Salivary Gland Disorders

Salivary stones = Sialoliths
1. 80% in the submandibular gland
2. Symptoms
  1. Pain/swelling when smelling or tasting food e.g. at mealtimes
  2. Pain, swelling or infection of gland
3. Adult males
4. Pathology
  1. Deposition of calcium salts around a nidus of organic material
5. Investigations
  1. 1. Radiograph
    1. Lower occlusal
      1. Submandibular
    2. Cheek
      1. Parotid
    3. 50% radiolucent
  2. Sialography
    1. inject contrast medium through the duct and take a lateral oblique usually
  3. Ultrasound
6. Management
  1. Ultrasonic shock wave therapy
  2. Surgical removal
Xerostomia
1. Management
  1. Saliva substitutes
    1. Sodium carboxymethylcellulose based
    2. Biotene products
  2. Stimulate residual secretory capacity
    1. Best method = sugar free chewing gum
    2. Pilocarpine
  3. Eliminate cause if poss.
    1. e.g. liaise with GP to change drug
2. Effects
  1. Reduced denture retention
  2. Increased risk of
    1. Caries & Perio
    2. Bacterial sialodenitis
    3. Candidosis
  3. Discomfort, difficulty eating, swallowing, talking
  4. Taste disturbance
3. Causes
  1. Sjogren's
  2. Drugs
    1. Anti-depressants
    2. Beta blockers, diuretics
  3. H&N DXT
  4. Diabetes
  5. Renal failure
Sialadenitis
1. Inflammation of salivary glands
  1. Usually major glands
2. Bacterial
  1. Acute
    1. Common pathogens
      1. Staph.Aureus
      2. Strep
    2. Presentation
      1. Painful swelling with rapid onset
      2. Unilateral
      3. Discharge (pus) from gland duct
    3. Diagnosis
      1. Radiograph to see if sialolith
      2. Pus swab
    4. Treatment
      1. Antibiotics e.g. amoxicillin
  2. Chronic
    1. Presentation
      1. Unilateral
      2. Intermittent, recurrent swelling & pain
    2. Most common pathogen = Staph. Aureus
    3. Treatment
      1. Stimulation of salivary flow
        Massage gland
        Chewing gum
  3. Predisposing factors
    1. Reduced salivary flow
      1. Sialolith
        Recurrent pain/swelling at mealtimes
      2. Dehydration
      3. Medications
      4. Radiotherapy
      5. Sjögren’s syndrome
    2. Poor oral hygiene
  4. General managment
    1. Rehydration
    2. Removal of sialolith
3. Viral = Mumps
  1. Pathogen = paramyxovirus
  2. Mostly affects Parotid gland
    1. can affect submandibular
  3. Self-limiting
  4. Presentation
    1. Bilateral, painful swellings
    2. Fever, malaise
  5. Children & young adults
  6. Treatment
    1. Fluids, analgesics, bed rest
  7. Prevention = MMR
  8. Droplet inhalation transmission
Sjogren's Syndrome
1. = autoimmune inflammatory disoder with dry eyes & dry mouth +/- systemic disease
  1. Destruction of glandular tissue
2. Primary = no systemic disease
  1. Inflammation seen histopathologically
  2. Women
  3. Diagnosis
    1. Exclude other causes
      1. Drugs
      2. DXT
    2. Salivary gland tests
      1. Saliva flow rate
      2. Salivary scintography
      3. Parotid sialography
    3. Biopsy
    4. Clinical
  4. Anti-Ro or Anti-La autoabs
3. Secondary = + systemic disease
  1. Systemic
    1. Rheumatoid arthritis
    2. Lupus erythematosus
    3. Scleroderma
  2. Diagnosis
    1. Clinical
    2. Biopsy
  3. Inflammation seen histopathologically
  4. Anti-Ro or Anti-La or rheumatoid factor
4. Clinical features
  1. Eyes
    1. Dry, gritty
    2. Painful, red
  2. Oral
    1. Xerostomia
    2. Recurrent/persistent gland swelling
      1. Painless
    3. 1st gland affected = Submandibular
  3. Systemic features (secondary)
  4. Increased risk of lymphoma
5. Management
  1. Anti-fungals
  2. Eyes
    1. Eye drops
    2. Minimise screen time
    3. Avoid AC, dust, wind
  3. Oral
    1. Saliva substitues
    2. Chewing gum, pilocarpine
  4. Immune-modulatory
    1. Ciclosporin
    2. Immunosuppression

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Salivary Gland Disorders

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	Created by Zainab Patel about 4 years ago

	Copied by sanna pathy about 4 years ago