

It may arise from the main duct or from the

ductules within the gland

PAROTID FISTULA:PAROTID FISTULA:PAROTID FISTULA:PAROTID FISTULA:

TREATMENTTREATMENT:: Sialography is performed to

establish the exact site or origin of the fistula

aa.. FistulaFistula ofof thethe glandgland maymay bebe XX--rayray therapytherapy toto

thethe glandgland..bb.. FistulaFistula ofof thethe ductduct treatedtreated byby anastomosisanastomosis

(construction)(construction)..

cc.. IfIf failfail superficialsuperficial parotidectomyparotidectomy..

aa.. FistulaFistula ofof thethe glandgland maymay bebe XX--rayray therapytherapy toto

thethe glandgland..bb.. FistulaFistula ofof thethe ductduct treatedtreated byby anastomosisanastomosis

(construction)(construction)..

cc.. IfIf failfail superficialsuperficial parotidectomyparotidectomy..


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Tumors of the salivary glands are

commonest in the parotid much lesscommon in the submandular gland andvery rare in the sublingual and minorsalivary glands. They are difficult toclassify as benign and malignant since all

of them tend to recur after removal.

Tumors of the salivary glands are

commonest in the parotid much lesscommon in the submandular gland andvery rare in the sublingual and minorsalivary glands. They are difficult toclassify as benign and malignant since all

of them tend to recur after removal.

SALIVARY GLAND TUMORS:SALIVARY GLAND TUMORS:SALIVARY GLAND TUMORS:SALIVARY GLAND TUMORS:


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II.. BenignBenign::a) Mixed salivary tumor or pleomorphic

adenoma

b) Adenolymphoma or warthins tumor

c) Oncocytoma

d) Monomorphic adenoma

IIII.. MalignantMalignant::

a) Primary carcinomab) Secondary carcinoma direct invasion

from skin or from secondarily involved lymph

nodes

Classification:Classification:Classification:Classification:


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The most common benign neoplasms of salivaryglands. Most pleomorphic present in middle age

but may occur at any age and equally in eithersex.

It usually remains benign for many years but unlessadequately removed it tend to recur and to turnmalignant.

Clinically:

a) Slow growing painless lump mostly in parotid andsome in submandular and few in the minorglands.

b) Mobile with well defined edge and smooth orlobulated surface.

Definitive diagnosis can only be made histologicallyafter excision

Treatment surgical removal (superficial parotidectomy)

The most common benign neoplasms of salivaryglands. Most pleomorphic present in middle age

but may occur at any age and equally in eithersex.

It usually remains benign for many years but unlessadequately removed it tend to recur and to turnmalignant.

Clinically:

a) Slow growing painless lump mostly in parotid andsome in submandular and few in the minorglands.

b) Mobile with well defined edge and smooth orlobulated surface.

Definitive diagnosis can only be made histologicallyafter excision

Treatment surgical removal (superficial parotidectomy)

PLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMA


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Benign tumor less than 10% ofsalivary tumor. It occur in parotidglands only between the ages 40-60

years male strong predominance.They are sometimes bilateral.

ClinicallyClinically:: The tumor present as painlesscystic swelling

TreatmentTreatment:: Surgical removal (superficialparotidectomy)

Benign tumor less than 10% ofsalivary tumor. It occur in parotidglands only between the ages 40-60

years male strong predominance.They are sometimes bilateral.

ClinicallyClinically:: The tumor present as painlesscystic swelling

TreatmentTreatment:: Surgical removal (superficialparotidectomy)

ADE

NOLYMPHOMAADE

NOLYMPHOMA (WarthinsT

umor)(WarthinsT

umor)ADE

NOLYMPHOMAADE

NOLYMPHOMA (WarthinsT

umor)(WarthinsT

umor)


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The malignat tumors are

1. Mucoepidermoid Carcinoma

2. Adeno Cystic Carcinoma

3. Adeno Carcinoma

4. Squamous Cell Carcinoma

5. Carcinoma in Pleomorphic Adenoma(Malignant Mixed Tumor)

6. Acinic Cell Tumor

7. Malignant Lymphoma8. Anoplastic Carcinoma

The malignat tumors are

1. Mucoepidermoid Carcinoma

2. Adeno Cystic Carcinoma

3. Adeno Carcinoma

4. Squamous Cell Carcinoma

5. Carcinoma in Pleomorphic Adenoma(Malignant Mixed Tumor)

6. Acinic Cell Tumor

7. Malignant Lymphoma8. Anoplastic Carcinoma

Malignant Salivary Tumors:Malignant Salivary Tumors:Malignant Salivary Tumors:Malignant Salivary Tumors:


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Clinical Features:Clinical Features:

Affects elderly people and common inparotid with equal sex distribution.

The tumor forms rapidly growing hardswelling with ill defined edges and nodularsurface.

Soon becomes fixed with pain-facial palsy,and lymph nodes enlargement but distantmetastasis are rare.

Clinical Features:Clinical Features:

Affects elderly people and common inparotid with equal sex distribution.

The tumor forms rapidly growing hardswelling with ill defined edges and nodularsurface.

Soon becomes fixed with pain-facial palsy,and lymph nodes enlargement but distantmetastasis are rare.


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1. Operable Tumors:

a) Radical parotidectomy combined with blockdissection of the cervical lymph node.

b) Post-operative radiotherapy

c) When the tumor arises in the other site ofsalivary tissues wide local excision isperformed with block dissection of

lymph node.2. Non operative tumor with infiltration

to the skull and pharynx.Radiotherapy can be given.

1. Operable Tumors:

a) Radical parotidectomy combined with blockdissection of the cervical lymph node.

b) Post-operative radiotherapy

c) When the tumor arises in the other site ofsalivary tissues wide local excision isperformed with block dissection of

lymph node.2. Non operative tumor with infiltration

to the skull and pharynx.Radiotherapy can be given.

TREATMENT:TREATMENT:TREATMENT:TREATMENT:


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1) Damage to facial nerve causes

facial palsy or damage to its

branches

2) Salivary fistula

3) Freys syndrome

1) Damage to facial nerve causes

facial palsy or damage to its

branches

2) Salivary fistula

3) Freys syndrome

Complication of Parotidectomy:Complication of Parotidectomy:Complication of Parotidectomy:Complication of Parotidectomy:


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There are two syndromes of slow,

progressive, painless enlargementof salivary glands.

Biopsy reveals the swelling is caused by

replacement of glandular tissues by lymphoidtissue and fibrosis.

There are two syndromes of slow,

progressive, painless enlargementof salivary glands.

Biopsy reveals the swelling is caused by

replacement of glandular tissues by lymphoidtissue and fibrosis.

Autoimmune salivary glandAutoimmune salivary glanddisorder or disease:disorder or disease:Autoimmune salivary glandAutoimmune salivary glanddisorder or disease:disorder or disease:


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1) Symmetrical enlargement of salivary

glands

2) Enlargement of the lachrymal glands

3) Dry mouth

1) Symmetrical enlargement of salivary

glands

2) Enlargement of the lachrymal glands

3) Dry mouth

MICKULICZs SYNDROMEMICKULICZs SYNDROMEMICKULICZs SYNDROMEMICKULICZs SYNDROME


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All the above conditions plus;

Dry eyes

Generalized arthritis

All the above conditions plus;

Dry eyes

Generalized arthritis

SJOGRENs SYNDROMESJOGRENs SYNDROMESJOGRENs SYNDROMESJOGRENs SYNDROME


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1) Mumps: Viral sialaidenitis both parotid

become painful and swollen and accompanied

by general malaise and subsided in few days.

2) Recurrent swellings of the parotid:

Due to obstruction of one or both parotid

ducts. Symptomatic treatment and reassurance

of the parents. There is no place for surgery.

1) Mumps: Viral sialaidenitis both parotid

become painful and swollen and accompanied

by general malaise and subsided in few days.

2) Recurrent swellings of the parotid:

Due to obstruction of one or both parotid

ducts. Symptomatic treatment and reassurance

of the parents. There is no place for surgery.

Salivary diseases in childhood:Salivary diseases in childhood:Salivary diseases in childhood:Salivary diseases in childhood:


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3) Tumors: The commonest tumor in infants

is haemangioma found in 2-3 years old child.

The tumor nearly undergo natural resolution.

4) Lymphangiomas: They have tendency

to enlarged and infection. The treatment

partial resection.

3) Tumors: The commonest tumor in infants

is haemangioma found in 2-3 years old child.

The tumor nearly undergo natural resolution.

4) Lymphangiomas: They have tendency

to enlarged and infection. The treatment

partial resection.


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