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S ALIVARY G LAND D ISORDERS

S ALIVARY G LAND D ISORDERS. I NTRODUCTION H ISTORY A NATOMY and P HYSIOLOGY OF SALIVARY GLANDS D IAGNOSTIC T ESTS DONE IN SALIVARY GLAND DISORDERS DIAGNOSTIC TESTS DONE IN SALIVARY GLAND DISORDERS CLASSIFICATION OF SALIVARY GLAND DISORDERS.

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S ALIVARY G LAND D ISORDERS

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  1. SALIVARYGLANDDISORDERS

  2. INTRODUCTION • HISTORY • ANATOMY and PHYSIOLOGYOF SALIVARY GLANDS • DIAGNOSTIC TESTSDONE IN SALIVARY GLAND DISORDERS • DIAGNOSTIC TESTS DONE IN SALIVARY GLAND DISORDERS • CLASSIFICATION OF SALIVARY GLAND DISORDERS

  3. CLASSIFICATIONOF SALIVARY GLAND DISORDERS • SALIVARY GLAND DISORDERS • XEROSTOMIA • SIALORRHEA • CONCLUSION • CONCLUSION

  4. HISTORY • HIPPOCRATES370- 460 BC PAROTID DISEASE • PAULUS AEGINETA AD 607- 690 • PAROTITIS • ABULCASIS936-1013 AD • RANULA • CABANES13 TH CENT • PAROTID TUMOUR

  5. HISTORY • THOMAS WHARTON 1614-1675 • ANATOMY OF SALIVARY GLANDS • FRANS DE SILVIN 1656 • DEMONSTRATION OF PAROTID DUCT IN MAN • JOHN HUNTER 1785 • SURGERY OF PAROTID TUMOUR

  6. ANATOMY OF SALIVARY GLANDS MAJOR MINOR

  7. PAROTID MAJOR SALIVARY GLANDS PAROTID SUBMANDIBULAR SUBLINGUAL

  8. PAROTID • LARGEST OF SALIVARY GLANDS • LOCATION: • STENSONS DUCT • SEROUS IN NATURE

  9. SUBMANDIBULAR • MIXED MUCOUS AND SEROUS GLAND • LOCATION: Floor of the mouth • WHARTONS DUCT

  10. SUBLINGUAL • PREDOMINETLY MUCOUS IN NATURE • LOCATION: ANT TO SUB MANDIBULAR • SERIES OF SMALL DUCTS

  11. LABIAL MINOR SALIVARY GLANDS BUCCAL PALATINE INCISIVE LINGUAL

  12. PHYSIOLOGY OF SALIVARY GLANDS Saliva • SECRETION • COMPOSITION OF SALIVA • FUNCTIONS OF SALIVA

  13. PHYSIOLOGY OF SALIVARY GLANDS Saliva Secretion: Controlled by CNS Parasympathetic stimulation Sympathetic stimulation

  14. FACTORS INFLUENCING SECRETION • Taste and smell • Mechanical stimulation of oral • mucosa and gingiva • Mastication of food • Chemical irritation of oral mucosa & • stomach • Distension / irritation of oesophagus • Pregnancy

  15. COMPOSITION OF SALIVA • Water :- 94.0 – 99.5% • Solids :- 6.0% (unstimulated), 0.5% (stimulated) • organic constituents:-urea, uric acid, glucose, aminoacid, lactate, fatty acids, proteins like amylase, peroxidase, lysosyme, IgA, IgM, IgG. • inorganic constituents:- Ca, Mg, F, HCO3, K, Na, Cl, NH4. • gases:- CO2, N2, O2. • constituents from oral cavity:- desquamative epithelial cells, bacteria.

  16. FUNCTIONS OF SALIVA • Inhibition of dental caries • Water balance • Lubrication action • Taste of food • Buffering action • Hygienic action • Digestion (Amylase, Lipase) • Antibacterial (Lysozyme, IgA, Peroxidase, FLOW) • Mineralization • Protective Pellicle

  17. DIAGNOSTIC APPROACHES • SALIVARY GLAND IMAGING • FINE NEEDLE CYTOLOGY • SALIVARY GLAND BIOPSY • SIALOENDOSCOPY • SIALOCHEMISTRY

  18. SALIVARY GLANDIMAGING

  19. Plain film radiography • Starting point (cost benefit point of view) • Can demonstrate Sialolith • Possible involvement of adj osseous structures EXTRAORAL INTRAORAL INTRAORAL

  20. SIALOGRAPHY • Oldest imaging procedure 1902- Carpy 1925- Basony and uslenghi • Infusion of radio opaque contrast agent before imaging • Parotid and submandibular gland easily studied

  21. Radioopaque materials used: water soluble fat soluble Indications Chronic sialadenitis Autoimmune disorders Benign tumors contraindications acute infections Iodine allergy pts

  22. Instruments used : Syringe Needle IV canula Lacrimal probe LA Lime pieces ADV and DIS adv Technique: Radiographic appearance: Chronic sialadenitis Sjogerns syndrome Benign tumours

  23. CT & MRI Displays both hard & soft tissues Better images of soft tissues Axial &coronal sections taken Less artifacts

  24. ULTRASOUND CYSTIC MASS SOLID MASS • INEXPENSIVE • WIDELY AVAILABLE • PAINLESS • NON INVASIVE

  25. RADIONUCLIDE SALIVARY IMAGING SCINTIGRAPHY

  26. SCINTIGRAPHY • Provides functional study of salivary glands • 99m TC PERTECHNECTATE is injected IV • Concentrated and excreted by glandular structures. ADV: Major salivary glands visualized at a time DIS ADV: Demonstrates little morphology(low image resolution)

  27. SIALO ENDOSCOPY • Minimally invasive procedure • Diagnosis and treatment Diagnosis of radiolucent calculi Treatment of other diseases- Chronic sialadenitis

  28. SIALO CHEMISTRY • LAB ANALYSIS OF SALIVA • HELPS IN DETECTING PATHOLOGY • USEFUL IN : • SJOGRENS SYNDROME – IgA ,IgG Elevated • OBSTRUCTIVE PAROTITIS- Sodium,Potassium,Chloride reduced. • SIALADENOSIS – phosphorus elevated.

  29. CLASSIFICATIONOF SALIVARY GLAND DISORDERS • SALIVARY GLAND DISORDERS

  30. DEVELOPMENTAL DISORDERS • APLASIA of Salivary Gland CLASSIFICATION • HYPOPLASIA • ACESSORY Salivary Gland And Ducts • ABERRANT Salivary Glands • DIVERTICULI

  31. OBSTRUCTIVE DISORDERS MAJOR SALIVARY GLAND • SIALOLITHIASIS CLASSIFICATION MINOR SALIVARY GLAND EXTRAVASATION • MUCOCELE RETENTION

  32. OBSTRUCTIVE DISORDERS • RANULA CLASSIFICATION • FOREIGN BODIES

  33. FUNCTIONAL DISORDERS CLASSIFICATION • XEROSTOMIA • PTYLASM

  34. INFLAMMATORY & REACTIVE DISORDERS NECROTISING SIALOMETAPLASIA RADIATION INDUCED SIALADINITIS ALLERGIC SIALADENITIS

  35. VIRAL DISEASES MUMPS • VIRAL INFECTIONS : HCV INFECTION HIV INFECTIONS CYTOMEGALOVIRUS INFECTION

  36. BACTERIAL DISEASES • BACTERIAL : ACUTE BACTERIAL SIALADENITIS CHRONIC OR RECURRENTSIALADENITIS

  37. SYSTEMIC CONDITIONS WITH SALIVARY GLAND INVOLVEMENT SYSTEMIC METABOLIC CONDITIONS : • Diabetes mellitus • anorexia • Bulimia • Alcoholism

  38. AUTOIMMUNE DISEASES: • SJOGERNS SYNDROME (prim & sec) • MICKULIZ DISEASE

  39. GRANULOMATOUS DISEASES: • TUBERCULOSIS • SARCOIDOSIS

  40. SALIVARY GLAND TUMOURS : • BENIGN • MALIGNANT PLEOMORPHIC ADENOMA WARTHINS TUMOUR MUCO EPIDERMOID CARCINOMA • MONOMORPHIC ADENOMA • ADENOID CYSTIC CARCINOMA • ONCOCYTOMA • ACINIC CELL CARCINOMA • BASAL CELL ADENOMAS • ADENOCARCINOMA • LYMPHOMA • CANALICULAR ADENOMA CARCINOMA EX PLEOMORHIC ADENOMA

  41. Classification of salivary gland neoplasms by the World health organization : Epithelial tumours • Mucoepidermoid tumour • Adenomas • Acinic cell tumour • Pleomorphic adenoma • Carcinomas • Monomorphic adenoma • Adenoid cystic carcinoma • Adenolymphoma • Undifferentiated carcinoma • Oxyphilic adenoma • others • Carcinoma in pleomorphic adenoma

  42. Non epithelial tumours • Unclassified tumours • Allied conditions CLASSIFICATION • Benign lymphoepithelial lesion • Sialosis • Oncocytosis

  43. DEVELOPMENTAL DISORDERS • APLASIA of Salivary Gland • HYPOPLASIA • ACESSORY Salivary Ducts • ABERRANT Salivary Glands • DIVERTICULI • Dariers disease

  44. OBSTRUCTIVE DISORDERS • SIALOLITHIASIS • MUCOCELE • RANULA

  45. SIALOLITHIASIS

  46. SIALOLITHIASIS • sialolith • sialolithiasis Major salivary gland – common Minor salivary gland - rare COMPOSITION Organic &inorganic substances

  47. Submandibular gland commonly involved:80-90% PAROTID : 5-15% SUBLINGUAL :2-5% Reason : Predisposing factors for sialolith • Inflammation • Ductal irregularities • Anticholinergic drugs

  48. CLINICAL PRESENTATION: • AcutePainful Intermittent Swelling • PAIN : DURING MASTICATION O/E :Ductal orifice inflammed Bimanual palpation COMPLICATIONS : Due to stasis of saliva Infections Fibrosis

  49. Acute sialadenitis OTHER COMPLICATIONS : DIAGNOSIS: Radiographic examination • Plain film radiography • Sialography • Sialendoscopy • Ultrasonography • CT imaging

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