Diseases of salivary glands Dr. Salah Ahmed

Obstructive Lesions 1- Mucocele: - is the most common lesion of the salivary glands - resulting from blockage or rupture of minor salivary gland duct - most common in the lower lip, as a consequence of trauma 2- Ranula: - occurs in floor of mouth - due to blockage of sublingual gland duct

Sialadenitis - inflammation of the major salivary glands - may be in origin: - traumatic - viral - bacterial - autoimmune - most common in the parotid gland - either acute or Chronic Acute: 1- viral: mumps: - may produce enlargement of all the major salivary glands ( parotids) - several viruses may cause mumps, the most important is a paramyxovirus: an RNA virus related to the influenza and parainfluenza viruses - childhood mumps is self-limited and rarely creates residual problems - mumps in adults may be accompanied by pancreatitis or orchitis, latter sometimes causes permanent sterility

2- Bacterial: - risk factors: 1- sialolithiasis 2- severe systemic dehydration (postoperative state) 3- chronic debilitating illness 4- compromised immunity 5- medication (contributing to dehydration) - The most common bacteria: Staph. Aureus, Strep. Viridans Chronic: - arises from decreased production of saliva with subsequent inflammation - Causes: 1- the common cause is autoimmune (Sjögren syndrome: dry mouth: xerostomia and dry eyes: keratoconjunctivitis sicca) 2- sarcoidosis 3- leukemia, lymphoma

Clinical presentation: - the gland is typically enlarged and tender - inflammation may affect the production of saliva and result in: 1- Sialorrhea (excess of saliva) or 2- Xerostomia (dry mouth due to the cessation of salivation)

Salivary gland tumors - most common in the parotid gland - Major salivary gland tumors are more likely to be benign - Minor salivary gland tumors are more likely to be malignant - include: 1- Pleomorphic adenoma: (mixed tumor) - the most common benign tumor of salivary glands - most common in parotid gland (80% of cases) - common in females between yrs of age - present as painless, mobile mass at the angle of the jaw - malignant transformation can occur - recurrence is common after resection

- Morphology: * encapsulated mass, well demarcated from adjacent tissue * epithelial cells intermixed with mesenchymal elements ( e.g. cartilage) in a myxomatous stroma

2- Warthin's tumor: (papillary cystadenoma lymphomatosum) - a benign tumor - common in parotid gland - is the second most common salivary neoplasia - most common in smokers with male predominance (50-70 yrs old) - Morphology: - is composed of glandular spaces lined by double layer of epithelial cells within benign lymphoid tissue

3- Mucoepidermoid carcinoma: - is the most common primary malignant tumor - occurs mainly in parotid gland - tumor composed of mixture of neoplastic squamous and mucus-secreting cells 4- Adenoid cystic carcinoma: - uncommon tumor - 50% of cases occur in minor salivary glands - slow growing tumor with tendency to invade perineural spaces - 50% of cases metastasize to distant sites (bone, liver, brain) - tumor composed of cells with dark nuclei and scant cytoplasm in cribriform pattern

** Xerostomia: - dry mouth - causes : 1- autoimmune: (Sjögren syndrome: dry eyes, dry mouth and CT disease e.g. RA ) 2- salivary glands inflammation and fibrosis 3- radiation

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