Short notes on Salivary Gland Disease

1.can be classified into:-
i)acquired -tumour - benign or malignant
-infection
-inflammation
-calculi
-drugs
-systemic disease
ii)congenital
2.benign tumour of salivary gland
i)pleomorphic adenoma
-most common benign tumour
-forms 90% of benign parotid tumours
-equal sex incidence
-peak age incidence in the 5th decade
-histologically contains epithelial and mesodermal element, mixed cell tumour
ii)warthin's tumour (papillary cystadenoma lymphomatosum)
-found only in the parotid
-common in male
-peak occur in 7th decade
-clinically soft, cystic and often fluctuate
iii)oncocytoma
-a.k.a oxyphil-cell adenoma
-arises from oncocytes derived from intralobular ducts or acini
-seen most in minor salivary gland
-common in elderly males
3.malignant tumour of salivary gland
i)adenoid cystic carcinoma
-commonest malignant tumour
-common in minor salivary gland
-6th decade and equal sex incidence
-may presents with painful mass with or without facial palsy
-low lymph nodes metastases
-60-80% of 5-year survival rate
ii)adenocarcinoma
-forms 3% of parotid tumour
-forms 10% of submandibular and minor salivary gland tumour
-equal sex incidence
-common in children
-3 basic histological patterns-tubular,papillary and undifferentiated(most agressive)
iii)squamous cell carcinoma
-rare in salivary gland
-common in males, in 7th decade
-rapid growth,pain,facial paralysis,skin fixation and ulceration
-high lymph nodes metastases
iv)malignant pleomorphic adenoma
-carcinoma ex-pleomorphic adenoma
-commonest in parotid
4.variable tumours
-mucoepidermoid-malignant
-acinic cell tumour
-rare tumours-hemangioma
-lymphangioma
-sarcoma
-lipoma
-metastatic carcinoma -especially from scalp or facial skin melanoma
5.inflammation or autoimmune
-sjogren's syndrome -primary sjogren syndrome -sicca syndrome
-xerostomia and xerophtalmia
-high risk turn to malignant
-secondary sjogren syndrom-xerostomia
-xeropthalmia
-connective tissue dis-rheumatoid artritis
-kimura disease
6.infection
-mumps
-echo or coxsackie virus
-parotitis -immunocompromised, dehydration
-tuberculosis
7.calculi
-sialectasis - progressive destruction of the alveoli and parenchyma of gland followed duct stenosis and cyst formation
-sialodenitis -inflammation of duct of gland
-sialolithiasis - calculi in duct of gland
8.drug-induced
-thiouracil
-phenylbutazone
-isoprenaline
-dextropropoxyphene
-paracetamol
-high oestrogen contraceptive pills
9.systemic disease
-myxoedema.diabetes mellitus,cushing's disease,bulimia,gout,alcoholism,hepatic cirrhosis
10.investigation
-plain xray -submandibular stones are nearly always radiopaque
-parotid stones are almost always radiotranslucent
-ct scan -to look extension (ie; deep or superficial lobe of parotid)
-sialography -not much used
-FNAC-fine needle aspiration cytology
11.differential diagnosis
-hypertrophic masseter
-winged mandible(first arch syndrome)
-dental cyst
-branchial cyst
-myxoma of masseter
-neuroma of the facial nerve
-facial vein thrombosis
-temporal artery aneurysm
-lipoma
-lymphangioma
-mandibulat tumour
-mastoiditis
-lymphadenitis of the preauricular nose
-sebaceous cyst
12.treatment -according to the disease
-superficial or total parotidectomy
-excision of submandibular gland
-sialogram-removal of stone
-incision and drainage
-intravenous antibiotic