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NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS

NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS. Benign Salivary Diseases. Infectious Acute Chronic Inflammatory Autoimmune Granulomatous Sialolithiasis. Cystic Congenital Acquired Other Sialorrhea Sialadenosis Rare. Viral Parotitis(Mumps). Paramyxovirus – A RNA virus

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NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS

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  1. NON NEOPLASTIC DISORDERS OF SALIVARY GLANDS

  2. Benign Salivary Diseases • Infectious • Acute • Chronic • Inflammatory • Autoimmune • Granulomatous • Sialolithiasis • Cystic • Congenital • Acquired • Other • Sialorrhea • Sialadenosis • Rare

  3. Viral Parotitis(Mumps) • Paramyxovirus – A RNA virus • Droplet infection/fomites • Children of school going age & young adults • Incubation period: 2-3 weeks • Patient is infective even before the onset of clinical manifestations and remains so 7-10 days after the swelling subsides • Virus excreted through nasal, salivary & urinary secretions

  4. Clinical features • Symptoms – fever, malaise, headache in 1/3rd, painful swelling of parotids – 70% bilateral. Occasionally submandibular glands affected • Tense, firm swelling - lasts for a week • Other features: Orchitis, Ophritis, Pancreatitis,aseptic meningitis, • thyroiditis, myocarditis, • nephritis,arthritis • Unilateral SNHL/sudden loss

  5. Diagnosis • Clinical diagnosis • Serum & urinary amylase are raised • Raised serum IgM & IgG by day 5

  6. Treatment • Good hydration • Rest • Analgesics • Cold & hot compression • MMR vaccination by 15 months

  7. Acute Bacterial Sialadenitis • 2 mechanical factors: • Retrograde contamination of the salivary gland duct & parenchymal tissue by bacteria • Stasis of salivary flow through ducts & parenchyma

  8. Predisposing factors • Systemic dehydration • Major surgical procedures • HIV Infections • Systemic diseases like Diabetes, renal failure, Sjogren’s syndrome, hepatic failure • Mechanical obstruction to the duct • Bacteriology: Staph aureus

  9. Clinical features • Sudden onset • Pain & enlargement of the affected gland • Tender, erythematous, indurated swelling over the parotid, aggravated by jaw movements • Fever & malaise • Stenson’s duct swollen & red with discharging pus on pressure

  10. Diagnosis • Clinical diagnosis • Leucocytosis with neutrophelia • Serum amylase normal

  11. Treatment • Treat the underlying cause • IV antibiotics • Adequate hydration • Proper oral hygiene • Surgical drainage if required

  12. Chronic recurrent Sialadenitis • Recurrent acute attacks of infection involving parotid gland • Symptoms: • Mildly painful, recurrent parotid enlargement – aggravated by eating • 80% develop xerostomia • O/E: • Palpable enlargement with scanty saliva on palpation • Will have acute picture during flare-ups

  13. Chronic Sialadenitis • Radiology: • Sialography – prominent sialectasia, filling defects due to debris, stenosis • Treatment: • Treatment of acute attack with antibiotics • Remove any calculus • Periodic ductal dilation, duct ligation, irradiation, gland excision

  14. Acute Suppurative Parotitis of Infancy • Unique to newborns – 40% of affected are premature • Usually in parotid • Bacteriology: • Staph. aureus • Streptococci, E. coli, Pseudomonas aeriginosa, Moroxellacatarrhalis • Treatment: • Hydration • IV antibiotics • Usually resolves within one week

  15. Recurrent Parotitis of Childhood • Second most common salivary disorder in children • Infections occur every 2-3 months, last days to 2 weeks and often resolve at puberty • Symptoms: • Recurrent acute/subacute swelling of parotid with fever and malaise – usually unilateral • Asymptomatic between episodes • Diagnosis: • History • USG to rule out new presentation of Sjögren’s syndrome (2-4 mm round hypoechoic areas in superficial lobes)

  16. Recurrent Parotitis of Childhood • Etiology: • Congenital malformation – congenital sialectases predispose to bacterial colonization • Recurrent ascending infection with mucus plug formation • Immune deficiency • Treatment: • Antibiotics with each episode (wait out infections until “burns out” at puberty) • Conservative measures • Parotid duct dilation to break-up mucus plugs • Rarely parotid duct ligation

  17. Sialectasis • Dilatation of the ductal system • Aetiology: congenital/Associated with Sjogren’s syndrome • Stasis of secretions & infection • CF: similar to chronic recurrent sialadenitis, can be differentiated by sialography which shows punctate/globular/cavitary types of dilatation

  18. Granulomatous diseases • Tuberculosis • Sarcoidosis • Actinomycosis

  19. Tuberculosis • Uncommon • Unilateral parotid swelling • Spread of infection from the teeth & tonsil • Two forms: Acute inflammatory/Chronic granulomatous • May present with fistula • Excision/Anti tubercular treatment

  20. Sarcoidosis • Heerfordt’s syndrome(Uveoparotid fever) – Uveitis, chorioretinitis, facial paralysis & Parotid enlargement • 20-30 years • Fever, malaise, weakness, nausea & night sweats • Diagnosis: Kveim’s test • Treatment: Steroids, symptomatic

  21. Actinomycosis • Uncommon • Acute abscess with sinus formation discharging sulphur like granules • Indolent swelling over the parotid • Surgical drainage • Penicillin/tetracyclin

  22. Sialolithiasis • Occur most commonly in submandibular glands (80 – 90%%) • More alkaline pH • Higher viscosity mucoid secretions • Anti-gravity flow through long duct • Uric acid stones in gout occur primarily in parotids • Composition: • Calcium phosphate as hydroxyapitite • Carbohydrate and amino acid matrix • Uric acid in gout • Etiology: • Infection alters protein composition of mucin – encourages calcium precipitation – prevalent in chronic sialadenitis • Duct stenosis/secretion stasis encourage stone formation

  23. Sialolithiasis • Symptoms: • Intermittent pain/swelling - exacerbated by eating • Symptoms can resolve between meals • Range from discomfort to cellulitis to purulent secretions • Diagnosis: • Usually can palpate stone in FOM • Plain films will show submandibular stones 80-90% • Only 10% for parotid stones • Sialography – nearly 100% sensitive, allows evaluation of gland anatomy/parenchyma also • Contraindicated in acute infection

  24. Sialolithiasis

  25. Sialolithiasis • Treatment: • Spontaneous extrusion with sialagogues • Proximal stones can be milked from duct after dilation • Local anesthesia and I&D of Warthin’s duct with stone removal • Higher risk of stenosis if I&D of parotid duct, must place stent • Gland excision if stone is in parenchyma • Failure to remove stones leads to abscess formation, duct stricture, chronic sialadenitis, gland destruction

  26. Sjogren’s Syndrome • Second most common autoimmune disorder after rheumatoid arthritis • Primary/Secondary

  27. Primary • Mikulicz’s disease / Benign lymphoepithelial disease • Xerostomia & Xero-opthalmia • Involves both the sexes

  28. Secondary • Keratoconjunctivitis sicca • Xerostomia • Rheumatoid arthritis • Bilateral parotid swelling • More common in females • Diagnosis: Raised ESR, + RH factor, +antinuclear antibodies, biopsy from lower lip • Treatment: Symptomatic, NSAID, Steroids

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