Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland
Diagnosis and management of salivary gland disorders
Al Azhar University Gaza Palestine
Dr. Lama El Banna
The document discusses tumors and neoplasms of the oral cavity. It defines a tumor as a swelling of tissue, while neoplasia is an abnormal mass of tissue that exceeds normal growth. For simplicity, tumors and neoplasms are used interchangeably. Tumors of the oral cavity are classified based on their tissue of origin into epithelial, connective, muscle, nerve or metastatic tumors. Benign epithelial tumors include squamous papilloma and keratoacanthoma. Squamous papilloma presents as a painless, cauliflower-like growth caused by HPV infection, while keratoacanthoma is a potentially malignant growth associated with sun exposure. Both lesions can be surgically excised with low recurrence rates
- Oroantral fistula is an abnormal communication between the maxillary sinus and oral cavity, usually resulting from tooth extraction or trauma.
- Symptoms include sinusitis, nasal discharge, pain, and escape of air/fluid through the nose or mouth. Diagnosis involves clinical exam, nasal blowing test, and radiographs.
- Treatment depends on whether the fistula is fresh or established. Immediate closure of small fistulas is attempted using sutures to hold a blood clot. Larger fistulas require local flaps like buccal or palatal flaps to close the defect without tension. Delayed fistulas may need grafting if bone is missing.
Genioplasty is a surgical procedure to alter the shape and projection of the chin bone. It can be done to augment a recessed chin or reduce a prominent chin, improving facial aesthetics and proportions. The surgery involves making precise bone cuts below the mental nerves and sliding the bony segment to reposition the chin. Careful preoperative evaluation and planning is required to determine the optimal surgical approach and amount of correction needed. Potential risks include injury to the mental nerves or poor healing of the bone cuts.
Vestibuloplasty is a surgical procedure to deepen the oral vestibule by changing the attachments of the soft tissue. There are several types of vestibuloplasty procedures, including mucosal advancement, secondary epithelization, and grafting. Mucosal advancement involves undermining and advancing the oral mucosa, while secondary epithelization uses the oral mucosa to line one side and allows the other side to heal through epithelization. Grafting can use skin, mucosa, or dermis grafts to line the extended vestibule. The document discusses techniques for each type of vestibuloplasty procedure.
1) The nasopalatine duct cyst originates from epithelial remnants of the nasopalatine duct and most commonly presents as a well-defined radiolucency in the midline of the anterior maxilla near the incisive foramen.
2) A 35-year-old male presented with a painless swelling over the palate that was diagnosed as a nasopalatine duct cyst based on radiographic and histological features.
3) The cyst was treated by surgical enucleation and recurrence is uncommon.
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
This document provides an overview of the anatomy and surgical procedures related to the maxillary sinus. It begins with the development, anatomy, functions, relations, and applied anatomy of the maxillary sinus. It then discusses diseases that can involve the sinus, including sinusitis, infections, tumors, and oroantral fistulas. Finally, it reviews surgical procedures such as Caldwell-Luc operation, functional endoscopic sinus surgery, sinus lifts, and treatments for maxillary sinus fractures and displaced teeth. In summary, the document is a comprehensive review of the maxillary sinus from an anatomical and surgical perspective.
The document discusses tumors and neoplasms of the oral cavity. It defines a tumor as a swelling of tissue, while neoplasia is an abnormal mass of tissue that exceeds normal growth. For simplicity, tumors and neoplasms are used interchangeably. Tumors of the oral cavity are classified based on their tissue of origin into epithelial, connective, muscle, nerve or metastatic tumors. Benign epithelial tumors include squamous papilloma and keratoacanthoma. Squamous papilloma presents as a painless, cauliflower-like growth caused by HPV infection, while keratoacanthoma is a potentially malignant growth associated with sun exposure. Both lesions can be surgically excised with low recurrence rates
- Oroantral fistula is an abnormal communication between the maxillary sinus and oral cavity, usually resulting from tooth extraction or trauma.
- Symptoms include sinusitis, nasal discharge, pain, and escape of air/fluid through the nose or mouth. Diagnosis involves clinical exam, nasal blowing test, and radiographs.
- Treatment depends on whether the fistula is fresh or established. Immediate closure of small fistulas is attempted using sutures to hold a blood clot. Larger fistulas require local flaps like buccal or palatal flaps to close the defect without tension. Delayed fistulas may need grafting if bone is missing.
Genioplasty is a surgical procedure to alter the shape and projection of the chin bone. It can be done to augment a recessed chin or reduce a prominent chin, improving facial aesthetics and proportions. The surgery involves making precise bone cuts below the mental nerves and sliding the bony segment to reposition the chin. Careful preoperative evaluation and planning is required to determine the optimal surgical approach and amount of correction needed. Potential risks include injury to the mental nerves or poor healing of the bone cuts.
Vestibuloplasty is a surgical procedure to deepen the oral vestibule by changing the attachments of the soft tissue. There are several types of vestibuloplasty procedures, including mucosal advancement, secondary epithelization, and grafting. Mucosal advancement involves undermining and advancing the oral mucosa, while secondary epithelization uses the oral mucosa to line one side and allows the other side to heal through epithelization. Grafting can use skin, mucosa, or dermis grafts to line the extended vestibule. The document discusses techniques for each type of vestibuloplasty procedure.
1) The nasopalatine duct cyst originates from epithelial remnants of the nasopalatine duct and most commonly presents as a well-defined radiolucency in the midline of the anterior maxilla near the incisive foramen.
2) A 35-year-old male presented with a painless swelling over the palate that was diagnosed as a nasopalatine duct cyst based on radiographic and histological features.
3) The cyst was treated by surgical enucleation and recurrence is uncommon.
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
This document provides an overview of the anatomy and surgical procedures related to the maxillary sinus. It begins with the development, anatomy, functions, relations, and applied anatomy of the maxillary sinus. It then discusses diseases that can involve the sinus, including sinusitis, infections, tumors, and oroantral fistulas. Finally, it reviews surgical procedures such as Caldwell-Luc operation, functional endoscopic sinus surgery, sinus lifts, and treatments for maxillary sinus fractures and displaced teeth. In summary, the document is a comprehensive review of the maxillary sinus from an anatomical and surgical perspective.
This document discusses various non-odontogenic tumors classified according to their origin. It covers giant cell lesions including central giant cell granuloma and brown tumor of hyperparathyroidism. Vascular lesions such as hemangiomas, vascular malformations, and neurogenic tumors including neurofibromas are also discussed. For each type of lesion, the document provides information on classification, clinical features, radiographic findings, diagnosis, and treatment options.
This document provides information about genioplasty surgery. It begins with an introduction and overview of genioplasty. It then discusses the history, indications, contraindications, preoperative evaluation including cephalometric and soft tissue analysis, surgical anatomy, classification of chin deformities, and surgical procedure. The surgical procedure section provides a step-by-step explanation of genioplasty surgery from incision and osteotomy to fixation and closure. Key steps include marking reference points, performing the osteotomy, mobilizing and repositioning the chin segment, and securing it with either screws or bone plates. Attention to details like reference marks, osteotomy angle and position, and bone contouring help achieve the planned aesthetic results of
Maxillary sinus diseases are presented by Dr. Vishal Modha. The maxillary sinus is the largest paranasal sinus located within the maxilla bone. It develops embryologically from the lateral nasal wall and grows postnatally. The maxillary sinus anatomy includes thin bony walls that are vulnerable to trauma and contain important structures. Mucociliary drainage flows from the maxillary sinus ostium to the nasal cavity. Common maxillary sinus diseases include acute or chronic sinusitis, which can result from dental infections, trauma, or nasal obstruction and cause symptoms like facial pain and nasal congestion. Radiographs and CT scans may reveal mucosal thickening or opacification in sinusitis. Treatment involves antibiotics,
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document describes the submandibular and retromandibular surgical approaches. The submandibular approach involves making a 1.5-2 cm incision inferior to the mandible and dissecting through the layers of the skin, subcutaneous tissue, platysma muscle, and pterygomasseteric sling. The retromandibular approach uses a vertical incision 2 cm posterior to the mandibular ramus and dissects through the same layers to the pterygomasseteric sling. Both approaches give access below the mandible for surgical procedures.
Pyogenic granuloma is a non-neoplastic, inflammatory hyperplasia that presents as a tumor-like, nodular growth in the oral cavity, most commonly on the gingiva. It appears as a red-to-purple, smooth or lobulated mass that can range in size from a few millimeters to several centimeters. While the lesions often bleed easily and are extremely vascular early on, they become more collagenous and pink as they mature. Potential causes include chronic oral irritation from factors like overhanging restorations or hormonal changes. Radiographs appear normal unless calcifications are present, in which case it may be a peripheral ossifying fibroma. Histologically, it shows a lobulated
This document discusses four techniques for performing a frenectomy: 1) Simple excision technique which involves making an elliptical incision and placing sutures at the maximal depth of the vestibule. 2) Z-plasty technique which involves making a small elliptical excision and rotating flaps into desired position. 3) Localized vestibuloplasty with secondary epithelialization which involves making a wide V-type incision and suturing mucosal margins to periosteum. 4) Laser-assisted frenectomy which uses supraperiosteal ablation and allows healing through secondary epithelialization. It also discusses lingual frenectomy techniques such as bilateral lingual blocks, hemostat placement, and
The document discusses various bone diseases that can affect the jaw bone, including inflammatory, hereditary, metabolic, and neoplastic diseases. It provides details on osteomyelitis, describing acute and chronic suppurative osteomyelitis as well as specific types like alveolar ostitis. It also discusses chronic osteomyelitis with proliferative periostitis, chronic sclerosing osteomyelitis, osteoradionecrosis, and fibro-osseous diseases like fibrous dysplasia. Histopathological features of many of these conditions are also summarized.
Peripheral giant cell granuloma (giant cell epulisKhin Soe
The document discusses two types of giant cell lesions of the jaw: peripheral giant cell granuloma (PGG) and central giant cell granuloma (CGG). PGG is a reactive lesion caused by local irritation or trauma that occurs on the gingiva. CGG is a benign process that occurs within the jaw bones and can be non-aggressive or aggressive depending on symptoms and growth rate. Both lesions contain multinucleated giant cells and are treated with surgical excision, with CGG having a slightly higher recurrence rate. Key distinguishing features and histological characteristics are provided.
The document describes the major salivary glands - the parotid, submandibular, and sublingual glands. It discusses their locations, secretions, duct systems, and common diseases. The parotid gland is the largest salivary gland and has a serous secretion. The submandibular gland has a mixed secretion and drains via Wharton's duct. The sublingual glands have a mucous secretion that can drain via the submandibular duct. Common diseases include salivary stones, infections, trauma, Sjogren's syndrome, and tumors. Diagnostic tools include sialography, scintigraphy, and biopsy.
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Diseases of salivary glands is a very important topic in the final MBBS/ MS ENT exam.
Dr. Krishna Koirala has described the salivary gland diseases in a lucid way in this presentation.
Leukoplakia and erythroplakia are two clinical lesions widely considered to be premalignant.
The term leucoplakia describes a white plaque that does not rub off and cannot be clinically identified as another entity. Most cases of leukoplakia are a hyperkeratotic response to an irritant and are asymptomatic, but about 20% of leukoplakic lesions show evidence of dysplasia or carcinoma at first clinical recognition.
An erythroplakia is a red lesion that cannot be classified as another entity. Far less common than leukoplakia, erythroplakia has a much greater probability (91%) of showing signs of dysplasia or malignancy at the time of diagnosis.
Dr Sachdeva’s Dental, Aesthetic And Implant Institute is one of the leading clinics in Delhi. So hurry up and book an appointment with us Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
The document discusses oral potentially malignant disorders (OPMD). It defines OPMD as a group of disorders that may lead to oral cancer. OPMD were previously referred to as precancerous lesions and conditions but this term was abandoned in 2005. The document categorizes OPMD into 4 groups based on etiology and pathogenesis. It provides detailed information about leukoplakia, including definition, risk factors, clinical features, histopathological grading, differential diagnosis and treatment options. Leukoplakia is considered the most common OPMD and accurate diagnosis requires biopsy and histopathological examination.
This document discusses temporomandibular joint (TMJ) arthroscopy. It begins by defining arthroscopy as examining the inside of a joint with an arthroscope. TMJ arthroscopy allows direct visualization of the TMJ structures and performing surgeries. The document outlines the techniques, indications, contraindications and complications of diagnostic and therapeutic TMJ arthroscopy. Common pathologies that can be evaluated arthroscopically include adhesions, perforations and folds in the TMJ. The summary emphasizes that TMJ arthroscopy is a less invasive alternative to open surgery that can treat pain and restricted joint mobility through lysis, lavage and release of adhesions.
This document summarizes different types of salivary gland disorders including developmental, functional, obstructive, cysts, infections, and autoimmune disorders. Developmental disorders include abnormalities like aplasia, hyperplasia, and atresia. Functional disorders involve increased or decreased salivary secretion known as sialorrhea and xerostomia. Obstructive disorders are due to blockages like sialolithiasis. Cysts include mucoceles and ranulas. Infections can be viral, bacterial, or mycotic. Autoimmune disorders include Sjogren's syndrome and Mikulicz's disease. The document also discusses diagnostic tools like sialography used to evaluate salivary gland
This document presents a case study of a 30-year-old female patient diagnosed with plexiform ameloblastoma based on a biopsy of her right mandible. It provides background on ameloblastoma, describing it as a benign odontogenic tumor arising from odontogenic epithelium. It discusses the various histological subtypes including follicular, plexiform, unicystic (three groups), peripheral, acanthomatous, granular, basal cell, and desmoplastic. Treatment typically involves radical excision, with curettage having the highest recurrence rates. The case study aims to educate on the clinical, radiographic, and histological features of ameloblastoma.
This document discusses salivary gland anatomy, function, and disorders. It begins by outlining the objectives of understanding salivary gland anatomy, diagnosing disorders, and familiarizing with treatments. It then describes the major salivary glands - parotid, submandibular, and sublingual glands - and their secretions. Minor salivary glands are also introduced. Diagnostic modalities like imaging, biopsies, and various treatment options for obstructive disorders like sialolithiasis and mucoceles are covered in detail.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
This document discusses various types of odontogenic cysts. It begins with introducing cysts in general and then classifies odontogenic cysts based on etiology and tissue of origin. Several specific types of odontogenic cysts are then described in more detail, including their clinical features, radiographic features, and differential diagnosis. These include dentigerous cysts, eruption cysts, odontogenic keratocysts, gingival cysts of newborn and adult, lateral periodontal cysts, calcifying odontogenic cysts, periapical cysts, residual cysts, and paradental cysts.
This document discusses the anatomy and embryology of the major and minor salivary glands. It describes the three pairs of major salivary glands - the parotid, submandibular, and sublingual glands. It details their development during embryogenesis, classification based on size and secretory cell type, structure, blood supply, innervation and relations to surrounding tissues. The document also briefly discusses the numerous minor salivary glands found in the oral cavity.
Saliva is produced by the major and minor salivary glands and consists of both serous and mucous secretions. The three pairs of major salivary glands - the parotid, submandibular, and sublingual glands - provide over 90% of the total saliva produced. The parotid glands are the largest and purely serous, while the submandibular glands are predominantly mucous and mixed. The sublingual glands are the smallest but also predominantly mucous and mixed. Whole saliva contains secretions from the major and minor salivary glands as well as other components from the oral cavity.
This document discusses various non-odontogenic tumors classified according to their origin. It covers giant cell lesions including central giant cell granuloma and brown tumor of hyperparathyroidism. Vascular lesions such as hemangiomas, vascular malformations, and neurogenic tumors including neurofibromas are also discussed. For each type of lesion, the document provides information on classification, clinical features, radiographic findings, diagnosis, and treatment options.
This document provides information about genioplasty surgery. It begins with an introduction and overview of genioplasty. It then discusses the history, indications, contraindications, preoperative evaluation including cephalometric and soft tissue analysis, surgical anatomy, classification of chin deformities, and surgical procedure. The surgical procedure section provides a step-by-step explanation of genioplasty surgery from incision and osteotomy to fixation and closure. Key steps include marking reference points, performing the osteotomy, mobilizing and repositioning the chin segment, and securing it with either screws or bone plates. Attention to details like reference marks, osteotomy angle and position, and bone contouring help achieve the planned aesthetic results of
Maxillary sinus diseases are presented by Dr. Vishal Modha. The maxillary sinus is the largest paranasal sinus located within the maxilla bone. It develops embryologically from the lateral nasal wall and grows postnatally. The maxillary sinus anatomy includes thin bony walls that are vulnerable to trauma and contain important structures. Mucociliary drainage flows from the maxillary sinus ostium to the nasal cavity. Common maxillary sinus diseases include acute or chronic sinusitis, which can result from dental infections, trauma, or nasal obstruction and cause symptoms like facial pain and nasal congestion. Radiographs and CT scans may reveal mucosal thickening or opacification in sinusitis. Treatment involves antibiotics,
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document describes the submandibular and retromandibular surgical approaches. The submandibular approach involves making a 1.5-2 cm incision inferior to the mandible and dissecting through the layers of the skin, subcutaneous tissue, platysma muscle, and pterygomasseteric sling. The retromandibular approach uses a vertical incision 2 cm posterior to the mandibular ramus and dissects through the same layers to the pterygomasseteric sling. Both approaches give access below the mandible for surgical procedures.
Pyogenic granuloma is a non-neoplastic, inflammatory hyperplasia that presents as a tumor-like, nodular growth in the oral cavity, most commonly on the gingiva. It appears as a red-to-purple, smooth or lobulated mass that can range in size from a few millimeters to several centimeters. While the lesions often bleed easily and are extremely vascular early on, they become more collagenous and pink as they mature. Potential causes include chronic oral irritation from factors like overhanging restorations or hormonal changes. Radiographs appear normal unless calcifications are present, in which case it may be a peripheral ossifying fibroma. Histologically, it shows a lobulated
This document discusses four techniques for performing a frenectomy: 1) Simple excision technique which involves making an elliptical incision and placing sutures at the maximal depth of the vestibule. 2) Z-plasty technique which involves making a small elliptical excision and rotating flaps into desired position. 3) Localized vestibuloplasty with secondary epithelialization which involves making a wide V-type incision and suturing mucosal margins to periosteum. 4) Laser-assisted frenectomy which uses supraperiosteal ablation and allows healing through secondary epithelialization. It also discusses lingual frenectomy techniques such as bilateral lingual blocks, hemostat placement, and
The document discusses various bone diseases that can affect the jaw bone, including inflammatory, hereditary, metabolic, and neoplastic diseases. It provides details on osteomyelitis, describing acute and chronic suppurative osteomyelitis as well as specific types like alveolar ostitis. It also discusses chronic osteomyelitis with proliferative periostitis, chronic sclerosing osteomyelitis, osteoradionecrosis, and fibro-osseous diseases like fibrous dysplasia. Histopathological features of many of these conditions are also summarized.
Peripheral giant cell granuloma (giant cell epulisKhin Soe
The document discusses two types of giant cell lesions of the jaw: peripheral giant cell granuloma (PGG) and central giant cell granuloma (CGG). PGG is a reactive lesion caused by local irritation or trauma that occurs on the gingiva. CGG is a benign process that occurs within the jaw bones and can be non-aggressive or aggressive depending on symptoms and growth rate. Both lesions contain multinucleated giant cells and are treated with surgical excision, with CGG having a slightly higher recurrence rate. Key distinguishing features and histological characteristics are provided.
The document describes the major salivary glands - the parotid, submandibular, and sublingual glands. It discusses their locations, secretions, duct systems, and common diseases. The parotid gland is the largest salivary gland and has a serous secretion. The submandibular gland has a mixed secretion and drains via Wharton's duct. The sublingual glands have a mucous secretion that can drain via the submandibular duct. Common diseases include salivary stones, infections, trauma, Sjogren's syndrome, and tumors. Diagnostic tools include sialography, scintigraphy, and biopsy.
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Diseases of salivary glands is a very important topic in the final MBBS/ MS ENT exam.
Dr. Krishna Koirala has described the salivary gland diseases in a lucid way in this presentation.
Leukoplakia and erythroplakia are two clinical lesions widely considered to be premalignant.
The term leucoplakia describes a white plaque that does not rub off and cannot be clinically identified as another entity. Most cases of leukoplakia are a hyperkeratotic response to an irritant and are asymptomatic, but about 20% of leukoplakic lesions show evidence of dysplasia or carcinoma at first clinical recognition.
An erythroplakia is a red lesion that cannot be classified as another entity. Far less common than leukoplakia, erythroplakia has a much greater probability (91%) of showing signs of dysplasia or malignancy at the time of diagnosis.
Dr Sachdeva’s Dental, Aesthetic And Implant Institute is one of the leading clinics in Delhi. So hurry up and book an appointment with us Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
The document discusses oral potentially malignant disorders (OPMD). It defines OPMD as a group of disorders that may lead to oral cancer. OPMD were previously referred to as precancerous lesions and conditions but this term was abandoned in 2005. The document categorizes OPMD into 4 groups based on etiology and pathogenesis. It provides detailed information about leukoplakia, including definition, risk factors, clinical features, histopathological grading, differential diagnosis and treatment options. Leukoplakia is considered the most common OPMD and accurate diagnosis requires biopsy and histopathological examination.
This document discusses temporomandibular joint (TMJ) arthroscopy. It begins by defining arthroscopy as examining the inside of a joint with an arthroscope. TMJ arthroscopy allows direct visualization of the TMJ structures and performing surgeries. The document outlines the techniques, indications, contraindications and complications of diagnostic and therapeutic TMJ arthroscopy. Common pathologies that can be evaluated arthroscopically include adhesions, perforations and folds in the TMJ. The summary emphasizes that TMJ arthroscopy is a less invasive alternative to open surgery that can treat pain and restricted joint mobility through lysis, lavage and release of adhesions.
This document summarizes different types of salivary gland disorders including developmental, functional, obstructive, cysts, infections, and autoimmune disorders. Developmental disorders include abnormalities like aplasia, hyperplasia, and atresia. Functional disorders involve increased or decreased salivary secretion known as sialorrhea and xerostomia. Obstructive disorders are due to blockages like sialolithiasis. Cysts include mucoceles and ranulas. Infections can be viral, bacterial, or mycotic. Autoimmune disorders include Sjogren's syndrome and Mikulicz's disease. The document also discusses diagnostic tools like sialography used to evaluate salivary gland
This document presents a case study of a 30-year-old female patient diagnosed with plexiform ameloblastoma based on a biopsy of her right mandible. It provides background on ameloblastoma, describing it as a benign odontogenic tumor arising from odontogenic epithelium. It discusses the various histological subtypes including follicular, plexiform, unicystic (three groups), peripheral, acanthomatous, granular, basal cell, and desmoplastic. Treatment typically involves radical excision, with curettage having the highest recurrence rates. The case study aims to educate on the clinical, radiographic, and histological features of ameloblastoma.
This document discusses salivary gland anatomy, function, and disorders. It begins by outlining the objectives of understanding salivary gland anatomy, diagnosing disorders, and familiarizing with treatments. It then describes the major salivary glands - parotid, submandibular, and sublingual glands - and their secretions. Minor salivary glands are also introduced. Diagnostic modalities like imaging, biopsies, and various treatment options for obstructive disorders like sialolithiasis and mucoceles are covered in detail.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
This document discusses various types of odontogenic cysts. It begins with introducing cysts in general and then classifies odontogenic cysts based on etiology and tissue of origin. Several specific types of odontogenic cysts are then described in more detail, including their clinical features, radiographic features, and differential diagnosis. These include dentigerous cysts, eruption cysts, odontogenic keratocysts, gingival cysts of newborn and adult, lateral periodontal cysts, calcifying odontogenic cysts, periapical cysts, residual cysts, and paradental cysts.
This document discusses the anatomy and embryology of the major and minor salivary glands. It describes the three pairs of major salivary glands - the parotid, submandibular, and sublingual glands. It details their development during embryogenesis, classification based on size and secretory cell type, structure, blood supply, innervation and relations to surrounding tissues. The document also briefly discusses the numerous minor salivary glands found in the oral cavity.
Saliva is produced by the major and minor salivary glands and consists of both serous and mucous secretions. The three pairs of major salivary glands - the parotid, submandibular, and sublingual glands - provide over 90% of the total saliva produced. The parotid glands are the largest and purely serous, while the submandibular glands are predominantly mucous and mixed. The sublingual glands are the smallest but also predominantly mucous and mixed. Whole saliva contains secretions from the major and minor salivary glands as well as other components from the oral cavity.
This document provides information about saliva and the salivary glands. It discusses the development, classification, anatomy and functions of the major and minor salivary glands. The major salivary glands are the parotid, submandibular and sublingual glands. It describes the stages of development of the salivary glands beginning in the 6th week of fetal life and the histochemical nature of secretions. Diseases and age-related changes of the salivary glands are also mentioned.
This document summarizes the salivary glands. It defines salivary glands as exocrine glands that secrete saliva into the oral cavity. It classifies salivary glands as major (parotid, submandibular, sublingual) or minor based on size, and as serous, mixed, or mucous based on secretory cell type. The document describes the anatomy, histology, development and functions of the major salivary glands. It also discusses the structure of salivary glands including secretory end pieces, ductal system, and secretory cell types.
This document summarizes the anatomy and functions of salivary glands. It describes the major salivary glands - parotid, submandibular and sublingual glands - as well as minor salivary glands. The functions of saliva include protection, buffering, tooth integrity, antimicrobial activity, tissue repair, digestion and taste. Saliva production is nerve-mediated and its composition includes water, electrolytes, proteins, immunoglobulins and other components. The document also discusses salivary gland development, histology and clinical considerations.
This document provides an overview of the salivary glands, including their anatomy, histology, development, functions, and common disorders. It describes the three major paired salivary glands - the parotid, submandibular, and sublingual glands - as well as the numerous minor salivary glands found in the oral cavity. The roles of saliva in lubricating food, aiding digestion, protecting teeth, and maintaining oral health are summarized. Developmental processes, secretory mechanisms, and potential issues affecting the salivary glands are also briefly outlined.
The document discusses the anatomy and function of the palate and salivary glands. The palate forms the roof of the mouth and floor of the nasal cavity. It is divided into the hard and soft palate. The soft palate contains muscles that allow it to lift and close the throat during speech and swallowing. The salivary glands produce saliva and include the parotid, submandibular, and sublingual glands. Each gland has a specific location, duct system, and nerve supply involved in stimulation of saliva secretion.
This document provides information on salivary glands:
- It defines salivary glands as exocrine glands that secrete saliva into the oral cavity. Major salivary glands include the parotid, submandibular, and sublingual glands. Minor salivary glands are scattered throughout the oral mucosa.
- The structure of salivary glands includes secretory end pieces or acini composed of serous or mucous cells that secrete into a ductal system comprising intercalated, striated, and terminal ducts that drain into the oral cavity. Myoepithelial cells surround the acini and ducts and aid in secretion.
The submandibular gland is a major salivary gland located in the submandibular region under the mandible. It develops from endodermal buds in the floor of the mouth and grows posteriorly lateral to the tongue. The gland has both superficial and deep parts divided by the mylohyoid muscle. It is a branched tubuloacinar gland composed of serous and mucous acini that secrete saliva. The submandibular gland duct, called Wharton's duct, emerges from the deep part of the gland and opens on the floor of the mouth. The gland is supplied by the facial artery and drains into submandibular lymph nodes.
The document discusses the anatomy and function of the major and minor salivary glands. It describes the location and secretory products of the parotid, submandibular, and sublingual glands. It also covers the clinical considerations of various salivary gland disorders like xerostomia, salivary gland infections, Sjogren's syndrome, and tumors. For prosthodontists, understanding salivary gland anatomy is important to avoid obstruction of the parotid and submandibular ducts during denture construction.
The document discusses the embryology, anatomy, histology and physiology of salivary glands. It begins by describing the development of the major salivary glands from oral ectoderm between 6-8 weeks of gestation. It then covers the classification, locations and duct systems of the parotid, submandibular and sublingual glands. The histology section examines the serous and mucous acini, ductal system and myoepithelial cells. It concludes with the innervation and secretory processes of the salivary glands.
The document discusses the anatomy and physiology of the major salivary glands - the parotid, submandibular, and sublingual glands. It describes the location, structure, blood supply, nerve supply, and duct system of each gland. It also discusses the development of the salivary glands and includes diagrams to illustrate key anatomical structures and relationships.
Introduction
Suprahyoid muscle and its embryology
Relation of mylohyoid and digastric muscle
Submandibular gland and duct
Development and histology
Sublingual gland and duct ,it’s development and histology.
Submandibular ganglion and its relations
Clinical anatomy
Blood and nerve supply of submandibular and sublingual duct
Conclusion
References
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2. Embryology, Anatomy and Physiology
• The salivary glands can be divided into two groups: the major and
minor glands.
• All salivary glands develop from the embryonic oral cavity as buds
of epithelium that extend into the underlying mesenchymal
tissues.
• These epithelial ingrowths, or anlages, are apparent at 8 weeks'
gestation and then branch to form a primitive ductal system that
eventually becomes canalized to provide a structural salivary
gland unit for drainage of salivary secretions .
2
4. • This unit consists of a myoepithelial cell, intercalated duct,
striated duct, and excretory duct.
• The minor salivary glands begin to develop around the fortieth
day in utero, whereas the larger major glands begin to
develop slightly earlier, at about the thirty-fifth day in utero.
• At around the seventh or eighth month in utero, secretory
cells called acini begin to develop around the ductal system.
• The acinar cells of the salivary glands are classified as
serous cells, which produce a thin, watery serous secretion,
or mucous cells, which produce a thicker, more viscous
mucous secretion.
4
6. • The minor salivary glands are well developed and
functional in the newborn infant.
• The acini of the minor salivary glands primarily produce
mucous secretions, although some are made up of serous
cells as well, thus classifying these minor glands as
mixed.
• Between 800 and 1000 minor salivary glands are found
throughout the portions of the oral cavity that are covered
by mucous membranes, with a few exceptions, such as
the anterior third of the hard palate, the attached gingiva,
and the dorsal surface of the anterior third of the tongue.
6
7. • The minor salivary glands are referred to as the labial, buccal,
palatine, tonsillar (Weber's glands), retromolar (Cannalts glands),
and lingual glands, which are divided into three groups:
(1) inferior apical (glands of Blandin and of Nuhn),
(2) taste buds (Ebner's glands), and
(3) posterior lubricating glands.
• The major salivary glands are paired structures and are the
parotid, submandibular, and sublingual glands.
• The parotid glands contain primarily serous acini with few mucous
cells. Serous cells are cuboidal cells with eosinophilic secretory
granules and produce thin, watery secretions with a low viscosity.
7
9. • Conversely, the sublingual glands are for the most part
composed of mucous cells, which are clear low columnar
cells with nuclei polarized away from the lumen of the
acini, and produce a thick secretion with high viscosity.
• The submandibular glands are mixed glands, made up of
approximately equal numbers of serous and mucous
acini, and produce a secretion with an intermediate
viscosity.
9
11. • The parotid glands, the largest salivary glands, lie superficial to the
posterior aspect of the masseter muscle and the ascending ramus of the
mandible. Peripheral portions of the parotid gland extend to the mastoid
process, along the anterior aspect of the sternocleidomastoid muscle, and
around the posterior border of the mandible into the pterygomandibular
space .
• The major branches of the seventh cranial (facial) nerve roughly divide the
parotid gland into a superficial lobe and a deep lobe while coursing anteriorly
from their exit at the stylomastoid foramen to innervate the muscles of facial
expression.
• Small ducts from various regions of the gland coalesce at the anterosuperior
aspect of the parotid gland to form Stensen's duct, which is the major duct of
the parotid gland. Stensen's duct is about 1 to 3 mm in diameter and 6 cm in
length.
11
12. Parotid gland anatomy: The course of Stensen's duct runs superficial to the
masseter muscle and then curves sharply anteriorly to pierce the buccinator
muscle fibers and enter the oral cavity.
12
13. • Occasionally, a normal anatomic variation occurs in which an
accessory parotid duct may aid Stensen's duct in drainage of
salivary secretions.
• Additionally, an accessory portion of the parotid gland may be
present somewhere along the course of Stensen's duct. The duct
runs anteriorly from the gland and is superficial to the masseter
muscle. At the location of the anterior edge of the masseter muscle,
Stensen's duct turns sharply medial and passes through the fibers of
the buccinator muscle.
• The duct opens into the oral cavity through the buccal mucosa,
usually adjacent to the maxillary first or second molar. The parotid
gland receives innervation from the ninth cranial
(glossopharyngeal) nerve via the auriculotemporal nerve from
the otic ganglion. 13
15. • The submandibular glands are located in the submandibular
triangle of the neck, which is formed by the anterior and posterior
bellies of the digastric muscles and the inferior border of the
mandible.
• The posterosuperior portion of the gland curves upward around
the posterior border of the mylohyoid muscle and gives rise to the
major duct of the submandibular gland known as Wharton's duct.
• This duct passes forward along the superior surface of the
mylohyoid muscle in the sublingual space, adjacent to the lingual
nerve. The anatomic relationship is such that the lingual nerve
loops under Wharton's duct, from lateral to medial, in the posterior
floor of the mouth.
15
16. Submandibular gland anatomy. The anterior and posterior bellies of the
digastric muscles and the inferior border of the mandible form the
submandibular triangle.
16
17. • Wharton's duct is about 5 cm in length, and the diameter
of its lumen is 2 to 4 mm.
• Wharton's duct opens into the floor of the mouth via a
punctum located close to the incisors at the most anterior
aspect of the junction of the lingual frenum and the floor of
the mouth.
• The punctum is a constricted portion of the duct, and it
functions to limit retrograde flow of bacteria-laden oral
fluids. This particularly limits those bacteria that tend to
colonize around the ductal orifices.
17
18. • The sublingual glands lie on the superior surface of the
mylohyoid muscle, in the sublingual space, and are
separated from the oral cavity by a thin layer of oral
mucosa.
• The acinar ducts of the sublingual glands are called
Bartholin's ducts and in most instances coalesce to form
8 to 20 ducts of Rivinus. These ducts of Rivinus are short
and small in diameter.
18
19. Sublingual gland anatomy. The interrelationships between the ductal
systems of the submandibular and the sublingual glands anel the
relationship of the lingual nerve to Wharton's duct are demonstrated.
19
20. • The ducts open individually directly into the anterior floor of
the mouth on a crest of mucosa, known as the plica
sublingualis, or they open indirectly through connections to
the submandibular duct and then into the oral cavity via
Wharton's duct.
• The sublingual and submandibular glands are innervated by
the facial nerve through the submandibular ganglion via the
chorda tympani nerve.
20
22. • The functions of saliva are to provide lubrication for speech and mastication,
to produce enzymes for digestion, and to produce compounds with
antibacterial properties.
• The salivary glands produce approximately 1000 to 1500 mL of saliva per
day, with the highest flow rates occurring during meals.
• The relative contributions of each salivary gland to total daily production
varies, with the submandibular gland providing 70%, the parotid gland 25%,
the sublingual gland 3% to 4%, and the minor salivary glands contributing
only trace amounts of saliva.
• The electrolyte composition of saliva also varies between salivary glands,
with parotid gland concentrations generally higher than the submandibular
gland, except for submandibular calcium concentration, which is
approximately twice the concentration of parotid calcium.
22
23. • The relative viscosities of saliva vary according to gland and
correspond to the percentage of mucous and serous cells;
therefore the highest viscosity is in the sublingual gland
composed of mostly mucous cells, followed by the
submandibular gland (mixed mucous and serous cells) , and
lastly, the parotid gland, which is composed mainly of serous
cells.
• Interestingly, the daily production of saliva begins to decrease
gradually after the age of 20.
23
24. • The control of salivary production is derived from sympathetic and
parasympathetic stimulation.
• The sympathetic innervation is from the superior cervical ganglion
to the glands via the arterial plexus of the face.
• The parasympathetic innervation to the parotid gland originates
from the tympanic branch of the glossopharyngeal nerve (IX),
which then travels via the lesser petrosal nerve to the otic
ganglion.
• Postganglionic parasympathetic nerves then travel via the
auriculotemporal nerve to the parotid gland.
24
25. • The parasympathetic control of the submandibular and
sublingual glands originates in the superior saliva tory
nucleus, which travels via the facial nerve (chorda
tympani branch) to the submandibular ganglion.
• Postganglionic parasympathetic nerves then travel
directly to the submandibular gland or with the lingual
nerve to the sublingual gland.
25
26. History and Clinical Examination
• The most important component of diagnosis in salivary
gland disorders, as with most other disease processes, is
the patient history and the clinical examination.
• In most cases the patient will guide the doctor to the
diagnosis merely by relating the events that have
occurred in association with the presenting complaint.
26
27. • The astute clinician must perform a thorough evaluation,
and in many instances the diagnosis can be determined
without the necessity of further diagnostic evaluation.
• At the very least the clinician may be able to categorize
the problem as reactive, obstructive, inflammatory,
infectious, metabolic, neoplastic, developmental, or
traumatic and guide further diagnostic testing.
• Occasionally, the clinician may find it necessary to use
any of several diagnostic modalities.
27
28. Salivary Gland Radiology
Plain Film Radiographs
• The primary purpose of plain films in the assessment of salivary
gland disease is to identify salivary stones (calculi) , although only
80% to 85% of all stones are radiopaque and therefore visible
radiographically.
• The incidence of radiopaque stones varies, depending on the
specific gland involved.
• A mandibular occlusal film is most useful for detecting sublingual
and submandibular gland calculi in the anterior floor of the mouth.
28
30. A , Mandibular occlusal
radiograph showing a
radiopaque sialolith (arrow).
B, Submandibular sialolith (1.0
cm) after intraoral removal is
demonstrated.
30
31. • Periapical radiographs can show calculi in each salivary gland or
duct, including minor salivary glands, depending on film
placement.
• A "puffed cheek view," in which the patient forcibly blows the
cheek laterally to distend the soft tissues overlying the lateral
ramus, may demonstrate radiopaque parotid stones.
• In most instances the radiographic image corresponds in size and
shape to the actual stone.
• Panoramic radiographs can reveal stones in the parotid gland and
posteriorly located submandibular stones.
31
32. A, Panoramic radiograph
demonstrates a right
submandibular sialolith
(arrows).
B, Panoramic radiograph
showing right parotid
stone (arrowhead).
32
33. Sialography
• The gold standard in diagnostic salivary gland radiology may be the
sialogram.
• Sialography is indicated as an aid in the detection of radiopaque stones. In
addition, when 15% to 20% of stones are radiolucent, sialography is also
useful in the assessment of the extent of destruction of the salivary duct or
gland or both as a result of obstructive, inflammatory, traumatic, and
neoplastic diseases.
• In addition to its diagnostic role, sialography may be used as a therapeutic
maneuver because the ductal system is dilated during the study, and small
mucous plugs or necrotic debris may be cleared during injection of contrast
medium.
33
34. • Sialography is a technique in which the salivary duct
(Stensen's or Wharton's duct) is cannulated with a plastic or
metal catheter, a radiographic contrast medium is injected
into the ductal system and the substance of the gland, and a
series of radiographs are obtained during this process.
• Approximately 0.5 to 1 mL of contrast material can be injected
into the duct and gland before the patient begins to
experience pain. The two types of contrast media available for
sialographic studies are water-soluble and oil-based. Both
types of contrast material contain relatively high
concentrations (25% to 40%) of iodine.
34
36. • Most clinicians prefer to use water-soluble media, which are more
miscible with salivary secretions, more easily injected into the
finer portions of the ductal system, and more readily eliminated
from the gland after the study is completed by drainage through
the duct or systemic absorption from the gland and excretion
through the kidneys.
• The oil-based media are more viscous and require a higher
injection pressure to visualize the finer ductules than do the water-
soluble media.
• As a result, oil-based media usually produce more discomfort to
the patient during injection.
36
37. • Oil-based media are poorly eliminated from the ductal
system and may cause iatrogenic ductal obstruction.
• Residual oil-based contrast medium is not absorbed by
the gland and may produce severe foreign-body reactions
and glandular necrosis.
• Additionally, if the patient has ductal disruption resulting
from chronic inflammatory changes, the extravasation of
oil-based media may cause significantly more soft tissue
damage than water-soluble material.
37
38. • A complete sialogram consists of three distinct phases, depending
on the time at which the radiograph is obtained after injection of
the contrast material:
1. Ductal phase, which occurs almost immediately after injection of
contrast material and allows visualization of the major ducts
2. Acinar phase , which begins after the ductal system has become
fully opacified with contrast medium and the gland parenchyma
becomes filled subsequently
3. Evacuation phase, which assesses normal secretory clearance
function of the gland to determine whether any evidence remains of
retention of contrast medium in the gland or ductal system after the
sialogram
38
39. Ductal phase of a submandibular sialogram.
Contrast medium is contained only within the main salivary ducts (
arrows ) . 39
40. Acinar phase of a submandibular sialogram.
Normal arborization of the entire ductal system of the gland (arrow) is
demonstrated. 40
41. Evacuation phase of a submandibular Sialogram with
some abnormal retention of contrast medium in the
ductal system after 5 minutes
41
42. • The retention of contrast medium in the gland or ductal system
beyond 5 minutes is considered abnormal.
• A normal sialogram shows a large primary duct branching
gradually and smoothly into secondary and terminal ductules.
• Evenly distributed contrast medium results in opacification of the
acinoparenchyma that outlines the gland and its lobules.
• When a stone obstructs a salivary duct, continued secretion by
the gland produces distention of the ductal system proximal to the
obstruction and finally leads to pressure atrophy of the
parenchyma of the gland.
42
43. Sialogram of right submandibular gland. Obstruction of duct by a
radiolucent sialolith (arrows) has caused dilation of the duct and
loss of normal parenchyma of the gland.
43
44. • Sialodochitis is a dilation o f the salivary duct resulting
from epithelial atrophy as a result of repeated
inflammatory or infectious processes, with irregular
narrowing caused by reparative fibrosis.
• Sialadenitis represents inflammation mainly involving the
acinoparenchyma of the gland.
• Patients with sialadenitis experience saccular dilation of
the acini of the gland resulting from acinar atrophy and
infection, which results in "pruning" of the normal
arborization of the small ductal system of the gland.
44
45. A, Sialogram of right parotid gland. The characteristic "sausage link"
appearance of the duct is demonstrated, which indicates ductal damage
from obstructive disease with irregular narrowing of duct caused by
reparative fibrosis.
B, Diagram of obstruction with proximal dilatation of the ductal system.
45
46. A, Parotid sialadenitis
with acinar destruction
from chronic disease.
B, Diagram of "pruning of
the tree" due to acinar
destruction.
46
47. • Centrally located lesions or tumors that occupy a
part of the gland or impinge on its surface displace
the normal ductal anatomy.
• On sialography, ducts adjacent to the lesion are
curvilinearly draped and stretched around the
mass, producing a characteristic ball-in-hand
appearance.
47
48. A, Sialogram of right
parotid gland illustrates ball-
in-hand phenomenon
(arrows). The filling defect
in this sialogram locates a
tumor of the gland with
displacement of normal
surrounding
ductal anatomy
B, Diagram of ball-in-hand
phenomenon due to tumor
displacement of acini.
48
49. • Sialograms are specialized radiologic studies performed by oral
and maxillofacial surgeons and some interventional radiologists
trained in the technique. Those inexperienced in performance of
or proper interpretation of the sialogram should not attempt this
examination. The three contraindications to performing a
sialogram are:
(1) acute salivary gland infections, because a disrupted ductal
epithelium may allow extravasation of contrast medium into the soft
tissues and cause severe pain and possibly a foreign-body reaction;
(2) patients with a history of iodine sensitivity, especially a severe
allergic reaction after a previous radiologic examination using
contrast medium; and
(3) before a thyroid gland study, because retained iodine in the
salivary gland or ducts may interfere with the thyroid scan. 49
50. • The use of computed tomography (CT) has been generally
reserved for the assessment of mass lesions of the salivary
glands.
• Although CT scanning results in radiation exposure to patients, it
is less invasive than sialography and does not require the use of
contrast material. Additionally, CT scanning can demonstrate
salivary gland calculi, especially submandibular stones that are
located posteriorly in the duct, at the hilum of the gland, or in the
substance of the gland itself. Three-dimensional CT scanning now
allows a much better delineation of the stone and of the ductal
system in a noninvasive fashion.
50
51. • The office-based cone beam computed tomography
(CBCT) technology has been evaluated with regard to the
diagnosis of sialolithiasis in the major salivary glands,
and, compared with ultrasonography, it was found to have
high sensitivity and specificity.
• While dental artifacts and patient movement that result in
poor image quality may limit its diagnostic value, the
availability, low cost, and lower radiation doses of CBCT,
compared with medical grade CT imaging, makes it a
valuable alternative for a noninvasive diagnosis of
sialolithiasis.
51
52. A, Computerized axial tomographic scan or the mandible and floor of mouth shows
a posterior submandibular sialolith (arrow) .
B, Coronal computed tomography scan showing a multisegment submandibular
duct stone.
52
54. • Magnetic resonance imaging is superior to CT scanning in
delineating the soft tissue detail of salivary gland lesions,
specifically tumors, with no radiation exposure to the patient
or the necessity of contrast enhancement.
• Three-dimensional MRI reconstruction and MRI virtual
endoscopy of the ductal system have shown promising
results in the visualization of abnormalities in conditions such
as Sjogren syndrome, sialolithiasis, cysts, tumors, and
inflammatory conditions.
• These advances in MRI may prove beneficial in studying and
understanding the relationship of the ductal system to
surrounding tissue as well as the endoluminal conditions of
the ducts.
54
55. • Current advances in ultrasound technology have made this imaging
modality extremely valuable in diagnosis of salivary gland pathology.
Ultrasonography can provide high-resolution images, is noninvasive, has
a low cost, and is an easy to perform procedure that allows for accurate
evaluation of the parotid and submandibular glands.
• In salivary gland tumor evaluation, important information regarding
vascularization can be obtained with color Doppler ultrasonographic
examination, which may aid in differentiation of benign and malignant
disease processes.
• Ultrasonography represents the most common examination method for
nodular lesions and is useful to guide biopsies for diagnostic purposes,
especially when clinical examination is limited because of the small sizes
and locations of the nodules.
• Finally, ultrasonography with intraductal injection of contrast material has
been proposed as a complementary method for evaluation of obstructive
salivary gland disease. In addition to the ductal system examination of
glands, parenchymal evaluation is possible with this technique.
55
56. Salivary Scintigraphy (Radioactive Isotope Scanning)
• The use of nuclear imaging in the form of radioactive isotope scanning, or
salivary scintigraphy, allows a thorough evaluation of the salivary gland
parenchyma with respect to the presence of mass lesions and the function of
the gland itself.
• This study uses a radioactive isotope (usually, technetium- 99m) injected
intravenously, which is distributed throughout the body and taken up by a
variety of tissues, including the salivary glands. The major limitation of this
study, aside from patient radiation exposure, is the poor resolution of the
images obtained. Salivary gland scintigraphy may demonstrate increased
uptake of radioactive isotope in an acutely inflamed gland or decreased
uptake in a chronically inflamed gland, as well as the presence of a mass
lesion, benign or malignant.
56
57. Salivary Gland Endoscopy (Sialoendoscopy)
• Minimally invasive modalities of diagnosis and treatment have recently been
applied to the major salivary glands.
• Salivary gland endoscopy (sialoendoscopy) is a specialized procedure that
uses a small video camera (endoscope) with a light at the end of a flexible
cannula, which is introduced into the ductal orifice.
• The endoscope can be used diagnostically and therapeutically. Salivary
gland endoscopy can demonstrate strictures and kinks in the ductal system,
as well as mucous plugs and calcifications. The endoscope may be used to
dilate small strictures and flush clear, small mucous plugs from the salivary
gland ducts. Specialized devices such as small balloon catheters (similar to
those used for coronary angioplasty procedures) may be used to dilate sites
of ductal constriction, and small metal baskets may be used to retrieve
stones in the ductal system. 57
58. A, Salivary gland endoscope with ports for visualization, illumination, irrigation, and
instrumentation. B, Endoscopic view of a stone on the ductal system. C, Endoscopic
retrieval of a stone with a mini-forceps grasper technique (arrow). 58
59. Diagram of an endoscopic retrieval of a stone with the
basket technique (arrow) .
59
60. Sialochemistry
• An examination of the electrolyte composition of the saliva of each
gland may indicate a variety of salivary gland disorders.
• Principally, the concentrations of sodium and potassium, which
normally change with salivary flow rate, are measured. Certain
changes in the relative concentrations of these electrolytes are
seen in specific salivary gland diseases.
• For example, an elevated sodium concentration with a decreased
potassium concentration may indicate an inflammatory
sialadenitis.
60
61. • Most recently, in the area of head and neck oncology,
tremendous interest and advances have been seen in
salivary proteomics for molecular markers to assist in the
detection and diagnosis of oral squamous cell carcinoma
61
62. Fine-Needle Aspiration Biopsy
• The use of fine-needle aspiration biopsy in the diagnosis of
salivary gland tumors has been well documented. This procedure
has a high accuracy rate for distinguishing between benign and
malignant lesions in superficial locations.
• Fine needle aspiration biopsy is performed using a syringe with a
20-gauge or smaller needle. After local anesthesia administration,
the needle is advanced into the mass lesion, the plunger is
activated to create a vacuum in the syringe, and the needle is
moved back and forth throughout the mass, with pressure
maintained on the plunger.
62
64. • The pressure is then released, the needle is withdrawn,
and the cellular material and fluid are expelled onto a
slide and fixed for histologic examination.
• This allows an immediate determination of benign versus
malignant disease; examination also offers the possibility
of providing a tissue diagnosis, especially if the oral
surgeon and oral pathologist are experienced in
performing and interpreting this examination and its
results.
64
65. Salivary Gland Biopsy
• A salivary gland biopsy, incisional or excisional, can be used to
diagnose a tumor of one of the major salivary glands, but it is
usually performed as an aid in the diagnosis of Sjogren's
syndrome (SS).
• The lower lip labial salivary gland biopsy has been shown to
demonstrate certain characteristic histopathologic changes that
are seen in the major glands in SS. The procedure is performed
using local anesthesia, and approximately 10 minor salivary
glands are removed for histologic examination.
65
66. A, Labial salivary gland biopsy.
The lower lip is everted and
controlled with a Chalazion
clamp. An incision through
mucosa permits visualization
of the minor salivary glands
(arrows).
B, The minor salivary glands
are removed and submitted for
histopathologic assessment.
66
67. • The labial minor salivary glands are then examined
histologically, and they are assigned a "focus score."
• A "focus“ represents an aggregate of 50 or more
lymphocytes, histiocytes, and plasma cells per 4 mm2 of
salivary gland tissue at high power.
• The diagnosis of SS is supported by the presence of one
or more foci in the minor salivary gland tissue .
67
68. A, Labial salivary gland biopsy
specimen in a patient
with Sjogren's syndrome (note
the presence of three foci of
lymphocytes at low power).
B, A high-power view of a
specimen of labial salivary gland
showing one focus (>50
lymphocytes) and normal
adjacent acinar tissue.
68
69. OBSTRUCTIVE SALIVARY GLAND DISEASE :
SIALOLITH IASIS
• The formation of stones, or calculi, may occur throughout the
body, including the gallbladder, urinary tract, and salivary glands.
• The occurrence of salivary gland stones is twice as common in
men, with a peak incidence between ages 30 and 50.
• Multiple stone formation occurs in approximately 25% of patients.
The pathogenesis of salivary calculi progresses through a series
of stages beginning with an abnormality in calcium metabolism
and salt precipitation, with formation of a nidus that subsequently
becomes layered with organic and inorganic material, to form a
calcified mass.
69
70. • The incidence of stone formation varies, depending on the
specific gland involved.
• The submandibular gland is involved in 85% of cases, which is
more common than all other glands combined.
• A variety of factors contribute to the higher incidence of
submandibular calculi. Salivary gland secretions contain water,
electrolytes, urea, ammonia, glucose, fats, proteins, and other
substances; in general, parotid secretions are more concentrated
than those of the other salivary glands.
• The main exception is the concentration of calcium, which is
about twice as abundant in submandibular saliva as in parotid
saliva.
70
72. • In addition, the alkaline pH of submandibular saliva may further support stone
formation. In addition to salivary composition, several anatomic factors of the
submandibular gland and duct are important.
• Wharton's duct is the longest salivary duct; therefore, saliva has a greater
distance to travel before being emptied into the oral cavity.
• In addition, the duct of the submandibular gland has two sharp curves in its
course: The first occurs at the posterior border of the mylohyoid muscle, and
the second is near the ductal opening in the anterior floor of the mouth.
• Finally, the punctum of the submandibular duct is smaller than the opening of
Stensen's duct. These features contribute to a slowed salivary flow and
provide potential areas of stasis of salivary flow, or obstruction, which is not
found in the parotid or sublingual ductal systems.
72
73. • Precipitated material, mucus, and cellular debris are more
easily trapped in the tortuous and lengthy submandibular
duct, especially when its small orifice is its most elevated
location, and its flow therefore occurs against the force of
gravity.
• The precipitated material forms the nidus of mucous plugs
and radiopaque or radiolucent sialoliths that may
eventually enlarge to the point of obstructing the flow of
saliva from the gland to the oral cavity.
73
74. • The clinical manifestations of the presence of submandibular stones become
apparent when acute ductal obstruction occurs at mealtime, when saliva
production is at its maximum and salivary flow is stimulated against a fixed
obstruction. The resultant swelling is sudden and is usually very painful .
• Gradual reduction of the swelling follows, but swelling reoccurs repeatedly
when salivary flow is stimulated. This process may continue until complete
obstruction, infection, or both occur.
• Obstruction, with or without infection, causes atrophy of the secretory cells of
the involved gland.
• Infection of the gland manifests itself by swelling in the floor of the mouth,
erythema, and an associated lymphadenopathy.
• Palpation of the gland and simultaneous examination of the duct and its
opening may reveal the total absence of salivary flow or the presence of
purulent material .
74
77. • Sialolithiasis in children is rare. Boys are more commonly
affected than girls, and the left submandibular gland is
most commonly affected.
• The diagnosis can be made clinically and confirmed
radiographically by plain films, ultrasound, Sialography, or
sialoendoscopy.
77
78. • The management of submandibular gland calculi depends on the
duration of symptoms, the number of repeated episodes, the size
of the stone, and perhaps most importantly, the location of the
stone.
• Submandibular stones are classified as anterior or posterior
stones in relation to a transverse line between the mandibular first
molars.
• Stones that occur anterior to this line are generally well visualized
on a mandibular occlusal radiograph and may be amenable to
intraoral removal.
• Small anteriorly located stones may be retrieved through the
ductal opening after dilation of the orifice.
78
79. Stone at the orifice of Wharton's duct that is amenable to intraoral removal
(arrow) .
79
80. • Occasionally, it becomes necessary to remove submandibular stones
via an incision made in the floor of the mouth to expose the duct and
the stone.
• A longitudinal incision is then made in the duct, the stone is retrieved,
and the ductal lining is sutured to the mucosa of the floor of the mouth.
Saliva then flows out of the revised duct.
• This procedure, known as a sialodochoplasty (i.e., revision o f the
salivary duct) , eliminates many o f the factors that contributed to
formation of the stone.
• The entire length of the duct is decreased, the opening created is now
larger, and gravity contributes less to salivary stasis. Regardless of the
procedure performed, patients are encouraged to maintain ample
salivary flow by using salivary stimulants, such as citrus fruits, flavored
candies, or glycerin swabs.
80
81. A, Surgical opening of the
submandibular duct
(Sialodochotomy) and
removal of the stone
(sialolithectomy) .
B, This is followed by a
ductal revision sutured to
the noor of mouth mucosa
(Sialodochoplasty) .
81
82. • Posterior stones occur in up to 50% of cases and may be
located at the hilum of the gland or within the substance
of the gland itself.
• A routine occlusal film will likely not demonstrate the
stone, and a panoramic radiograph or a CT scan may be
necessary to localize the stone.
• In cases of posterior stones that cannot be palpated
intraorally and in many instances of repeated chronic
stone formation and symptoms, the submandibular gland
and the stone should be removed by an extraoral
approach.
82
83. A, Diagram of extraoral technique for removal of the
submandibular gland.
83
84. B, Submandibular gland removal (sialoadenectomy) .
C, Specimen of submandibular gland and associated
stone.
84
85. • Clinical trials using extracorporeal shock wave lithotripsy have
been successful in treating small salivary gland stones.
• This technology uses transcutaneous electromagnetic waves to
break the calculus apart into smaller calcified debris particles,
which can be flushed from the ductal system by the normal flow of
saliva.
• This procedure has few reported complications but is limited by
the size of the salivary gland stone (usually less than 3 mm) , the
number of stones (usually fewer than three) , and the location of
the stone (intraglandular stones may be less amenable to
extracorporeal shock wave lithotripsy) .
85
86. • Salivary gland calculi occur much less commonly in the parotid gland.
The parotid gland is examined by inspection and palpation of the gland
extra orally over the ascending mandibular ramus.
• Stensen's duct and its orifice can be examined intra orally. Palpation of
the gland and simultaneous observation of the duct allow observation
of salivary flow or the production of other material, such as purulence,
from the punctum of the duct.
• Parotid sialoliths found in the distal third of Stensen's duct that can be
palpated intraorally may be removed after dilation of the duct orifice or,
if slightly more proximal, may require surgical exposure to gain access
to the stone. On rare occasions the presence of a parotid stone at the
hilum of the gland or in the gland itself may necessitate an extraoral
approach to remove the stone and the superficial lobe of the parotid
gland.
86
87. • Obstruction of the sublingual gland as a result of stone
formation is unusual, but if it occurs, it is usually the result
of obstruction of Wharton's duct on the same side of the
oral cavity.
• Although stone formation is rare in the sublingual and
minor salivary glands, the treatment is simple excision of
the stone and associated gland.
• The sublingual gland is examined by observation and
bimanual palpation of the anterior third of the floor of the
mouth.
87