Salivary gland diseases

Introduction

Salivary gland diseases are a wide spectrum of disorders. Examples of them include mumps, Xerostomia, Sialadenitis, Neoplasms of the salivary gland and Sjogren’s syndrome.
They are diseases due to

  • Obstruction
  • Salivary calculi
  • Parotid papilla and duct strictures
  • Salivary fistulae
  • Mucoceles and cysts Ranula

1. Sialadenitis

Sialadenitisis an acute infection and inflammation of the salivary glands

Types:

1. Parotitis (mumps-acute, non suppurative)

  1. Mainly affects children
  2. It is the most common sialadenitis
  3. Usually not related to sialolithiasis

2. Suppurative parotitis
3. Chronic sialadenitis
4. Sub-mandibular sialadenitis

  • Less common in children
  • Abundant salivary flow with rich mucus component
  • Rapid excretion

5. Sublingual sialadenitis 

  • This is rare

2. Mumps (acute non-suppurative)

Painful non-erythematous swelling of
one or both parotid glands, occurring 1
2 weeks following exposure to the
aetiologic virus

Epidemiology of mumps

Most common in children aged 6-8
years with epidemics occurring during
winter and spring, before the onset of
routine vaccination against measles,
mumps and rubella

Clinical features of mumps

  • Preauricular swelling
  • Preauricular pain
  • Fever
  • Chills
  • Headache

Diagnosis

Based on history and clinical findings

  • Virological evaluations may be
    employed

Differential Diagnosis

  • Bacterial infections.
  • Obstructive diseases.

Complications of mumps

  1. Meningitis
  2. Pancreatitis
  3. Otitis
  4. Nephritis
  5. Orchitis
  6. Testicular atrophy
  7. Sterility

Treatment for mumps

Supportive care for fever, headache and malaise

  • Antipyeritics
  • Analgesics
  • Adequate rehydration.

3. Xerostomia

This is simply known as dry mouth.
It can be caused by the following:

  1. Sjogren’s syndrome
  2. Irradiation
  3. Dehydration
  4. Psychogenic
  5. Drugs

4. Sjogren’s syndrome

  • Presents with dryness of the eyes
    and mouth (primary type)
  • In the secondary type, dryness occurs in association with rheumatoid arthritis or other connective tissue disease

5. Neoplasms of the salivary gland

  • The next most common neoplasms of the mouth after squamous cell carcinomas [PSI]
  • Above 70% develop in the parotid gland
  • Over three-quarters are benign
  • Women are slightly more frequently affected

Classification

The modified WHO classification (1972) includes:
Epithelial tumours

  • Adenomas:
    • Pleomorphic adenoma (‘mixed tumour’)
    • Monomorphic adenomas
    • Warthin’s tumour, oxyphoitic adenoma
  • Carcinomas:
    • Mucoepidermoid carcinoma
    • Acinic cell carcinoma
    • Adenocarcinoma
    • Epidermoid carcinoma
    • Undifferentiated carcinoma
    • Malignant mixed tumour

Non-epithelial tumours

  • Lymphomas
  • Sarcomas

Clinical features

  • Benign tumours are generally¬† asymptomatic enlargements
  • Malignant varieties are painful, irregular, ulcerative and metastatic

Investigations

  • Sialography
  • Postero-anterior view of the skull
  • Oblique lateral view of the jaws

Management

  • Benign and malignant lesions: surgical excision
  • Malignant lesions: radiotherapy and chemotherapy in addition to excision
  • Secondary bacterial infections: treat with antibiotics e.g. ampicillin/cloxacillin 250/250 mg every 6 hours for 5-7days
  • Adjust doses as appropriate for children