BY

Dr Soliman Altarifi
Salivary Glands
 Major glands: parotid,
submandibular and
sublingual
 Minor salivary glands:
There are 800-1000 minor
salivary glands located
throughout the oral cavity
within the sub mucosa.
Parotid gland
 The largest of all glands
 Located between mastoid
process, styloid process and
ramus of mandible
 Traverse by facial nerve, and
surrounded by parotid sheath.
 Mainly serous with few
mucinous acini.
 Deep and superficial parts.
…..Parotid gland
 Blood supply: Brs from ECA, venous
drainage to retromandibular vein
 Lymphatic drainage: deep cervical LNs
 Nerve supply:
▪ Parasympathatic: secretomotor from otic
ganglion through auriculotemporal nerve.
▪ Sympathatic: vasoconstrictor, from superior
cervical ganglion, ECA plexus.
▪ Sensory: auriculotempral nerve, V3.
…..Parotid gland
 Parotid duct: (Stensen’s duct )
Emerges from the anterior boarder
Submandibular gland
 Located in the
submandibular fossa,
deep to the mandible.
 Has superficial and
deep parts
 Produces both
mucinous and serous
saliva.
…Submandibular gland
 Blood supply: facial artery and vein
 Lymphatic drainage to submandibular
LNs
 Nerve supply:
▪ Parasympathetic: secretomotor, from
submandibular ganglion
▪ Sympathetic: vasoconstrictor
…Submandibular gland
 Submandibular
gland Duct:
▪ 5cm long.
▪ arises from
superficial part,
near the post
boarder.
▪ opens in the floor
of the mouth next
to the frenulum
Sublingual salivary gland
 Mucus secreting gland.
 Located beneath
the mucous membrane of
the floor of the mouth.
 They are drained by 8-20
excretory ducts called the
ducts of Rivinus.
 ducts open separately
into the floor of the mouth
on the plica sublingualis,
on either side of
the frenulum linguae.
Salivary glands neoplasms:
 Benign or Malignant: 1ry or 2ry
 80% from parotid gland
 80% of parotid neoplasm are benign
(80% of them pleomorphic adenoma)
 33% of submandibular glands tumors
are malignant
 50% of minor salivary gland tumors are
malignant
….Salivary glands neoplasms:
1. Adenomas:
▪ Pleomorphic adenoma
▪ Adenolymphoma (Warthin’s tumour)
▪ Myoepithelioma
▪ Basal cell adenoma
▪ Ductal papilloma
▪ Cystadenoma
….Salivary glands neoplasms:
2. Carcinoma:
▪ Acinic cell carcinoma
▪ Mucoepidermoid carcinoma
▪ Adenocystic carcinoma
▪ Carcinoma ex-pleomorphic adenoma
▪ Sqaumous cell carcinoma
▪ Undefferenciated carcinoma
….Salivary glands neoplasms:
3. Non epithelial tumors:
▪ Haemangioma
▪ Lymphangioma
▪ Lipoma
▪ Neuroma
4. Malignant lymphoma
5. Secondery tumors
6. Unclassified tumors
7. Tumor like conditions eg. Sialometaplasia,
sialoadenitis.
Pleomorphic adenomas:
 In the fifth decade
 Males=females
 Have pseudo capsule
 Arise from myoepithelial
cells and intercalated
duct cells
 Presented as painless
smooth mass
….Pleomorphic adenomas:
 Diagnosis:
1. Clinical picture
2. Radiology
3. FNA
 Treatment:
surgical excision
Adenolymphoma
Warthin’s tumor:
 Male to Female
ratio 7/1
 60-70yrs
 Usually arise at
parotid tail from
lymphoid tissues
 One in ten
bilateral, rare
synchronously
Adenocystic carcinoma
 Slowly growing
 Often spread along nerve sheath
 Most common malignant tumor of
salivary glands
 More in minor glands
 Patients may presented with facial pain
of facial nerve palsy
 LN mets is uncommon
Adenocarcinoma
 3% of parotid tumors
 10% of submandibular and minor glands
 20% of patients have +ve nodes on
presentation
Mucoepidermoid tumors
 Arise mainly in parotid
gland
 Metastesize to LNs
 Can spread to lungs
and brain
 Most common salivary
neoplasm in children.
Carcinoma ex-pleomorphic
adenoma:
 It is a malignancy arising within a pre-
existing benign pleomorphic adenoma
 Incidence 1to 5% in adenoma that has
been presented for more than 10yrs
Diagnosis and work up
 Clinical picture
 Radiology including CAT scan and MRI
 FNA
A parotid tumor with facial nerve
affection, skin tethering,
lymphadenopathy, pain or
sudden growth is highly
suggestive of malignancy
Treatment
 Surgical :
▪ Resection with safety margin
▪ total resection : conservative or radical
▪ Extended resection
▪ Neck dissection : in node +ve, and in
high grade tumors eg: SCC,
adenocarcinoma, undeferanciated
 Radiotherapy: adjuvant or paliative
Non-neoplastic salivary galnds
disease:
 infection:
▪ Acute sialadenitis
▪ Chronic recurrent sialadenitis
▪ Granulomatous sialadenitis
 Stones ( sialolithiasis)
 Inflamatory
▪ Sjogren syndrome
 Sialomegaly
▪ Drugs
▪ Metabolic causes
 Sialectasis
Infections of salivary glands
 Acute viral :
▪ Mumps: bilateral in
children, can cause
pancreatitis,
orchitis, meningitis
or encephalitis,
usually self limiting
▪ Coxsackie virus
▪ HIV
▪ Echovirus
… infection of salivary glands
 Acute bacterial
sialoadenitis:
▪ Caused by staphylococci
▪ Pain, tender, and discharge
from duct
▪ Seen in dehydrated patients
and immunocompromised
▪ Treatment : systemic Abs
and rehydration
…. Infection of salivary glands
 Chronic recurrent sialoadenitis:
▪ Recurrent slightly painful enlargement
▪ Caused by decreased salivary flow
▪ Treatment : sialogogues, hydration and
massage if not responding surgery
 Granulomatous sialoadenitis
▪ Srcoidosis
▪ TB
▪ Syphilis
▪ HIV
Sialolithiasis
 C/P: pain and swelling at meal
time
 Seen in middle age
 80% submandibular
 65% of submandibular stones
radio-opaque
 65% of parotid stones
radiolucent
 Diagnosis: X ray, sialogram or
US
 Treatment : trans oral
extraction, resection
Trans oral extraction
THANK YOU