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4Salivary Glands in humanbody. .pptx

The document outlines various conditions affecting the salivary glands, including causes, symptoms, and treatment options for mumps, acute and chronic parotitis, parotid calculus, and neoplasms. It also discusses submandibular gland issues like calculus formation and pharyngitis, emphasizing the importance of diagnosis and treatment strategies such as surgery, antibiotics, and sialography. Detailed treatment protocols and clinical features for each condition are provided, highlighting the clinical implications of salivary gland diseases.

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Dr Osman Abas Mohamed MBChB Salivary Glands 5/29/2024 2:56:34 PM 1
AFFECTS OF THE PAROTID GLAND Mumps Mumps is caused by the mumps virus which spreads by droplet infection. It affects mainly children of school-going age and young adults. Most cases occur in spring. The incubation period is 18 days. Clinical Features Malaise, fever and pain in the angle of jaw is soon followed by a tender swelling of one or both parotid glands. The submandibular salivary glands may also be involved. The swelling subsides in a few day. 5/29/2024 2:56:34 PM 2
Complications Orchitis, pancreatitis and encephalitis are the usual complications. Treatment Isolation, care of oral hygiene and symptomatic treatment is instituted. Difficulty in opening the mouth may need feeding through a straw. Steroids are given in cases where orchitis develops. 5/29/2024 2:56:34 PM 3
Acute Parotitis Infection reaches the parotid gland either from the mouth or through blood. In severe cases the causative organism is Staphylococcus aureus. The infection is often confined to one parotid gland. Aetiology Acute parotitis may result from the following: 1. Postoperative. 2. 2. As a complication of debilitating diseases like typhoid and cholera. 3. 3. Secondary to obstruction of Stensen’s duct. This may be due to parotid calculus and foreign bodies. 4. 4. As a complication of septicaemia. 5. 5. Idiopathic 5/29/2024 2:56:34 PM 4
Clinical Features There is a painful swelling on the side of face. Signs of toxaemia are usually present. Temperature is over 100oF. Pus can be expressed from the Stensen’s duct. Treatment Treatment involves cleaning the mouth correction of dehydration and administration of antibiotics. 5/29/2024 2:56:34 PM 5
Chronic Parotitis Chronic parotitis is more common than acute cases. The condition is frequently bilateral but may be unilateral. Purulent saliva can be expressed from the Stensen’s duct if gentle pressure is exerted over the gland. A parotid calculus must be excluded by X-ray. Sialography reveals sialectasis, calculus, or stenosis of the duct. Treatment Catheterizing the Stensen’s duct with a fine ureteric catheter and injecting antiseptic fluid such as 1 per cent mercurochrome or tetracycline are resorted to. These measures can be repeated if necessary. In long-standing cases, parotidectomy is done 5/29/2024 2:56:34 PM 6
Parotid Calculus Parotid calculi are uncommon as compared to submandibular calculi. The patient complains of a painful swelling of gland occurring especially at meals. Sialography demonstrates the parotid calculus. Treatment If a stone is found in the Stensen’s duct, it can be removed by splitting the duct. If the calculus is deeply placed within the parotid tissue, the gland is exposed and calculus is removed through a transverse incision in the gland substance. If multiple stones are present superficial lobectomy should be done. 5/29/2024 2:56:34 PM 7
Neoplasms The tumours of the parotids are of the following types: 1. Benign: Adenolymphoma (Warthin’s tumour). 2. 2. Potentially malignant: Mixed parotid tumour. 3. 3. Malignant (carcinoma): Cylindroma, adenocarcinoma, anaplastic carcinoma, squamous carcinoma. The mixed parotid tumour is the most common parotid tumour. It occurs equally in both the sexes and is seen in early adult life. A firm, rounded, slowly growing neoplasm commences from the lower part of the gland. Although benign for a varying period it acquires characteristics of malignancy and invades the pterygoid fossa and upper part of neck. A benign parotid tumour never causes facial palsy. 5/29/2024 2:56:34 PM 8
Treatment Nearly all parotid tumours are radioresistant. Surgery is the treatment of choice and various surgical procedures are the following: 1. Extracapsular excision is done for very small superficial tumours 2. Superficial parotidectomy with preservation of the facial nerve is done for most of tumours when i. Tumour has broken its confines, or ii. Tumour has recurred after local excision. As recurrence is very common following local excision only, superficial parotidectomy is now recommended as the treatment of choice even if the tumour is small in size. 4. Total parotidectomy with or without block dissection of neck for malignant lesions of the parotid 5/29/2024 2:56:34 PM 9
AFFECTS OF THE SUBMANDIBULAR GLANDS The most common cause of the involvement of this gland is a foreign body in the duct or a stone. Calculus The most common site for salivary calculus is within the submandibular gland or its duct (Wharton’s duct). It is fifty times more frequent here than in the parotid gland and its duct. This is because salivary secretions from the submandibular gland are more mucoid and are rich in calcium. These salivary calculi consist of phosphates of calcium and magnesium. 5/29/2024 2:56:34 PM 10
Clinical Features Painful swelling of the gland before or during meals is characteristic of this condition. The patient should be given fruit juice to sip at the time of clinical examination. Little or no saliva pours out from the orifice of Wharton’s duct on the affected side. A stone in the Wharton’s duct can be detected by bidigital palpation. Treatment 1. Stones in the duct should be removed under local or general anaesthesia. The tissues immediately behind the stone are grasped with tenaculum forceps, which steady the stone and elevate it. An incision is then made in the long axis of the duct and the stone slips out. The wound is left unsutured. 2. Stones in the gland necessitate removal of the gland. 5/29/2024 2:56:34 PM 11
SIALOGRAPHY 1. Differential diagnosis of swellings in the region of the salivary glands, e.g. sialectasis. 2. Obstruction of the duct due to stricture, calculus or foreign body. 3. Subacute and chronic infections, the degree of damage to the ducts and glands can be shown. 4. The extent of involvement of the gland by a neoplasm can be assessed. 5. To know the site of communication of the fistula with the duct which helps in planning treatment 5/29/2024 2:56:34 PM 12
Pharyngitis Inflammation of the oropharynx can be classified into acute and chronic. ACUTE PHARYNGITIS Acute inflammation of the pharyngeal mucosa may be an accompanying feature of many local and systemic diseases. It may follow an attack of common cold and may be a feature of other infections like measles, chickenpox or influenza. Acute inflammatory lesions of the pharynx may develop after trauma by a foreign body or after instrumentation. 5/29/2024 2:56:34 PM 13
The patient’s chief symptom is sore throat, associated with fever and other constitutional symptoms. Examination reveals diffuse congestion of the pharyngeal wall, uvula and adjacent faucial tissues. Depending upon the severity of infection, there may be oedema of the lining mucosa and uvula and enlargement of the glands of the neck. Treatment consists of bed rest, analgesics and antibiotics preferably penicillin or erythromycin. 5/29/2024 2:56:34 PM 14
CHRONIC PHARYNGITIS Chronic inflammation of the pharynx may be due to nonspecific or specific lesions. Chronic Non-specific Pharyngitis The infected discharge from the nose and paranasal sinuses as in rhinitis and sinusitis constantly irritates the pharyngeal mucosa, and often results in chronic inflammatory changes. Similarly obstructive lesions in the nose like deflected septum, nasal polyp and adenoids lead to a habit of mouth breathing which is an important predisposing cause of pharyngitis 5/29/2024 2:56:34 PM 15
Caries of the teeth and infected gums may also lead to pharyngeal infection. External conditions may play an important role in pharyngitis. People working in dusty atmosphere and smokers are the usual victims. Clinical Features The most constant symptom is discomfort in the throat with a foreign body sensation. Spasms of cough and tendency to clear the throat are common. Tiredness of voice and difficulty in swallowing may occur. Treatment of Chronic Pharyngitis The primary aetiological factor in the nose, nasopharynx or oral cavity should receive proper treatment. Such patients are usually in the habit of making frequent swallowing attempts in order to clear the throat. This should be forbidden as such attempts at clearing the throat or hawking only add to the misery. Cough suppressants like codeine phosphate linctus should be given to relieve the cough. 5/29/2024 2:56:34 PM 16
SPECIFIC INFECTIONS OF THE PHARYNX Tuberculosis Tuberculosis of the pharynx usually results as a secondary manifestation to advanced chronic pulmonary tuberculosis. Mucosal ulceration with undermined edges occurs in the oropharyngeal region. The chief complaint of the patient is pain with dysphagia. Treatment is by antitubercular drugs. 5/29/2024 2:56:34 PM 17
Lupus Vulgaris Lupus of the nose may extend posteriorly to involve the pharynx, soft palate and fauces. Tubercles appear on the pharyngeal mucosa which break down with subsequent cicatrisation and scarring of the fauces and soft palate. Syphilis The pharynx is usually involved in the secondary stage of syphilis. It shows diffuse congestion and there occur mucous patches and snail- track ulcers with lymphadenitis. 5/29/2024 2:56:34 PM 18
In tertiary syphilis, the gumma may sometimes be a presenting feature on the fauces, palate and pharynx. The diagnosis is by biopsy and serological tests. Penicillin is the drug of choice for the treatment of syphilis. 5/29/2024 2:56:34 PM 19