7. 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
8. 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
9. 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
12. 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
13. 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
14. Saliva samples-
Stimulated – saliva:less than 1ml/min –
abnormally low
Unstimulated –saliva:less than 0.1ml/ min
abnormally low
15. salivry glnd imaging
Plain film radiography
Sialography
Ultrasonagraphy
Radionuclide imaging/scintigraphy
C T
M R I
19. 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
20. 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
26. Ac Bacterial S’itis
Clinical features:
Age:adults mean-70yrs
Parotid 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
27. Acute Bacterial
sailadenitis
Acute infection of salivary gland bacteria
Bacterial strains:staphylococcus Aureus and
streptococcus viradans
Predisposing Factors:
1. Dehydration that reduces salivary flow
28. 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 balance
Oral hygine
Surgical drianage
29. 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
34. 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.
35.
36.
37.
38. 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
39. 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
40. 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
41. Ranula
Superficial Ranula-
superficial to
mylohyoid muscle
Deep ranula:deep to
mylohyoid muscle
[plunging R.]
Treatment
Deep R./Recurrent R.
Surgical excision
Other modalities
Large lesions:
Marsupalization
Intralesional steriods
42.
43. 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 phosphate
Traces of Mg,, Cl, K,Carbon&ammonium
44. sialoliths
Etiology /p. factors [Debatable]
1. Inflammation
2. Drugs [anticholenergic
medications,antihistamines]
3. Defects in calcium and phospharous
metabolism
45. 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
46. 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
55. 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.
56. 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
57. 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
58. SIALOGRAPHY
CONTRAST AGENTS:
WATER SOLUBLE
LIPID SOLUBLE
Water soluble:
Advantages:
a]Good flow rate
b] Less painful
DIS advantages;absorbed by
duct :poor contrast
Lipid soluble;ADV.good
contrast. Not absorbed by
duct
DISadvantages:painful
infusions:poor flow rate
59. SIALOGRAPHY
procedure
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
mionitoring
5.Images are taken
3.phases
Ductal phase
Glandular phase
Secreatary phse
68. 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
73. 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