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Head And Neck

Head and Neck. Head And Neck. Walid Galal El Shazly. MD of General Surgery. Lecturer of Colorectal Surgery. Swellings In Parotid Region. Acute: SC tissue abcess Parotid Mumps, septic parotitis Bone Ostemyelitis Chronic: Salivary Gland origin

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Head And Neck

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  1. Head and Neck Head And Neck Walid Galal El Shazly MD of General Surgery Lecturer of Colorectal Surgery

  2. Swellings In Parotid Region • Acute: SC tissue abcess Parotid Mumps, septic parotitis Bone Ostemyelitis • Chronic: Salivary Gland origin Extrasalivary Gland origin

  3. Salivary Gland origin Unilateral (suspect Tumor): Cystic Adenolymphoma Solid Tumor (B or M) Bilateral (mostly Benign): Inflammatory (chronic Parotitis) Sialactaisis Endemic (Nutrirional) parotitis Mikulicz Syndrome,Sjogren’s Tumor (10% Adenolymphoma) Others

  4. Extra-salivary Gland • Skin • Subcutaneous • Lymph Node • Facial Nerve Neuroma • Masseter Muscle Idiopathic Hypertrophy, Fibrosarcoma • Mandibule Adamantimoma

  5. Anatomy of Parotid Gland Zygomatic arch Parotid Duct Masseter Muscle Angle of Mandibule

  6. Acute parotitis (Parotid Abscess) • Aetiology: Organism: Staphaureus Route: mouth rare Blood Predisposed: Dehydration,Bad hygiene • Clinical Picture General: Toxaemia Local: Swelling, oedema, Throbbing pain, Tender gland, oral cavity pus on pressure on the gland, Cervical LN • Treatment Incision and Drainage

  7. Acute parotitis (Parotid Abscess)

  8. Chronic Parotitis (Recurrent Parotitis) • Adulthood: Obstruction by stone or stenosis Autoimmune (Bilateral) Sjogren’s Syndrme • Childhood (Sialectasis): Congenital Autoimmune ( 3m-10y )remit at 15y

  9. Chronic Parotitis due to obstruction by stone

  10. Chronic Parotitis due to Sjogren’s Syndrome Keratoconjuntivitis Sicca Xerostomia Rhematoid Arthritis

  11. Cavitary sialectasis with Sjogren’s Syndrome

  12. Mikulicz syndrome lacrimal parotid submandibular

  13. Sialectasis (snow storm apperance in sialogram)

  14. submandibular gland anatomy

  15. submandibular

  16. submandibular

  17. submandibular

  18. Salivary Gland Calculi • 50 times more common in submandibular gland ! • Clinically • recurrent inflammation, • pain increase with meals, • stone may felt in mouth floor • Diagnosis : Plain x ray or Sialogram

  19. Submandibular stone

  20. Submandibular stone

  21. Parotid stone

  22. submandibular

  23. submandibular after lemon test

  24. Treatment of salivary Gland Calculi • Parotid Gland single direct extraction multiple superficial parotidectomy Duct extraction in front of masseter transoral over the masseter parotid incision • Submandibular Gland Excision Duct stone extraction from mouth

  25. Submandibular excision upper flap not elevated till reach capsule (to protect mandibular branch of facial) Lower flap till hyoid bone

  26. Facial artey cut and ligated at the posterior end of the gland and as it emerges below the border of the mandibule Duct ligated and cuted not injre LIngual and Hypoglossal nerves

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