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Salivary Gland Disorder

Disease of Salivary Glands


Presentation

  • Patients were seen for any salivary gland disorder presentation, ranging from sialorrhea to glandular masses. RESULTS: A total of 70.4% of patients presented to the SGDC with a chief complaint of sialorrhea.[ncbi.nlm.nih.gov]
  • Inflammatory and infectious swellings Inflammatory and infectious swellings present acutely and are often painful enlargements of the salivary glands.[clinicaladvisor.com]
  • The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges.[aafp.org]
  • Tumors of the salivary glands typically present as asymptomatic masses.[asams.org]
  • […] in someone who is immunosuppressed or from a high-risk population. [ 6 ] Presentation Swelling which is usually painful and tender.[patient.info]
Localized Pain
  • Standard dental imaging is often sufficient in the initial evaluation of local pain and swelling of the salivary gland, particularly those associated with larger radiopaque sialoliths.[asams.org]
  • The parotitis is characterized by local pain and edema, as well as otalgia and trismus. Most cases are bilateral, though it commonly begins on one side. Diagnosis is confirmed through viral serology.[aafp.org]
Sighing
  • Sialadenitis (sigh a la dent I tis) is a painful infection of a salivary gland. Staphylococcus, streptococcus, Haemophilus influenzae or anaerobic bacteria are usually the cause.[cedars-sinai.edu]
Fissured Tongue
Meningism
  • Tender & pain on eating sore food Involved gland continues to enlarge for 2-3 days & comes back to normal.Complicationoophritis, orchitis, meningitis, encephalitis.Management Self limiting MMR vaccine Systemic corticosteroids 29.[slideshare.net]
  • […] parotitis usually due to mumps), so that any acute or chronic sialadenitis not responding to conservative treatment should be referred for specialist opinion. [ 7 ] Complications Complications of mumps parotitis include orchitis, oophoritis, aseptic meningitis[patient.info]

Workup

  • Workup should focus on identifying a predisposing factor, such as a calculus or stricture. If no cause is found, treatment is conservative and should consist of sialagogues, massage, hydration, and anti-inflammatory medications.[aafp.org]
  • Sialography was commonly used in the workup of parotid disease in the past, and this group demonstrates punctate sialectasis, which implies point like dilatations within the gland. Six-year-old girl with recurrent parotitis of childhood.[emedicine.medscape.com]
HLA-DR5
  • A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5. Ann Intern Med 112: 3 - 10.[doi.org]
  • The differential diagnosis includes not only calculi, fatty infiltration, sarcoid, amyloid, tuberculosis, leukemia, and lymphoma, but now also a Sjögren's syndrome—like disorder related to the human immunodeficiency virus and linked to HLA-DR5 and CD8[nejm.org]

Treatment

  • Over 35% of patients had previously attempted medical treatment and 31.5% had no prior treatment attempts. 87% of all patients were offered further treatment options, including interventional, surgical, medical, and conservative measures.[ncbi.nlm.nih.gov]
  • Surgical Treatment for Disorders of the Salivary Gland Surgical treatment is geared to the specific tumor. Removal of the the parotid or submandibular glands is accomplished in the operating room, under general anesthetic through a neck incision.[entdoctorsphiladelphia.com]
  • Treatment Like the symptoms, the treatments for salivary gland disorders are also problem specific. For salivary gland tumors, surgery is required.[lybrate.com]
  • If the mass is cancerous, you may need radiation treatments to kill off cancerous cells. These treatments won’t typically start until your body has had time to heal. This is typically four to six weeks after surgery.[healthline.com]
  • [v] Lim YC, Choi EC Treatment of an acute salivary fistula after parotid surgery: botulinum toxin type A injection as primary treatment. Eur Arch Otorhinolaryngol. 2008 Feb;265(2):243-5.[medicine.uiowa.edu]

Prognosis

  • Prognosis for salivary tumors is quite favorable if they are detected early. When to Call a Doctor See your doctor if you develop pain or swelling in or around the mouth or cheek, or if you experience an increase or decrease in saliva production.[healthcommunities.com]
  • Embryonic rhabdomyosarcomas of the cephalic salivary glands are rare [ 55 ] and have a poor prognosis since the patients present in most cases with already far advanced tumor invasion.[head-face-med.biomedcentral.com]
  • A malignancy which presents with pain often indicates nerve involvement, and as such, a poorer prognosis.[asams.org]
  • […] parotid gland; may undergo malignant transformation, so excision is advised Warthin tumor 6 to 10 More common in older men; associated with smoking; may be multifocal or bilateral Malignant Mucoepidermoid carcinoma 4 to 13 Usually low-grade; excellent prognosis[aafp.org]
  • Salivary Glands n Mixed malignant tumour Long standing pleomorphic adenoma n Older age group n Worse prognosis n Lymph node mets 15% n Distant mets 30% n 5 year survival 40% - 50% n 15% year survival 20% n 111.[slideshare.net]

Etiology

  • Etiology Infection (Bacterial and Viral) Acute Viral Sialadenitis Over a third of all pediatric salivary gland disorders are of an inflammatory nature, with either an obstructive or non-obstructive etiology.[pocketdentistry.com]
  • Algorithm for determining the etiology of salivary gland swelling. Information from reference 3. Evaluation of Patients with Suspected Salivary Gland Disorders Figure 1. Algorithm for determining the etiology of salivary gland swelling.[aafp.org]
  • Sialoliths and granulomatous diseases are inflammatory conditions that cause enlargement and pain but do not have an infectious etiology.[clinicaladvisor.com]
  • The etiology is believed to be secondary to local trauma or focal vascular compromise which results in necrosis. This condition should be observed, and usually heals spontaneously in 6-10 weeks.[asams.org]
  • For chronic sialadenitis the predominant etiological factors are secretion disorders and immunological reactions [ 11 ].[head-face-med.biomedcentral.com]

Epidemiology

  • Pathology and Genetics of Head and Neck Tumours Lyon, IARC Press, 2005;209-215 Bradley P: General epidemiology and statistics in a defined UK population.[karger.com]
  • The epidemiology of the oral lesions of HIV infection in the developed world. Oral Dis 8(Suppl 2): 34 - 39. Google Scholar Crossref Medline ISI Griffiths, DJ, Venables, PJ, Weiss, RA, Boyd, MT ( 1997 ).[doi.org]
  • NORSK Epidemiology, 18(1): 67 [ PM ] [ EČ ][ GS ] Carbone, A., Gloghini, A., Ferlito, A. (2000) Pathological features of lymphoid proliferations of the salivary glands: lymphoepithelial sialadenitis versus low-grade B-cell lymphoma of the malt type.[scindeks.ceon.rs]
Sex distribution
Age distribution

Pathophysiology

  • ORL J Otorhinolaryngol Relat Spec. 2012;74(1);12-5 Lakraj AA, Moghimi N and Jabbari B: Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins.[medicine.uiowa.edu]
  • Pathophysiology of cystic fibrosis with emphasis on salivary gland involvement. J Dent Res, 66: 667-671, 1987. 14-Hakeem V; Fifield R; al-Bayaty HF; Aldred MJ; Walker DM; Williams J. et al.[scla.org.sy]
  • Because the pathophysiology is poorly understood, the rationale of several surgical treatments is rather weak. Parotidectomy removes the diseased gland but begs the question of specific treatment.[emedicine.medscape.com]
  • Kazushige Uchida and Kazuichi Okazaki, Clinical and pathophysiological aspects of type 1 autoimmune pancreatitis, Journal of Gastroenterology, 10.1007/s00535-018-1440-8, 53, 4, (475-483), (2018).[doi.org]

Prevention

  • Preventative measures FIRST to prevent caries/erosion: -topical fluoride, good dental hygiene Symptomatic measures: -oral rinses and gels, mouthwash, water, decrease caffeine/ETOH Local salivary stimulation- chewing on sugar free gum/candies Systemic[quizlet.com]
  • Prevention To prevent acute suppurative parotitis, consider risk factors, avoid anticholinergics and other drugs likely to disrupt saliva flow in the vulnerable and maintain good hydration and mouth care perioperatively and amongst critically ill patients[patient.info]
  • Saliva aids in swallowing, prevents infection, and helps keep the mouth and teeth clean.[healthcommunities.com]
  • Most of the problems with salivary glands are not preventable. Adequate hydration, use of sialogogues (things that increase salivation -- for example, sour candy), and massage of the gland can increase salivary flow and help prevent infection.[lutheranhealthcare.org]
  • Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery. Right after surgery, the staff may check your facial movements by asking you to smile or pout. If you have a drain, they may show you how to care for it.[wkomsi.com]

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