Salivary gland diseases

Mustansiriya University, College of Dentistry, Department of Oral Medicine.

Oral Medicine lecture
Dr.Ahmad Fliah Hassan

Saliva:-
Is a glandular secretion that is essential for the maintenance of healthy orodental tissues.
Saliva is a complex fluid and many of the functions of saliva have a protective role (Lubricant,
buffer, antimicrobial, digestion, facilitates taste, cleanses the teeth, water balance)
Salivary Gland Classifications
1- Major Salivary Glands
A- Parotid gland
 Parotid saliva is secreted through Stenson’s duct, the orifice of the duct is covered
by a small flap of mucosa called the parotid papilla and situated opposite the
maxillary second molar ,Secretes serous type of saliva.
B- Submandibular gland
 The duct is called Wharton’s duct, the orifice of Wharton’s duct is open into the
sublingual papilla, just lateral to the lingual frenum; mixed secretion(mostly
serous)
C- Sublingual glands
 Located just below the floor of the mouth beneath the sublingual folds of mucous
membrane. Numerous sublingual ducts that open in to the mouth along the
sublingual folds; mixed secretion (mostly mucous)
2- Minor Salivary Glands
Consist of hundreds of minor salivary glands throughout the mouth and extending
down the tracheobronchial tree, which are named for their anatomic location (labial
mucosa, buccal mucosa, tongue, floor of the mouth, and palate)
Salivary gland imaging
 Plain-film radiography.
Panoramic or lateral oblique view used to visualize the parotid gland (sialoliths).
Panoramic, occlusal or lateral oblique view used to visualize the submandibular gland
(sialoliths).

 CT and MRI: Are useful for evaluating salivary gland pathology, adjacent structures,
and the proximity of salivary lesions to the facial nerve.

 Ultrasonography: The parotid and submandibular glands are easily visualized by

ultrasonography due to its superficial locations but the deep portion of the parotid
gland is difficult to visualize because the mandibular ramus lies over the deep lobe.
Ultrasonography is best at differentiating between intra and extra glandular masses, as
well as between cystic and solid lesions.

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Salivary gland diseases
Mustansiriya University, College of Dentistry, Department of Oral Medicine.
Oral Medicine lecture
Dr.Ahmad Fliah Hassan

 Sialography: Is the recommended method for evaluating intrinsic and acquired

abnormalities of the ductal system because it provides the clearest visualization of the
branching ducts and acinar end pieces. Sialography can be performed on both the
submandibular and parotid glands. The two contraindications to sialography are active
infection and allergy to contrast media (iodine sensitivity) and the radiographic views
for sialography include panoramic, lateral oblique and anteroposterior views.
Sialolithiasis (salivary stones)
Sialoliths are calcified organic matter that forms within the secretory system of the major
salivary glands. Several factors that cause pooling of saliva within the duct are known to
contribute to stone formation: inflammation, irregularities in the duct system, local irritants,
and anticholinergic medications.
The Prevalence of sialoliths varies by location. It most common in the submandibular
glands (80-90%), followed by parotid glands (5-15%) and then sublingual (2-5%) glands.
The higher rate of sialolith formation in the submandibular gland is due to:-
1-The torturous course of Whartons duct. 2-Higher calcium and phosphate levels. 3-Position
Clinical features:
Most commonly present with a history of acute, painful and intermittent swelling
associated with food intake or saliva stimulation. The degree of symptoms is dependent on
the extent of salivary duct obstruction and the presence of secondary infection.

 Diagnosis:- Plain radiography , CT images and Sialography

 Treatment:- Analgesics, antibiotics, hydration, ductal dilatation and “milking” of
the gland, surgical removal of the stone or surgical removal of the whole gland

Mucocele
Is a clinical term that describes swelling caused by the accumulation of saliva at the site of
a traumatized or obstructed miner salivary gland duct. Mostly occur on the lower lip, buccal
mucosa, tongue, floor of the mouth, and palate. A large form of mucocele located in the floor
of the mouth is known as a ranula.

Classifications of mucoceles:-
1-Extravasation type
 Etiology: Trauma to a minor salivary gland excretory duct. Laceration of the duct
results in the pooling of saliva in the adjacent submucosal tissue and consequent
swelling. More common than the retention type.

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Salivary gland diseases
Mustansiriya University, College of Dentistry, Department of Oral Medicine.
Oral Medicine lecture
Dr.Ahmad Fliah Hassan

2-Retention type
 Etiology: Obstruction of a minor salivary gland duct by calculus or contraction of
scar tissue around an injured minor salivary gland duct. The blockage of salivary
flow causes the accumulation of saliva and dilation of the duct.

 Mucoceles present as discrete, painless, smooth-surfaced swellings that can range

from few mm to a few cm in diameter and blue in color(superficial)
 Treatment : Surgical excision, Aspiration and Intralesional injections of
corticosteroids

Sialadenitis
Is the term used to describe inflammation of SG. Most commonly the result of viral
(RNA paramyxovirus, CMV, EBV, HCV and HIV) or bacterial infection, but occasionally
due to other causes (ex. Allergic reactions, irradiation)

Viral sialadenitis (Mumps)

Is an acute viral infection caused by a RNA paramyxovirus and is transmitted by direct
contact with salivary droplets. Typically occurs in children between the ages of 4-6 years
incubation period is 14-21 days this is followed by salivary gland inflammation and
enlargement, fever, malaise, preauricular pain, headache & myalgia. Salivary gland ducts are
inflamed but without purulent discharge. Swelling is usually bilateral parotid involvement
and lasts approximately 7 days.
 Complications: Orchitis, oophoritis, encephalitis, myocarditis, meningitis, pancreatitis.
 Diagnosis: Detection of IgM.
 Treatment: Supportive and symptomatic treatment.( Vaccination is important for
prevention).

Bacterial sialadenitis
Bacterial infections of the salivary glands are most commonly seen in patients with
reduced salivary gland function. An acute and sudden onset of a swollen and painful salivary
gland is termed an acute bacterial sialadenitis, whereas repeated infections are termed
chronic bacterial sialadenitis due to continuing and nonresolved infections. Predisposed by
salivary stasis. Usually a mixed infection of aerobic and anaerobic bacteria are gram-negative
bacilli.

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Salivary gland diseases
Mustansiriya University, College of Dentistry, Department of Oral Medicine.
Oral Medicine lecture
Dr.Ahmad Fliah Hassan

Clinically: painful tender swelling of the SG. Purulent saliva can be expressed and
overlying skin is erythematous
 Diagnosis: culture and antibiotic sensitivity test, sialography, sialoendoscopy and CT are
useful in diagnosis of chronic salivary gland infections cysts and obstructions.
 Treatment: antibiotics, salivary stimulants, increased hydration

Sjogren’s syndrome
Is a chronic autoimmune disease of the exocrine glands that particularly involves the
salivary and lacrimal glands. And 90% of patients are females, and is classified as primary
Sjogren’s syndrome consists of dry eyes (xerophthalmia) and dry mouth and is not associated
with a connective tissue disease. And secondary Sjogren’s syndrome consists of dry eyes and
dry mouth and is associated with a connective tissue disease (eg. Systemic lupus
erythematosus, scleroderma, primary biliary cirrhosis and the most commonly rheumatoid
arthritis).
Clinical manifestations
 Oral complications that result from decreased salivary function; (Dry, cracked lips,
angular cheilitis, depapillated tongue, candidal infections ). Salivary gland
enlargement (intermittent or chronic). Increased risk of lymphoma(B-cell
lymphomas)
 Diagnosis: Sialometry-low salivary flow rate, Lacrimal flow rate (Schirmer test),
Labial gland biopsy, Sialography: sialactasia (snow storm appearance), Autoantibody
screen.
Sialosis (Sialadenosis)
Non-neoplastic, non-inflammatory, bilateral painless, recurrent swelling of salivary
glands. Associated factors: Systemic diseases (diabetes mellitus, acromegaly, liver cirrhosis,
anorexia nervosa) Drugs( drugs containing iodine, antirheumatic, adrenergic)

Sarcoidosis
Is a chronic granulomatous disorder that may rarely present as painless, persistent
enlargement of the major salivary gland. There is often an associated Reduction in salivary
flow

Xerostomia
Is a subjective feeling of oral dryness. A lack of saliva either due to loss of secretory
tissue or disturbance in the secretory innervation mechanism (drugs or neurological disease)

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Salivary gland diseases
Mustansiriya University, College of Dentistry, Department of Oral Medicine.
Oral Medicine lecture
Dr.Ahmad Fliah Hassan

Complications: difficulty in talking (dysphonia), reduced denture retention, Candidosis,

Caries, Periodontal disease, Salivary gland infection/swelling, burning sensation of the
tongue.
Causes:-
 Medications (antidepressants, antipsychotics, diuretics….)
 Systemic diseases
 Dehydration (renal failure, diarrhea, severe haemorrhage …)
 Psychogenic (anxiety/depression, burning mouth syndrome…)
 Radiotherapy
 Local cause (mouth-breathing)
Management of xerostomia:-
Intrinsic (increase gland activity); sugar-free gum, pilocarpine.
Extrinsic; saliva substitutes
Excessive saliva
An increased salivary flow rate is also known as Sialorrhoea or Ptyalism
Causes Note:-In patients with hypersalivation:
 Patients wearing dentures for the first time saliva is normally cleared from the
 Foreign body in the oral cavity mouth by swallowing. Drooling
 Oral infected or ulcerative lesions occurs due to a failure to swallow
 Oral carcinoma saliva (overproduction or not) and is
 neuromuscular dysfunction common in infants and with poor
neuromuscular coordination
 Psychiatric disturbances
Management; Elimination of (or habituation) the causative factor.

Salivary gland tumours

Salivary gland tumours compromise about 3 per cent of all tumours. The majority occur
in the parotid glands. Only 10 per cent of all salivary gland tumours affect the minor
salivary glands; the majority of these are pleomorphic adenomas occurring in the palate.

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