The document provides an overview of salivary gland anatomy, disorders, clinical approach, and surgical aspects. It describes the four major salivary glands - parotid, submandibular, and sublingual glands. Common disorders discussed include sialolithiasis, infections, tumors, and Sjogren's syndrome. The clinical approach involves history, examination, and investigations like imaging and biopsy. Surgical management is described for procedures like parotidectomy, submandibular gland excision, and tumor removal. Post-operative complications are also outlined.
The document provides an overview of salivary gland anatomy, disorders, clinical approach, and surgical aspects. It describes the four major salivary glands - parotid, submandibular, and sublingual glands. Common disorders discussed include sialolithiasis, infections, tumors, and Sjogren's syndrome. The clinical approach involves history, examination, and investigations like imaging and biopsy. Surgical management is described for procedures like parotidectomy, submandibular gland excision, and tumor removal. Post-operative complications are also outlined.
The document provides an overview of salivary gland anatomy, disorders, clinical approach, and surgical aspects. It describes the four major salivary glands - parotid, submandibular, and sublingual glands. Common disorders discussed include sialolithiasis, infections, tumors, and Sjogren's syndrome. The clinical approach involves history, examination, and investigations like imaging and biopsy. Surgical management is described for procedures like parotidectomy, submandibular gland excision, and tumor removal. Post-operative complications are also outlined.
The document provides an overview of salivary gland anatomy, disorders, clinical approach, and surgical aspects. It describes the four major salivary glands - parotid, submandibular, and sublingual glands. Common disorders discussed include sialolithiasis, infections, tumors, and Sjogren's syndrome. The clinical approach involves history, examination, and investigations like imaging and biopsy. Surgical management is described for procedures like parotidectomy, submandibular gland excision, and tumor removal. Post-operative complications are also outlined.
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Introduction.
Anatomy. Disorders of glands. Clinical approach. Surgical aspect.
Salivary glands: are composed of 4 major glands, in addition to minor glands. Major: 2 parotid glands. 2subma nd-ibular gland
Minor: Sublingual. Multiple minor glands
Important structure that run
through the parotid gland: 1.Branch of facial nerve. 2.Terminal branch of external carotid artery that divided into maxillary & superficial temporal artery. 3.The retromandibular vein ( post. Facial ). 4.Intraparotid lymph node.
THE PAROTID DUCT:
Stensens duct is 5 cm long.
open opposite the second
upper molar tooth
Its paired of gland that lie below the
mandible on either side. Has 2 lobes, superficial & deep. Warthons duct, drained submandibular gland that opens into anterior floor of mouth. Anatomical relationship: 1.Lingual nerve. 2.Hypoglossal nerve. 3.Anterior facial vein. 4.Facial artery. 5.Marginal mandibular branch of facial nerve.
Lie on the superior surface of the
mylohyoid muscle and are separated from the oral cavity by a thin layer of mucosa. The ducts of the sublingual glands are called Bartholins ducts.
About 450 lie under the mucosa
They are distirbuted in the mucosa of the lips, cheeks, palate, floor of mouth & retromolar area Also appear in oropharyanx, larynx & trachea
Its either: Extravasation cyst result from trauma to overlying mucosa. Mucous retention cyst in the floor of the mouth due to obstruction. RANULA extravasation cyst that arises from sublingual gland.
It is rare form of mucus retention cyst
arise from both sublingual & submandibular. The mucus collects around the gland &penetrates the mylohyoid diaphragm to enter the neck. Dumbbell shaped Pt. presents with swelling , soft, fluctuant & painless
Tumors of minor & sublingual salivary
gland are extremely rare. 90% are malignant. Most common site: upper lip, palate & retromolar region.
The most common ectopic tissue is
called stafne tissue (what is it?) Presentation Discovered by x-ray: treatment
Treatment: antibiotics and surgically
Most common cause is sialolithiasis
which 80% happens in the submandibular gland Presentation: painful swelling in submandibular area What would aggreveate it? Clinical findings: tender, pus draining investigations : x-ray Treatment: surgical
They are very rare in this gland and
50% are benign Presentation Investigations: CT and MRI Never do open biopsy but do FNA.. Treatment is surgical
They extremly rare like agenesis, , duct atresia and congenital fistula formation
A- viral infections: Mumps Mode of infection Prodromal period Presentation Diagnosis Treatment is conservative Complications: Orchitis, oophoritis, pancreatitis, sensorineural deafness, nemimgoencephalitis but they are rare
B- bacterial: Precipitating factors??! Causative organisms Presentation Treatment :conservative and it might eed drainage
This occurs in 3-6 years of age and the
symptoms last for 3-7 days accompanied with fever and malaise Diagnosis is made by HX and sialography showing a characteristic snowstorm appearance Treatment: -antibiotics -prophylactic antibiotics -parotidectomy..
C- chronic parotitis (HIV)?
-It is pathognomonic for HIV Presentation : very similar to sjograns syndrome Differentiated by negative autoantibody On investigation : CT and MRI show characteristic swiss cheese appearance of the cysts
treatment: Surgery to improve the appearance although its painless
A- papillary obstruction: It less common than in submandibular gland Most commonly due to trauma Presentation Treatment is papillotomy
B- stone formation: As mentioned before it is 80% in submandibular but only 20 % in parotid Investigations: position Treatment is surgical
The parotids are the
commonest glands for tumors of salivary glands
Slowly painless growing temor
below the ear, or infront of it
Sometimes on the upper
aspect of the neck:
If it arised from the accessory lobe
it will look like a presistant cheek swelling If it arises from the deep lobe it will present as parapharyngeal mass Symptoms: Difficult swallowing Snoring Clinical examination
Investigations: CT AND MRI FNA OPEN BIOPSY IS CONTRAINDICATED TREATMENT: SURGICAL
1-granulomatous sialadenitis: Mycobacterial infection: Sarcoidosis Cat scratch disease Toxoplasmosis Syphilis Deep mycosis Wgners granulomatosis Allergic sialdenitis due to radiotherapy of the head and neck
They are a group of diseases
that are hard to diagnose and are not under any group of the other diseases: Sialadenosis Adenomatoid hyperplasia Multifocal adenomporphic adenomatosis
progressive destruction of the salivary glands and the lacrimal glands.. Presentation is xerostomia and keratoconjunctivitis They also present with pain and asendng infection .females more than males 10:1 Parotis is more common
The charachtaristic feature is progressive
lymphocytic infiltration acinar cell destruction and prolifration of duct epithilium Diagnosis based on history Treatment remains symptomatic: Artificial tears Salivary substitiuants or water Floride to avoid dental carries Complications are B cell lymphoma
Normal salivary flow decreases with age
Mostly in woman postmenopausal complaining of burning tongue of mouth.. Causes: -chronic anxiety and depression.. -dehydration -anticholinergic drugs -sjograns syndrome -radiotherapy of the neck and head
Causes: some infections and drugs
Drooling: In children that are mental handicap Also in cerebral palsy Management is surgical Bilateral submandibular duct repositioning and sublingual duct excision Bilateral submandibualr gland excision Bilateral submandibualr gland excision and repositioning of the parotis duct
History. Clinical examination. Investigation.
History of swellings / change over time?
Trismus? Pain? Variation with meals? Bilateral? Dry mouth? Dry eyes? Recent exposure to sick contacts (mumps)? Radiation history? Current medications?
PALPATION: Palpate for cervical lymphadenopathy Bimanual palpation of floor of mouth in a posterior to anterior direction Have patient close mouth slightly & relax oral musculature to aid in detection Examine for duct purulence
Effective for intraductal stones, while. intraglandular, radiolucent or small stones may be missed.
Large stones or small CT slices done.
Also used for inflammatory disorders
Operator dependent, can detect small
stones (>2mm), inexpensive, non-invasive
Consists of opacification of the ducts by a
retrograde injection of a water-soluble dye. Provides image of stones and duct morphological structure May be therapeutic, but success of therapeutic sialography never documented
Disadvantages:
Irradiation dose Pain with procedure Perforation Infection dye reaction Push stone further Contraindicated in active infection.
is useful preoperatively to determine
if gland is functional.
Allows complete exploration of the
ductal system, direct visualization of duct pathology Success rate of >95%2 Disadvantage: technically challenging, trauma could result in stenosis, perforation
Structures to be preserved: Facial nerve marginal branch Platysma muscle fibers Facial artery Hypoglossal nerve Lingual nerve Anterior facial vein should be ligated
Hematoma wound infection marginal mandibular nerve injury lingual nerve injusry hypoglossal nerve injury transection of the nerve to the myelohyoid muscle causing submental skin anesthesia
Superficial parotidectomy: If the tumor lies in the superficial lobe a superficial peotidectomy should be performed with preserving the facial nerve It is the commonest procedure
1-the inferior portion of the cartilaginous
canal called conleys pointer the facial nerve lies 1 cm deep and inferior to its tip 2-the upper border of the posterior belly of the digastric muscle The facial nerve is superior to it A nerve stimulator might come in handy
Whole gland is remover
Facial nerve is transected Masseter muscle removed Neck dissection
Hematoma Infection Temporary facial nerve weakness. Transection of the facial nerve and permenant facial weakness.. Sialocele Facial numbness. Permenant numbness of the ear lobe due to transection of the great auricular nerve Freys syndrome
Cause Prevention Treatment is incidence Antiperspirants like ALCL Denervation by tympanic neurectomy Injection of botulinum toxin to the skin area
Download Phagocytosis of Bacteria and Bacterial Pathogenicity Advances in Molecular and Cellular Microbiology 1st Edition Joel D. Ernst ebook All Chapters PDF
Download Phagocytosis of Bacteria and Bacterial Pathogenicity Advances in Molecular and Cellular Microbiology 1st Edition Joel D. Ernst ebook All Chapters PDF
