Saliva

DR BASAVARAJ T BHAGAWATI, SBBDC GZBD

Salivary gland D’S

CLASSIFICATION:DEVELOPMENTALINFLAMMATARYCYSTICAUTOIMMUNENEOPLASTIC

CLASSIFICATION

Developmental 1.Hypoplasia/

aplasia Aberrent s.

gland[ectopic] Accessary s. gland Diverticuli

Inflammatary diseases

Viral:mumps, CMV HIV

Bacterial:Acute B. SialadenitisChronic B.

Sialadenitis

S.G. DISEASES

CYSTIC MUCOCELE RANULA AUTOIMMUNE MUKULICZ D’S SJOGREN’S

SYNDROME

NEOPLASTIC

BENIGN TUMOURS

MALIGNANT TUMOURS

Omdr-2011

SG-3

Symptom –xerostomia Pt c/o dryness of oral mucosal surfaces/

reduced oral fluids Difficulty in chewing,swallowing and

speaking Burning mouth/ mucosa-aggrevates

on eating spicy and coarse food Pain in the mucosal surfaces

Sg-3

Medical history:present/past h/o Radiotherapy to head & neck

tumours Medications-tricyclic

atidepressents,sedative,antihistamines

dryness in the eyes,throat and vagina

clinical examination

Cracked lips,corrugated -buccal mucosa Lipstick sign:presence of shed epithelial

cells on labial sufaces of max. Anteriors teeth

Tongue blade sign:hold the tongue blade against the buccal mucosa and mucosa is adhered to tongue blade as the blade is lifted away

Enlargement of salivary glands

Saliva collection

Stimulated saliva sample

Unstimulated saliva samples

methods

Draining methods spitting method Suction method absorbent

methods

Suction method Saliva is collected by using suction tip

or saliva ejectors for defined time period Absorbent method:uses pre weighed

gauge sponge for a set of time period

Saliva secreation can be stimulated by applying 2% citric acid on the tip of the tongue

Methods-indidual/specific sg Parotid gland saliva collected by

placing carlosons-crittenden collectors over the ductal orifices

submandibular and sublingual gland saliva collected by alginate held collector called segregator

Saliva samples-

Stimulated – saliva:less than 1ml/min –abnormally low

Unstimulated –saliva:less than 0.1ml/ min abnormally low

salivry glnd imaging

Plain film radiography Sialography Ultrasonagraphy Radionuclide imaging/scintigraphy C T M R I

SALIVARY FLOW OVER A 24 HOUR PERIOD

MUMPS

Viral infection of salivary gland caused by paramyxo virus

Infects SG s, Gonads, CNS PAROTID commonly affected

MUMPS [c/f]

Age:2nd deacde peak incidece

CL. Presentation; Prodromal

symptoms like fever,malaise anorexia and tenderness at the angle of the jaw.

Parotid swelling may be the first indication in many cases

swollen parotid may extend from ear to lower part of the mandibular ramus displacing ear upwards&outwards

MUMPS[C/F]

Bilateral parotitis is common but one gland swells 1-2 days after the other

Edema of the skin over the gland and red,inflamed ductal orifice

DIAGNOSIS:History/Cl. Exmn. Negative h/o mumps in the past&vaccine

Investigation: 1.Antibody titres:4fold increased.2. Serum amylase levels increased

Mumps

Treatment:supportive

analgesics&antipyretic

Preventive vaccine:

MMRSystemicsteriods:Orchitis

COMPLICATIONS MENINGITIS ENCEPHALITIS ORCHITIS PANCRETITS MYOCARDITIS

Ac Bacterial S’itis

Clinical features:Age:adults mean-70yrsParotid gland

commonly affected,unilateral

Syptoms:sudden on set of pain at the angle of the jaw& which increases on eating

Other sympoms ;Fever

Clinical exmn reveals a tender enlarged gland & overlaying skin warm &red

Diagnosis is confirmed by collection of purulent material from the ductal orifice

Acute Bacterial sailadenitis Acute infection of salivary gland

bacteria Bacterial strains:staphylococcus

Aureus and streptococcus viradans Predisposing Factors:1. Dehydration that reduces salivary

flow

Acute Bacterial sailadenitis Investigations

Culture of purulent material collected from duct.[gram stain]

Blood: leukocytosis

Treatment:antibiotics

[Parentaral] amoxycillin+cloxacillin[250mg+250mg]Metronidazole[400mg]Fluid balanceOral hygineSurgical drianage

Chronic sialadenitis

Chronic infection of SG’s

Bacterial strains step.viridans E coli,proteus C/f :children

&young adults affected.

Parotids commonly affected

Syptoms:pain at the angle

Purulent discharge from ductal orfice

Antibiotics resolve the infection but recurrence is noted

Recurrences lead to fibrosis of gland

Treatment

ANTIBIOTICS [after culture /gram’stian]

Fluid balance Other modalities:INTRADUCTAL

ANTIBIOTICS –Erythromycin/ tetracyclines

Mucocele

Mucocele is a swelling caused by pooling of saliva at the site of injured or obstructed minor salivary gland duct

Mucocele are classified as 1.Mucous retention M. 2.Extravasation M.

Mucocele

Mucous retntion M.is caused by obstruction of minor salivary gland duct

Extravasation mucocele occurs because of laceration of of minor salivary gland duct

Mucocele[C/F]

Clinical appearance depends on location of the lesion.

R.M. is common on the palate/floor mouth

EV.M. is seen on lips where trauma is common

Super ficial lesions are vesicles containig mucin

Bluish in colour and on rupturing they release mucin

Size vary from 3-4mm to 1cm in diameter

Deep lesions well defined and covered by normal mucosa

Ranula

Ranula is Mucocele which occurs on the floor mouth because of trauma to the sublingual gland duct.

Slow growing lesion causing difficulty in mastication.

Types :

Super ficial

Deep

Ranula

Superficial Ranula-superficial to mylohyoid muscle

Deep ranula:deep to mylohyoid muscle [plunging R.]

Treatment Deep R./Recurrent R.

Surgical excisionOther modalities

Large lesions:Marsupalization

Intralesional steriods

Sialoliths [s.calculi] Sialolith are calcified and organic matter

that form within the secreatory system of the

of major salivary gland

Composition Hydroxyappetite crystal

Octocalcium phosphateTraces of Mg,, Cl, K,Carbon&ammonium

sialoliths

Etiology /p. factors [Debatable]1. Inflammation2. Drugs [anticholenergic

medications,antihistamines]3. Defects in calcium and phospharous

metabolism

SIALOLITH Sialoliths are common in the

submandibular gland duct, because……..

Anatomical course of wharton’s duct has sharp curves which may trap mucin/calculus

High mucin level of the gland may trap foreign bodies &debris

Calcium content is higher in the saliva of sub.mand. Gland

Flow rate of the saliva is slower than parotid Dependent position of the gland increases

chances of stasis of saliva

SIALOLITH

Clinical features: Intermittent swelling in the region of major salivary gland that enlarges during eating and resolves later

Pain because of the back up saliva behind the stone

Stasis of saliva may lead to infection /fibrosis /atropy of the gland

Sinus /fistula and ulceration in chronic cases

They may be palpable if they are at periphery of the duct

They are circumscribed &firm to hard masses

SIALOLITH[Investigations]

OCCLUSAL RADIOGRAPH:

SUB.MAND. GLAND /SUBLINGUAL

PA View/OPG: PAROTIDS

Modern imaging

SIALOGRAPHY,CT SCAN,ULTRASOUND

SIALOGRAPHY

It is a radiographic technique where in a radiographic contrast agent is infused into the ductal system of major salivary gland and imaged with plain films,fluroscopy or CT Scan.

SIALOGRAPHY

INDICATIONS: Sialoliths Chronic infection Tumours of SG gland Autoimmune d’s;

sjogren’s syndrome For extrinsic/intrinsic

masses in gland

CONTRA INDICATIONS:

Acute infections Allergy to

contrast agents

SIALOGRAPHY

INDICATIONS: Sialoliths Chronic infection Tumours of SG gland Autoimmune d’s;

sjogren’s syndrome For extrinsic/intrinsic

masses in gland

CONTRA INDICATIONS:

Acute infections Allergy to

contrast agents

SIALOGRAPHY

CONTRAST AGENTS:

WATER SOLUBLE LIPID SOLUBLE

Water soluble:Advantages:a]Good flow rate b] Less painfulDIS

advantages;absorbed by duct :poor contrast

Lipid soluble;ADV.good contrast. Not absorbed by duct

DISadvantages:painful infusions:poor flow rate

SIALOGRAPHYprocedure 1.Ductal orifice

located and dilated by lacrimal probe

2.Cannula is passed into ductal orifice

3.Syringe is inserted into the cannula andd slowly solution is infused

PAROTID:0.75-1.5ml

SUB.MAND:0.5-1ml 4.Infusions done

with fluroscopic mionitoring5.Images are taken3.phases

Ductal phaseGlandular phaseSecreatary phse

THANK U

Ptyalism

Hypersalivation (also called ptyalism[1] and sialorrhea[2]) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.[3

Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).[4]

Contents  [show

Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling

Conditions-ptyalism

Rabies Gastroesophageal r

eflux disease,

Pregnancy Pancreatitis Liver disease Serotonin syndrom

e Mouth ulcers Oral Infections

Medications that can cause overproduction of saliva include:[3]

clozapine pilocarpine Ketamine TOXINS:

mercury copper

DECREASED –CLEARANCE-SALIVA Infections : tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps.jaw fracture/TMJ dislocationRadiation Therapy

Neurological disorders:

myasthenia gravis, Parkinson's disease, Multiple System Atrophy, , bilateral facial nerve palsy and hypoglossal nerve palsy.

Management

. Removal of cause Antihistamine or atropine sulphate

Self-contained saliva test kit for use at the point of care that will target markers for periodontal diseases, caries, infectious diseases, pancreatic cancer, diabetes, salivary gland diseases, renal diseases, steroids and inflammatory markers for cardiovascular and pulmonary diseasesDetermining hormone