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Management salivary gland disease .pptx

1. The document discusses various inflammatory diseases of the parotid gland including risk factors, symptoms, diagnosis, and treatment of conditions like parotid infections, Sjogren's syndrome, mumps, and sarcoidosis. 2. Key risk factors for parotid infection include reduced saliva flow, drugs, irradiation, and abnormalities in gland structure. Acute parotid infections usually cause swelling and tenderness that can be relieved by milking the gland. 3. Sjogren's syndrome is an autoimmune disease that causes dry mouth and eyes and increases risk of lymphoma. Mumps causes painful swelling of the parotid glands due to viral parotitis.

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INFLAMMATORY DISEASE OF PAROTID GLAND BY DR. MOHAMMAD AHMED
RISK FACTORS ASSOCIATED WITH PAROTID INFECTION Reduced salivary flow Drugs Opiate Irradiation Sjogren’s syndrome dehydration Abnormal gland architecture Sialoths (stones) Strictures Sialectasis Oral microorganism Mostly staph SALIVARY GLAND INFECTION
WHY ASK ABOUT HISTORY?
1. Gender : sjogren syndrome common in menopausal women 2. Age : paromyxovirous most common in children about 4 - 10 y 3. Medical profile : Dm , arteriosclerosis, hormonal imbalance and neurological disorder
4. Drug history : xerostomia is caused by diuretic and antihypertensive drug 5. Postprandial swelling : is associated duct obstruction 6. Radiation history 7. Nutrition history : patient who dehydrated chronically from bulimia or anorexia suffer from porosities
OBSTRUCTIVE PAROTITIES • Obstructive disease is sialolithiasis, mucous plugs, strictures, and duct ectasia may also cause obstruction and give rise to chronic sialoadenitis • 80% of salivary calculi occur in the submandibular gland and remaining stones occur in the parotid, of which around 60% are radio-opaque
• he classical presentation is an intermittent postprandial salivary gland swelling that gradually subsides over minutes to hours • Secondary infection often supervenes with fever, redness, and purulent discharge from the duct
RADIOGRAPHICALLY Calculi measuring 2 mm or larger are easily detected as echogenic foci, which cast distal acoustic shadows Obstructive calculi are associated with ductal dilatation.
TREATMENT IT IS RELATED TO THE SIZE OF STONE AND LOCATION ALONG THE DUCT AND ALSO ITS CHRONICITY 1.Milking of duct • The author successfully treats stones up to two times the narrowest diameter of the natural duct
2. Sialodochoplasty • Those at the orifice or in the distal half of this duct, are removed transorally via sialodochoplasty
• 3. Surgical exposure of parotid stone
• The branch of the facial nerve supplying the upper lip runs parallel with the duct either on its surface or a few millimetres superior to the duct • A longitudinal incision is made in the duct wall and the calculus is carefully teased out of the duct
• Cannulation of duct for re epethilization
• 4. Ultrasound-guided basket retrieval of stone
5. Parotidectomy the stone is in gland parenchymal or in the proximal part of the duct duct
B- INFECTIVE POROSITIES ACUTE POROSITIES • parotid gland is enlarged, possibly displacing the earlobe laterally, and tender to palpation erythema of floor of the mouth • The act of “milking” of the parotid gland with bimanual pressure to Stensen’s duct express purulent material if the duct is patent. • Constitutional symptoms, including fever, chills, and sweats, can occur if an established infection is present
TREATMENT OF AP SALIVARY GLAND • Remove the risk factor like stone • antistaphylococcal penicillin (methicillin, oxacillin, or dicloxacillin) or a first-generation cephalosporin (cephalexin) was considered a reasonable choice for empiric therapy • fluid intake • heat packs • sialogogues (e.g., sugar-free lemon drops or glycerin swabs • analgesics as needed for pain
• The characteristic fluctuance typical of abscesses is absent due to the tense fibrous capsule of the gland, which envelops the abscess • CT evaluation is warranted to evaluate for this potentially serious complication Incisions are made into the parotid fascia parallel to the course of the facial nerve and its branches.
UNCOMMON BACTERIAL INFECTION TB • Secondary to pulmonary infection ACTINOMYCOSI S • A.Israeli most common
VIRAL PARAMYXOVIRUS (MUMPS) • Acute, nonsuppurative communicable infectious disease, primarily of the parotid gland tissue, that often occurs in epidemics during spring and winter months. • The viral incubation period between exposure and the development of signs and symptoms is 15 to 18 days. • The disease includes a prodromal period that lasts 24 to 48 hours, and includes fever, chills, headache, and preauricular tenderness.
ACUTE VIRAL PARAMYXOVIRUS ( MUMPS ) • Infection is characterized by rapid, painful, non erythematous unilateral or bilateral swelling of the parotid glands that may be sufficiently severe to displace the earlobe • Serum amylase levels may also be elevated This is in contrast to acute bacterial parotitis, which does not cause an elevation of serum amylase levels
TREATMENT OF MUMPS • The disease usually resolves spontaneously within 5 to 10 days; therefore, symptomatic treatment of pain and fever and the avoidance of dehydration are essential. • Attempts to eradicate the disease have resulted in routine administration of measlesmumps-rubella (MMR) vaccine in children at 12 months of age
IMMUNOLOGICAL SALIVARY GLAND DISORDERS SJÖGREN SYNDROME (BENIGN LYMPHOEPITHELIAL LESIONS) • Primary Sjögren syndrome is an autoimmune disease affecting the major and minor salivary glands causing xerostomia (dry mouth) and xerophthalmia (dry eyes) • Secondary = primary + multisystem connective tissue disorder, most commonly rheumatoid arthritis • Ninety percent of the patients affected are female, typically middle-aged
DIAGNOSIS: • Clinical confirmation of dry eyes and dry mouth and two out of three positive tests: (1) typical ultrasound findings; (2) detection of autoantibodies, such as anti-Ro/anti-SS-A and anti-La/anti- SSB; and (3) biopsy of the labial minor salivary glands • Snow storm appearence in the sialogram of parotid gland
COMPLICATION OF SJOGREN • The complications of Sjögren syndrome include acute and chronic sialadenitis (which may be infective), sialolithiasis, dental caries due to xerostomia, and corneal ulceration due to xerophthalmia • In addition, the risk of parotid lymphoma is increased 44-fold and must e excluded by FNA
TX OF SJOGREN • Symptomatic treatment as artificial tears or saliva • Follow up for parotid lymphoma • Refer to rhomatology
IMMUNOLOGICAL SALIVARY GLAND DISORDERS COLLAGEN SIALADENITIS (SLE) • Collagen sialadenitis occurs most frequently in women in the fourth and fifth decades of life. The disorder can affect any of the major salivary glands and usually manifests as a slowly enlarging gland • diagnosis is made by identification of the underlying systemic disorder, and sialochemistry studies may reveal sodium and chloride ion levels that are elevated twofold to threefold higher than normal values.
IMMUNOLOGICAL SALIVARY GLAND DISORDERS SARCOIDOSIS • Sarcoidosis is a chronic, granulomatous disease characterized by non-caseating granulomas that may affect the salivary glands in up to 6% of cases • Heerfordt syndrome, or uveoparotid fever, occurs in 10% of cases and consists of a triad of parotid enlargement, uveitis, and seventh cranial nerve palsy
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