1. SALIVARY GLANDS DISEASES
by:
Dr. Saad Al Asiri
MD, DLO, KSF, Rhino
General Secretary Assistant for Training &
Program Accreditation
ENT Consultant and Rhinologist

7. Clinical Anatomy Parotid Gland
The largest of all major salivary glands
It lies in preauricular region deep to skin & subcutaneous tissues

8. The parotid region contain: Parotid gland Vessels, nerve, lymphatic
Secrete serous type
The facial nerve divide the gland into large superficial + small deep lobe
The parotid region contain:
Parotid gland
Vessels, nerve, lymphatic
7/16/2018

9. The stensen duct 1. 5 cm below zygoma, anterior is masseter M
The stensen duct 1.5 cm below zygoma, anterior is masseter M. & pierce buccinator → open intraorally just opposite 2nd upper molar
It run with buccal branch of Facial Nerve
The parotid facial is surrounding firmly the gland

10. Facial Nerve
Emerge from skull "stylomastoid foramen" lies lateral to styloid process
Three muscular branch at syloid foramen
Styloid M
Post auricular M
Post belly of digestive M

11. Tragal pointer - junction cartilage, bony
Ex. Meatus
Facial Nerve lies 6-8 mm anterior & inferior to tympenomastoid suture line
Variation of FN & parotid gland
Branches - temporal, zygomatic, buccal, marginal "mandibular" & cervical
7/16/2018

12. Auriculotemporal Nerve
Mandibular → Foramen Oval innervate scalp
Carries post ganglion fiber " parasympathetic" from otic ganglion to P. Gland
Frey's syndrom "gustatory sweating"
Artery Supply & Venous Drainage
Superior Temporal A.
Transverse F A 

13. Nerve → Vein → Artery
Lymphatic drainage
Upper deep Cx L N
Sublingual salivary gland
Minor salivary gland

14. Submandibular Gland It lies in the submandibular triangle
The triangle is formed by
Anterior belly of digastric muscle
Posterior belly of digastric muscle
Inferior margin of mandible
Wrap around mylohyoid muscle in C shaped "two lobe
Facial
Wharton duct 5 cm length

15. Duct & hypoglossal & lingual
Lingual nerve → duct XII nerve
Chorda tympani nerve carry parsymphatetic supply
There marginal mandibular 7 nerve relation
Facial artery is the major artery supply

16. The main function of salivary gland is:
production of saliva
Aid in digestion
Protect mucosa from desiccation
Dental caries
Assists in the maintenance of homeostasis

17. The salivary gland secretory unit
Myoepithelial cells
Acinar cells
Intercalated duct cell
Striated duct cell
Excretory duct cell

18. Differential Diagnosis "DD" of parotid region mass
Other Tumors
Haemangioma, sarcoma, lipoma, metastatic tumors
Differential Diagnosis "DD" of parotid region mass
Masseter hypertrophy
Dental abscess

19. Parapharyngeal space tumor Infra temporal fossa
Intraparotid lession "V, N, A, LN, fat"
Metabolic disease
Drug induced
7/16/2018

20. Parotitis Acute bacterial parotitis
Common in elderly, dehydrated patient
Dry mouth is predisposing factor
Staph Auries > other organism
C/F symptoms & signs
W/ UP
Rx AB antistaph + hydration 

21. Viral Parotitis Children > adults Incubation period 2-3 weeks
Infection persist 10 days post Rx
G/F unilateral swelling > than others

22. Complication: Orchitis, ophritis Pancreatitis mild Meningitis
Unilateral SNHL
Dx is clinically
Serum & urine amylase is high
Serology 1gG 1gM
Rx - supportive, hydration, analgesia, prevention, MMR vaccine

23. Chronic " recurrent sialadenitis"
Parotid & submandibular secretion
Less secretion
Recurrent infection
Sialectasis + stone formation
C/F
Rx w/up - lab
Salivary flow rate
Role of radiology

24. Sjogren's Syndrome Rx - supportive Primary "dry mouth , eye"
Conservative
Surgery rarely when.
Sjogren's Syndrome
Primary "dry mouth , eye"
Secondary RA
C/F

25. Salivary Gland Tumors
% of benign tumors of parotid gland are pleomorphic adenoma
Warthin tumor benign
Oncocytoma
Vascular lymphatic malformation

26. Symptoms of Benign Tumor
Painless slow growing
When it become painful → malignancy or hemorrhage
When present with LN enlargement or nerve palsy

27. Common malignancies
Adenoid cystic CA
Mucoepidermoid CA
Sg cell CA
Acinous cell CA
Adeno carcinoma
Malignant mixed tumor

28. Investigation Management: CT, MRI FNA Biopsy TNM staging
Surgery - superficial parotidectomy
Total
Submandibular excision
Neck dissection

29. Complication of Surgery
Frey's syndrome
Nerve damage
Salivary fistula
Predisposing factor to salivary malignancy
Recurrent infection
Radiation exposure

30. 7/16/2018