Salivary Gland Disease Dent 451 Lecture 6 Dr. Jumana

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Salivary Gland Disease

• Dent 451
• Lecture 6
• Dr. Jumana Karasneh

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Functions of Saliva

• Lubricant ? coat protect mucosa
• Cleanses the teeth
• Ion reservoir ? remineralization
• Buffer ? neutralizes PH
• Antimicrobial ? IgA Enzymes
• Pellicle formation
• Digestion ? amylase
• Facilitates taste ? by acting as solvent
• Water balance ? stimulate need for fluid intake

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Saliva

• Resting salivary flow
• Submandibular ? 65
• Parotid ? 15-20
• Sublingual minor ? 7-8
• Stimulated salivary flow
• Parotid (rich in amylase)? 45-50
• Diurnal variation in salivary flow
• 0.3 ml / min day time
• 0.1 ml / min sleep time
• Daily flow rate 500-600 ml /day

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Anatomy Physiology

• Parotid
• Serous
• Sublingual
• Mucous
• Submandibular
• Mixed
• Minor salivary glands
• Controlled mainly by parasympathetic

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Anatomy of parotid gland

• Largest salivary gland
• Front of ear behind
• mandibular ramus
• Apex is deepest part
• Facial nerve
• Stensons duct covered by parotid papilla
  opposite first molar

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Anatomy of submandibular gland

• ½ the size of Parotid
• Wedged between body of mandible mylohyoid
  muscle
• Whartons duct opens into sublingual papilla
  lateral to lingual frenum

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Anatomy of sublingual gland

• Smallest gland
• Below floor of the mouth beneath sublingual fold
• Numerous sublingual ducts open in the mouth

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Assessment of the salivary gland1- Examination -
Parotid

• Visual examination by standing behind the Pt
• Palpate the gland
• Stand in front of pt
• 2-3 fingers over the posterior border of
  ascending ramus
• Back word inward movement with light pressure
• Slightly rubbery
• Painless unless infected/inflamed
• Check motor function of facial nerve
• Intraoral examination to check papilla if
  inflamed
• Compress the gland to see saliva flow

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Assessment of the salivary gland1- Examination -
submandibular

• Palpate below angle body of mandible
• Bimanual palpation
• Intraoral examination to
• check papilla if inflamed
• Compress the gland to see saliva flow

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Assessment of the salivary gland 2- Sialometry

• To measure salivary flow rate (resting /
  stimulated)
• Carlson-Crittenden collector for individual gland
• Whole saliva flow rate determined under
  standardized conditions
• Changes in salivary flow rate in an individual is
  more informative than a single measure
• Unstimulated whole saliva flow rate 0.3 ml/min
• Stimulated whole saliva flow rate 1-2 ml / min

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Assessment of the salivary gland 3- Salivary
gland imaging

• Plain-film radiography
• Sialography
• Ultrasonography
• Scintigraphy (Radioisotope imaging)
• Computed tomography (CT)
• Magnetic resonance (MRI)

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Assessment of the salivary gland 3- Salivary
gland imaging Plain-film radiography

• Used for calculi (NOT ALL RADIO-OPAQUE)
• Two views at 90?
• Parotid
• OPG / Oblique - lateral
• Rotated anterior-posterior
• Submandibular
• Occlusal
• OPG
• Lateral oblique

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Assessment of the salivary gland 3- Salivary
gland imaging Sialography

• Radiographic visualization of the ducts by a
  retrograde injection of a water-soluble contrast
  dye.
• Provides image of stones and duct morphological
  structure
• May be therapeutic.
• Demonstrate 3 phases
• Preoperatively
• Filling phase
• Emptying phase

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Sialography continued

• Disadvantages
• Irradiation dose
• High skill is needed to conduct the procedure
• Pain with procedure
• Possible perforation
• Push stone further
• Contraindications
• Acute infection
• Calculus close to duct opening
• Allergy to contrast media

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Assessment of the salivary gland 3- Salivary
gland imaging Scintigraphy (radioisotope)

• Indications To assess salivary gland function
• Pass through 3 stages
• Flow phase 15-20 sec
• Concentration phase up to 10-15 min
• Symmetrical distribution in parotid,
  submandibular
• Washout phase
• Pt is given a lemon juice drop
• Prompt, uniform symmetric emptying

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Assessment of the salivary gland 3- Salivary
gland imaging Ultrasonography

• Shows superficial part of gland
• Indications
• Differentiate between extra intra glandular
  mass
• Differentiate between cystic solid lesion

Hypoechoic benign tumor
Echogenic sialolith
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Assessment of the salivary gland 3- Salivary
gland imaging Magnetic resonance imaging (MRI)

• Indications
• Suspected salivary gland tumour
• Proximity of the lesion to facial nerve
• Contraindications
• Paediatric cases
• Claustrophobic
• Mentally physically challenged

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Assessment of the salivary gland 3- Salivary
gland imaging Computed tomography (CT)

• Indications
• Sialolith
• Osseous erosions sclerosis
• To differentiate cysts from abscess
• CT Vs MRI

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Assessment of the salivary gland 4- Salivary
gland biopsy

• Labial minor salivary gland biopsy
• Sjögrens syndrome
• Amyloidosis
• FNA
• Major salivary gland mass
• Major salivary gland biopsy
• Extra-oral
• High morbidity

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Assessment of the salivary gland 5-
Sialochemistry
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Assessment of the salivary gland 6- Serologic
evaluation

• Sjögrens syndrome
• Antinuclear antibodies (80)
• Anti SS-A, anti SS-B (60)
• RF (Rheumatoid factor)
• ESR