1. DR BASAVARAJT BHAGAWATI, SBBDC GZBD

3. Salivary gland D’S
CLASSIFICATION:
DEVELOPMENTAL
INFLAMMATARY
CYSTIC
AUTOIMMUNE
NEOPLASTIC

4. CLASSIFICATION
 Developmental
 1.Hypoplasia/aplasia
 Aberrent s.
gland[ectopic]
 Accessary s. gland
 Diverticuli
 Inflammatary
diseases
 Viral:mumps, CMV HIV
 Bacterial:
Acute B. Sialadenitis
Chronic B. Sialadenitis

5. S.G. DISEASES
 CYSTIC
 MUCOCELE
 RANULA
 AUTOIMMUNE
 MUKULICZ D’S
 SJOGREN’S
SYNDROME
 NEOPLASTIC
 BENIGNTUMOURS
 MALIGNANT
TUMOURS

6. Omdr-2011

7. SG-3
 Symptom –xerostomia
 Pt c/o
 dryness of oral mucosal surfaces/ reduced
oral fluids
 Difficulty in chewing,swallowing and
speaking
 Burning mouth/ mucosa-aggrevates on
eating spicy and coarse food
 Pain in the mucosal surfaces

8. Sg-3
 Medical history:present/past
 h/o
 Radiotherapy to head & neck tumours
 Medications-tricyclic
atidepressents,sedative,antihistamines
 dryness in the eyes,throat and vagina

9. clinical examination
 Cracked lips,corrugated -buccal mucosa
 Lipstick sign:presence of shed epithelial cells
on labial sufaces of max. Anteriors teeth
 Tongue blade sign:hold the tongue blade
against the buccal mucosa and mucosa is
adhered to tongue blade as the blade is lifted
away
 Enlargement of salivary glands

10. Saliva collection
 Stimulated saliva sample
 Unstimulated saliva samples

11. methods
 Draining methods
 spitting method
 Suction method
 absorbent

12. methods
 Suction method
 Saliva is collected by using suction tip or
saliva ejectors for defined time period
 Absorbent method:uses pre weighed gauge
sponge for a set of time period
 Saliva secreation can be stimulated by
applying 2% citric acid on the tip of the
tongue

13. Methods-indidual/specific
sg
 Parotid gland saliva collected by placing
carlosons-crittenden collectors over the ductal
orifices
submandibular and sublingual gland
saliva collected by alginate held
collector called segregator

14. Saliva samples-
 Stimulated – saliva:less than 1ml/min –
abnormally low
 Unstimulated –saliva:less than 0.1ml/ min
abnormally low

15. salivry glnd imaging
 Plain film radiography
 Sialography
 Ultrasonagraphy
 Radionuclide imaging/scintigraphy
 C T
 M R I

16. SALIVARY FLOW OVER A 24 HOUR PERIOD

18. MUMPS
 Viral infection of salivary gland caused by
paramyxo virus
 Infects SG s, Gonads, CNS
 PAROTID commonly affected

19. MUMPS [c/f]
 Age:2nd
deacde peak
incidece
 CL. Presentation;
 Prodromal symptoms
like fever,malaise
anorexia and
tenderness at the angle
of the jaw.
 Parotid swelling may
be the first indication
in many cases
 swollen parotid may
extend from ear to
lower part of the
mandibular ramus
displacing ear
upwards&outwards

20. MUMPS[C/F]
 Bilateral parotitis is common but one gland
swells 1-2 days after the other
 Edema of the skin over the gland and
red,inflamed ductal orifice
 DIAGNOSIS:History/Cl. Exmn. Negative h/o
mumps in the past&vaccine
 Investigation: 1.Antibody titres:4fold
increased.2. Serum amylase levels increased

21. Mumps
Treatment:supportive
analgesics&antipyretic
Preventive vaccine:
MMR
Systemicsteriods:
Orchitis
 COMPLICATIONS
 MENINGITIS
 ENCEPHALITIS
 ORCHITIS
 PANCRETITS
 MYOCARDITIS

26. Ac Bacterial S’itis
 Clinical features:
Age:adults mean-70yrs
Parotid gland commonly
affected,unilateral
Syptoms:sudden on set
of pain at the angle of
the jaw& which
increases on eating
Other sympoms ;Fever
 Clinical exmn reveals a
tender enlarged gland
& overlaying skin warm
&red
 Diagnosis is confirmed
by collection of
purulent material from
the ductal orifice

27. Acute Bacterial
sailadenitis
 Acute infection of salivary gland bacteria
 Bacterial strains:staphylococcus Aureus and
streptococcus viradans
 Predisposing Factors:
1. Dehydration that reduces salivary flow

28. Acute Bacterial
sailadenitis Investigations
 Culture of purulent
material collected
from duct.[gram stain]
 Blood: leukocytosis
 Treatment:antibiotics
[Parentaral]
amoxycillin+cloxacillin
[250mg+250mg]
Metronidazole
[400mg]
Fluid balance
Oral hygine
Surgical drianage

29. Chronic sialadenitis
 Chronic infection of
SG’s
 Bacterial strains
 step.viridans
 E coli,proteus
 C/f :children &young
adults affected.
 Parotids commonly
affected
 Syptoms:pain at the
angle
 Purulent discharge
from ductal orfice
 Antibiotics resolve the
infection but
recurrence is noted
 Recurrences lead to
fibrosis of gland

30. Treatment
 ANTIBIOTICS [after culture /gram’stian]
 Fluid balance
 Other modalities:INTRADUCTAL
ANTIBIOTICS –Erythromycin/ tetracyclines

34. Mucocele
 Mucocele is a swelling caused by pooling of
saliva at the site of injured or obstructed
minor salivary gland duct
 Mucocele are classified as
 1.Mucous retention M.
 2.Extravasation M.

38. Mucocele
 Mucous retntion M.is caused by obstruction
of minor salivary gland duct
Extravasation mucocele occurs because of
laceration of of minor salivary gland duct

39. Mucocele[C/F]
 Clinical appearance
depends on location
of the lesion.
 R.M. is common on
the palate/floor
mouth
 EV.M. is seen on lips
where trauma is
common
 Super ficial lesions
are vesicles containig
mucin
 Bluish in colour and
on rupturing they
release mucin
 Size vary from 3-
4mm to 1cm in
diameter
 Deep lesions well
defined and covered
by normal mucosa

40. Ranula
 Ranula is Mucocele
which occurs on the
floor mouth because
of trauma to the
sublingual gland duct.
 Slow growing lesion
causing difficulty in
mastication.
 Types :
Super ficial
Deep

41. Ranula
 Superficial Ranula-
superficial to
mylohyoid muscle
 Deep ranula:deep to
mylohyoid muscle
[plunging R.]
Treatment
Deep R./Recurrent R.
Surgical excision
Other modalities
Large lesions:
Marsupalization
Intralesional steriods

43. Sialoliths [s.calculi]
Sialolith are calcified and organic matter that form
within the secreatory system of the
of major salivary gland
Composition
Hydroxyappetite crystal
Octocalcium phosphate
Traces of Mg,, Cl, K,Carbon&ammonium

44. sialoliths
 Etiology /p. factors [Debatable]
1. Inflammation
2. Drugs [anticholenergic
medications,antihistamines]
3. Defects in calcium and phospharous
metabolism

45. SIALOLITH
 Sialoliths are common in the submandibular
gland duct, because……..
 Anatomical course of wharton’s duct has sharp
curves which may trap mucin/calculus
 High mucin level of the gland may trap foreign
bodies &debris
 Calcium content is higher in the saliva of
sub.mand. Gland
 Flow rate of the saliva is slower than parotid
 Dependent position of the gland increases
chances of stasis of saliva

46. SIALOLITH
 Clinical features:
Intermittent swelling
in the region of major
salivary gland that
enlarges during eating
and resolves later
 Pain because of the
back up saliva behind
the stone
 Stasis of saliva may
lead to infection
/fibrosis /atropy of the
gland
 Sinus /fistula and
ulceration in chronic
cases
 They may be palpable if
they are at periphery of
the duct
 They are circumscribed
&firm to hard masses

54. SIALOLITH[Investigations]
OCCLUSAL RADIOGRAPH:
SUB.MAND. GLAND /SUBLINGUAL
PA View/OPG: PAROTIDS
Modern imaging
SIALOGRAPHY,CT SCAN,ULTRASOUND

55. SIALOGRAPHY
 It is a radiographic technique where in a
radiographic contrast agent is infused into
the ductal system of major salivary gland
and imaged with plain films,fluroscopy or CT
Scan.

56. SIALOGRAPHY
 INDICATIONS:
 Sialoliths
 Chronic infection
 Tumours of SG gland
 Autoimmune d’s;
sjogren’s syndrome
 For extrinsic/intrinsic
masses in gland
 CONTRA INDICATIONS:
 Acute infections
 Allergy to contrast
agents

57. SIALOGRAPHY
 INDICATIONS:
 Sialoliths
 Chronic infection
 Tumours of SG gland
 Autoimmune d’s;
sjogren’s syndrome
 For extrinsic/intrinsic
masses in gland
 CONTRA INDICATIONS:
 Acute infections
 Allergy to contrast
agents

58. SIALOGRAPHY
 CONTRAST AGENTS:
 WATER SOLUBLE

 LIPID SOLUBLE
 Water soluble:
Advantages:
a]Good flow rate
b] Less painful
DIS advantages;absorbed by
duct :poor contrast
Lipid soluble;ADV.good
contrast. Not absorbed by
duct
DISadvantages:painful
infusions:poor flow rate

59. SIALOGRAPHY
procedure
 1.Ductal orifice located
and dilated by lacrimal
probe
 2.Cannula is passed
into ductal orifice
 3.Syringe is inserted
into the cannula andd
slowly solution is
infused
 PAROTID:0.75-1.5ml
 SUB.MAND:0.5-1ml
 4.Infusions done with
fluroscopic
mionitoring
5.Images are taken
3.phases
Ductal phase
Glandular phase
Secreatary phse

67. THANK U

68. Ptyalism
 Hypersalivation (also
called ptyalism[1]
and
sialorrhea[2]
) is
excessive production of
saliva. It has also been
defined as increased
amount of saliva in the
mouth, which may also
be caused by
decreased clearance of
saliva.[3
Hypersalivation can
contribute to drooling
if there is an inability to
keep the mouth closed
or in
difficulty in swallowing
the excess saliva.
 Hypersalivation also
often precedes emesis
(vomiting), where it
accompanies nausea (a

69. Conditions-ptyalism
Rabies
 Gastroesophageal reflux disease
,
 Pregnancy
 Pancreatitis
 Liver disease
 Serotonin syndrome
 Mouth ulcers
 Oral Infections
 Medications that can
cause overproduction
of saliva include:[3]
 clozapine
 pilocarpine
 Ketamine
 TOXINS:
 mercury
 copper

70. DECREASED –CLEARANCE-SALIVA
Infections : tonsillitis,
retropharyngeal and
peritonsillar abscesses,
epiglottitis and mumps.
jaw fracture/TMJ dislocation
Radiation Therapy

71. Neurological disorders:
 myasthenia gravis,
Parkinson's disease,
Multiple System
Atrophy, , bilateral
facial nerve palsy and
hypoglossal nerve
palsy.

72. Management
. Removal of cause
Antihistamine or
atropine sulphate

73. Self-contained saliva test
kit for use at the point of
care that will target
markers for periodontal
diseases, caries,
infectious diseases,
pancreatic cancer,
diabetes, salivary gland
diseases, renal diseases,
steroids and inflammatory