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CH 43
CH 43
CH 43
DISEASES OF THE
SALIVARY GLANDS
William R. Carroll, MD
C. Elliott Morgan, DMD, MD
oral cavity and are located in the hard and soft palate, lips,
buccal mucosa, floor of the mouth, and tongue.
INFLAMMATORY DISEASES OF
THE SALIVARY GLANDS
Viral Infections (Mumps)
Mumps (epidemic parotitis) is a disease of viral origin that
most commonly occurs in the pediatric age group. Viral
parotitis is usually caused by a paramyxovirus (specifically
the Rubulavirus), but many viral pathogens may cause acute
infections within salivary glands. Typical symptoms include
fever, malaise, and headaches, followed by tenderness and
enlargement of the parotid glands. The most common com-
plication from paramyxovirus parotitis is orchitis, occur-
ring in 20 to 30% of males. Oophoritis occurs in 5% of
females. Involvement of the germinal tissues does not usu-
ally cause sterility. Aseptic meningitis is a complication in
about 10% of patients with viral parotitis. Pancreatitis
occurs in 5%. Treatment of viral salivary gland infection
is supportive. Live attenuated mumps vaccine as part of
mumps, measles, rubella (MMR) immunization is given to
children after 12 months of age.
Sjögren’s Syndrome
Sjögren’s syndrome is a chronic autoimmune disorder of the
exocrine glands, which affects predominantly, but not exclu-
sively, the salivary glands. It is the second most common
autoimmune disease, trailing only rheumatoid arthritis. Women
in the fourth to fifth decade of life constitute 90% of cases.
The most common symptom of Sjögren’s syndrome is
xerostomia (dry mouth). The decreased salivation causes dif-
ficulty with swallowing, altered taste, and speech difficulties.
Long-term xerostomia causes an increase in dental caries.
Ocular involvement in Sjögren’s syndrome is characterized as
510 Otorhinolaryngology
Sarcoidosis
The salivary glands are involved in 6 to 10% of patients with
sarcoidosis. The parotid gland is involved most commonly.
Diseases of the Salivary Glands 511
Wegener’s Granulomatosis
Wegener’s granulomatosis is a systemic disorder often
involving the respiratory tract from the nose to the lungs, as
well as the kidneys. Wegener’s granulomatosis affects both
sexes equally, occurs in all ages, and is usually seen in
Caucasians. Histologically, Wegener’s granulomatosis is
characterized by vasculitis of medium and small vessels.
More than 70% of the features associated with Wegener’s
granulomatosis are related to the ears, nose, and throat.
Symptoms develop insidiously, with sinusitis being the most
frequent presentation. Salivary gland enlargement may
accompany the nasal and sinus symptoms, with the parotid or
submandibular glands, or both, being affected. Subglottic
stenosis commonly occurs. In the lower airway, pulmonary
infiltrates or cavitary nodules are also noted. Renal involve-
ment indicates systemic Wegener’s granulomatosis and is the
most frequent cause of death.
Intranasal biopsies should be taken with a generous sec-
tion of viable nasal mucosa. These can be taken from the
turbinate, septum, or lateral nasal wall. The specimen should
be examined for fungal microorganisms as well. Wegener’s
granulomatosis must be differentiated from other granulo-
matous diseases including polymorphic reticulosis, Churg-
512 Otorhinolaryngology
Chronic Sialadenitis
Patients with chronic sialadenitis experience recurrent, low-
grade inflammation and edema of the gland, minor pain, and
sialorrhea that may be slightly purulent. Streptococcus viri-
dans is the usual infecting microorganism. Measures to
increase salivary flow should be instituted and appropriate
antibiotics given. Attempts to identify stones or duct stric-
tures should be made.
Warthin’s Tumor
Warthin’s tumor or papillary cystadenoma lymphomatosum
is the second most common benign neoplasm of the salivary
glands. Interestingly, Warthin’s tumor occurs almost exclu-
sively in the parotid glands. It typically involves the lower
pole of the parotid gland and may be bilateral in up to 10%
of cases. The most popular etiologic theory suggests that
Warthin’s tumor arises in salivary ducts that are trapped
within intraparotid lymph nodes. The recommended treat-
ment for Warthin’s tumor is complete surgical excision sim-
ilar to that described for pleomorphic adenoma.
Monomorphic Adenomas
Monomorphic adenomas include basal cell adenoma, clear
cell adenoma, and glycogen-rich adenoma among other less
common tumors. The most common monomorphic adenoma
is the basal cell adenoma, which comprises 1 to 3% of sali-
vary gland neoplasms. Treatment of monomorphic adenomas
includes wide surgical excision with an adequate cuff of nor-
mal surrounding tissue.
Oncocytomas
Oncocytomas comprise less than 1% of all salivary gland neo-
plasms. Oncocytomas are grossly encapsulated, single lesions.
Histologically, the tumors are composed of large cells with
round nuclei. Treatment of oncocytoma involves wide local
excision with a cuff of surrounding gland parenchyma. Rarely,
malignant oncocytomas are detected. Cytologic differentia-
Diseases of the Salivary Glands 515
Hemangiomas
Hemangiomas are the most common tumor arising in the
salivary gland from the connective tissue elements. They are
the most common salivary gland tumor of any type in chil-
dren and are often detected within the first year of life.
Hemangiomas often occur over the angle of the mandible,
and the overlying skin may contain a bluish discoloration.
Engorgement of the lesion with crying or straining is often
also seen. Most hemangiomas in the salivary glands undergo
spontaneous resolution.
Mucoepidermoid Carcinoma
Mucoepidermoid carcinoma is the most common malignant
salivary gland tumor. Approximately one-half of all mucoepi-
dermoid carcinomas occur in the parotid gland, with the
majority of the remainder occurring in minor salivary glands.
516 Otorhinolaryngology