Major SG Parotid Submandibular Sublimgual Minor SG Those in Tongue, Palatine tonsil, Palate, Lips & Cheeks.
They are composed of acinar and ductal cellsarranged much like a cluster of grapes on stems. The acinar cells make up the secretory end pieces.The duct cells (the “stems”) form an extensively branching system that carries the saliva from the acini into the oral cavity.The secretion of saliva is controlled by sympathetic and parasympathetic neural input.
The symptoms are related to reduced fluid in the oral cavity & its effects on O. mucosa, like: Pain Sensitivity to spicy foods Sensitivity to coarse foods Speech difficulty Swallowing difficulty Lips cracking Food accumulation interdentally Infection Dental caries
Developmental abnormalities Sialolithiasis (Salivary stone) Extravasation & Retention Mucoceles & Ranules Inflammatory & reactive lesions Allergic sialadenitis Viral diseases Bacterial sialadenitis Systemic conditions with SG involvement Tumors
Complete absence (Aplasia or Agenesis):Mostly associated with malformations of the first and second brachial arch, which manifest with various craniofacial anomalies, like hemifacial microstomia, mandibulofacial dysostosis, cleft palate ….. etc.Importantly, rampant dental caries in children who have no other symptoms has led to the diagnosis of congenitally missing salivary glands.Enamel hypoplasia, congenital absence of teeth, and extensive occlusal wear are other oral manifestations of salivary agenesis.
Accessory SALIVARY DUCT:Are common & do not require treatment.The most frequent location was superior and anterior to the normal location of Stensen’s duct.
Diverticuli: It is a pouch or sac protruding from the wall of a duct. Diverticuli in the ducts of the major salivary glands often lead to pooling of saliva and recurrent sialadenitis. Diagnosis is made by sialography. Patients are encouraged to regularly milk the involved salivary gland and to promote salivary flow through the duct.
Sialoliths are calcified organic matter that forms within the secretory system of the major salivary glands. The real etiology is unknown, but there're precipitating factors: Inflammation Irregularities in ductal system Local irritants Anticholinergic medications (Atropine)
The chemical composition of Sialolith is: Calcium Phosphate Carbon Magnesium Potassium chloride Ammonium 50% of Parotid & 20% of Submandibular sialoliths are poorly calcified Not detected Radiographically
Mucocele is classified as Extravasation types & Retention types. Extravasation Mucocele: believed to be the result of trauma to minor SG excretory duct. Laceration of the duct results in pooling of saliva in the submucosal tissues & subsequent swelling. Retention Mucocele: is caused by obstruction of a minor salivary gland duct by calculus or possibly by the contraction of scar tissue around an injured minor salivary gland duct.
The Extravasation type is more common than the Retention type. Although named a cyst, the extravasation mucocele does not have an epithelial cyst wall or a distinct border.
Extravasation mucoceles most frequently occur on the lower lip, where trauma is common. The buccal mucosa, tongue, floor of the mouth, and retromolar region are other commonly traumatized areas where mucous extravasation may be found. Mucous retention cysts are more commonly located on the palate or the floor of the mouth.
It presents as isolated, painless, smooth- surfaced swellings that can range from a few millimeters to a few centimeters in diameter. Superficial lesions frequently have a characteristic blue hue. Deeper lesions can be more diffuse, covered by normal-appearing mucosa without the distinctive blue color.
It’s a large mucocele located on the floor of the mouth.The most common cause of ranula formation is trauma. Other causes include an obstructed salivary gland or a ductal aneurysm.They are most common in the second decade of life and in females.
The term ranula is used because this lesion often resembles the swollen abdomen of a frog. The most common presentation is a painless, slow-growing, soft, and movable mass located in the floor of the mouth. Usually, the lesion forms to one side of the lingual frenum; however, if the lesion extends deep into the soft tissue, it can cross the midline.
Like mucoceles, superficial ranulas can have a typical bluish hue, but when the lesion is deeply seated, the mucosa ma have a normal appearance. Larger lesions can cause deviation of the tongue. A deep lesion that herniates through the mylohyoid muscle and extends along the fascial planes is referred to as a plunging ranula and may become large, extending into the neck.
Radiography will help rule out a sialolith as a cause of duct obstruction. Radiopaque material instilled into the ranula cavity may be helpful in delineating the borders and full extent of the lesion.
It’s a benign, self-limiting, reactive inflammatory disorder of the salivary tissue.This lesion mimics a malignancy, and failure to recognize this lesion has resulted in unnecessary radical surgery.The etiology is unknown, although it likely represents a local ischemic event, infectious process, or perhaps an immune response to an unknown allergen.
It has a rapid onset. It occurs predominantly on the Palate. Lesions initially present as a tender erythematous nodule. Once the mucosa breaks down, a deep ulceration with a yellowish base forms. Patients often describe only a moderate degree of dull pain. Lesions often occur shortly after oral surgical procedures, restorative dentistry, or administration of local anesthesia Lesions mostly associated with smoking in males, may be as a result of vasculitic changes, resulting in ischemia which leads to infarction of salivary tissues.
Biopsy…Complete Hx should be provided to be distinguished fro SCC.Squamous metaplasia in the duct + epitheliomatous
It’s a retrograde contamination of the salivary ducts and parenchymal tissues by bacteria inhabiting the oral cavity.Stasis of salivary flow through the ducts and parenchyma promotes acute suppurative infection.
Sudden onset of erythematous swelling of the pre/post auricular areas extend into the angle of the mandible and the patient may have low-grade fever, trismus and purulent discharge.It’s bilateral in 20%. Staphylococcus aureus is the most common pathogen.
Treatment by antibiotics. Can also consider adding metronidazole or clindamycin to broaden coverage. Limited role for surgery. When a discrete abscess is identified, surgical drainage is undertaken.
Several viruses have been associated with acute nonsuppurative salivary gland enlargement. These include: Paramyxovirus Cytomegalovirus (CMV) HIV Hepatitis C virus (HCV)
It’s an acute viral infection caused by a ribonucleic acid (RNA) paramyxovirus and is transmitted by direct contact with salivary droplets .
Typically occurs in children between the ages of 4 and 6 years. The incubation period is 2 to 3 weeks; this is followed by salivary gland inflammation and enlargement, preauricular pain, fever, malaise, headache, and myalgia. The salivary gland enlargement is sudden and painful to palpation, with edema in the skin overlying the involved glands. 10% of the cases involve the submandibular glands alone.
Swelling is usually bilateral and lasts approximately 7 days. Salivary gland ducts are inflamed but without purulent discharge. If partial duct obstruction occurs, the patient may experience pain when eating. One gland can become symptomatic 24 to 48 hours before another gland does. Trismus may be present.
It’s usually made on clinical presentation.Confirmatory diagnosis could be made by demonstration of antibodies to mumps antigens.
Due to the dense capsule surrounding the salivary glands, it is difficult to determine, based on physical examination alone, whether an abscess has formed. Sialography, sialoendoscopy, ultrasonography, and CT are useful in the diagnosis of chronic salivary gland infections, cysts, and obstructions.
It’s a chronic autoimmune disease characterized by symptoms of oral and ocular dryness, exocrine dysfunction and lymphocytic infiltration, and destruction of the exocrine glands.The etiology of is unknown, and there is no cure.The salivary and lacrimal glands are primarily affected, but it is a systemic disorder, and dryness may affect other mucosal areas (nose, throat, trachea, vagina)The female- to-male ratio is 9:1.
Patients with experience the full spectrum of oral complications that result from decreased salivary function. All patients complain of dry mouth and the need to sip liquids throughout the day. Difficulty with chewing, swallowing, and speaking without additional fluids. The mucosa may be painful and sensitive to spices and heat. The tongue is often smooth (depapillated) and painful.
Decreased salivary flow results in increased dental caries and erosion of the enamel structure. Patients may experience intermittent or chronic salivary gland enlargement. They are also susceptible to salivary gland infections and/or gland obstructions that present as acute exacerbations of chronically enlarged glands.
Sialorrhea is defined as an excessive secretion of saliva or hypersalivation. The cause is an increase in saliva production or a decrease in salivary clearance. It can be caused by medications, hyperhydration, infant teething, the secretory phase of menstruation, idiopathic paroxysmal hypersalivation, heavy metal poisoning, nausea, gastroesophageal reflux disease, neurologic changes such as in a cerebral vascular accident (CVA) &neuromuscular diseases.
It can cause drooling, which produces social embarrassment, rejection, and a severe impairment in the quality of a person’s life.In severe cases, a partial or total blockage of the airway can occur, producing aspiration of oral contents and possibly aspiration pneumonia.It also causes perioral irritations and traumatic ulcerations that can become secondarily infected by fungal or bacterial organisms.