Transcript Other Salivary gland dosorders (sunil)

Classification
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Xerostomia
Sialorrhea
Mucocele
Mucous retention
Ranula
XEROSTOMIA
Xerostomia
• Xerostomia (dry mouth)
• Is not a disease but a symptom caused by
many factors.
Function of Saliva
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Lubrication
Speech
Eating
Antibacterial action
Buffering action: tooth remineralization
Retention of removable denture
Symptoms & Signs
• Symptoms:
– Oral dryness (most common)
– Halitosis
– Burning sensation
– Loss of sense of taste or change taste
– Difficulty in swallowing
– Tongue tends to stick to the palate
– Decreased retention of denture
Symptoms & Signs
– Signs
– Angular cheilitis
– Rampant caries: cervical or cusp tip
– Periodontitis
– Candidiasis
– Saliva pool disappear
– glossitis
Clinical picture
Clinical picture
Etiology (Causes)
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Developmental
Water/Metabolite loss
Iatrogenic
Systemic Diseases
Local factors
Developmental
• Salivary gland aplasia
Water/Metabolite loss
• Impaired fluid in take
• Blood loss (Hemorrhage)
• Vomiting / Diarrhea
Iatrogenic
• Medication
• Radiation therapy
Iatrogenic (Medication)
• Anti histamine (Diphenhydramine,chlorpheniramine)
• Anti depressant (Amitriptyline)
• Anti hypertensive
(Reserpine,Methyldopa,furosemide,CCB,
heloperidol,chlorothiazide)
• Anti cholinergic (Atropine,Scopolamine)
Systemic Diseases
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Sjogrens Syndrome
Diabetes mellitus
Diabetes insipidus
Sarcoidosis
HIV infection
Psychogenic disorder
Local factors
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Aging
Foods
Emotions
Stress
Mouth breathing
Foods:
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alcohol,
coffee,
coco cola,
Smoke.
Diagnosis
• History taking
• Clinical examination
• Investigations
– Salivary flow rate (Sialometry)
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Salivary scintiscanning
Sialochemical analysis & laboratory values
Labial biopsy
Sialography
Salivary flow rate (Sialometry)
Lashley cup (Sialometry)
Lashley cup (Sialometry)
Management
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Dietary & environmental considerations
Preventive Dental Care Measures
Saliva stimulatants
Saliva substitutes
SIALORRHEA
Ptyalism
Drooling
SIALORRHEA
• Excess Saliva
• The condition in which there is increased
Salivary flow
Causes
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Ill fitting Denture
New Denture Wearer
Apthous Ulcers
GIT Diseases
Rabies bites
Metal poisoning
Stroke
Hemiplagia--paralysis patient
Sour or Spicy Foods
Causes
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Drugs (antipsychotic, Cholinergic drugs)
Mentally retard Patients
Recent surgery
Neuromuscular problems
Large tongue (Macroglossia - Downs
syndrome)
Clinical Features
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Drooling of Saliva
Soiling of cloths
Ulcers around the corners of mouth
Choking of saliva during speech
Perioral infections
Chin and Neck infection
Respiratory problems
Diagnosis
• History
Normal 14 months of age
• Examination
resection of mandible, mental retard, GIT
disorders, Drugs
• Investigation
Sialometry
Management
• Identify and Remove the Cause
• Non Medical
• Medical
• Surgical
Management
• Non Medical or Physical
1-Self motivation
2-Habit Breaking
3-Physiotherapy
4- Radiotherapy
Management
• Medical
1- Glycoprrolate tablet 1 to 2 mg
two times a day
2- Scopolamine patches 1.5mg
once day
Management
• Surgical
• Ligation Of duct like Parotid duct
• Repositioning of Duct like Submandibular ,
Parotid S Gland
• Excision of Submandibular Gland
Mucocele
MUCOCELE
• It is a tissue swelling composed of pooled
mucus that escapes into the connective tissue
from several excretory ducts
Mucocele
• When salivary duct is severed the acinar cells
will continue to secrete saliva into the severed
duct.
• At the site of the cut/severance the secretory
product escape into the connective tissue
forming a pool of mucus that distends the
surrounding tissue
Mucocele
Mucocele
ETIOLOGY:
• Minor glands of the lip are most prone to
severance as a result of injury or biting the
mucosa.
• Intra oral minor salivary gland can also be
effected as result of some irritation as well.
CLINICAL FEATURES
• Mostly encountered in children and young adults.
• Two third of the Mucocele occur in the 3rd decade of
life.
• Both males and females are effected equally.
• SITE: mucosal surface of the lower lip
buccal mucosa
floor the mouth
ventral surface of the tongue and
palate
• Clinical appearance of the Mucocele depends on its
location within the submucosa
CLINICAL FEATURES
• More superficial zones of mucous
extravasations presents a fluctuant mass with
bluish translucent appearance.
• Patient usually feels the Mucocele and the
fluctuation in its size
• Pain is quite rare .
• Initially the Mucocele are well circumscribed
but with repeated trauma they become
nodular ,more diffuse and firm on palpation.
Clinical picture
Clinical picture
HISTOPATHOLOGY:
• Underlying pool of mucin distends the surface epithelium.
• The mucin is walled of by the rim of granulation tissue or in
long standing cases by condensed collagen.
• An epithelial lining is lacking
• The mucinous material basophilic or acidophillic and
contains neutrophils and large oval foam cells the
histocytes .
• The base of the mucocele will reveal feeder duct.
• Long standing mucoceles will show acinar degeneration
with fibrosis and minimal inflammation
HISTOPATHOLOGY:
TREATMENT:
• Minor salivary gland mucocele will not resolve
on its own it must be surgically excised.
• To minimize the chances of recurrence the
feeder gland should also be removed.
Mucus retention cyst
Mucus retention cyst
• It is a swelling caused by an obstruction of a
salivary gland excretory duct resulting in an
epithelial lining cavity containing mucus.
• Mucus retention cyst is sometimes also
referred as Sialocyst.
Mucus retention cyst
• The mucus retention cyst is lined by
epithelium and rarely occur in the major
salivary gland, when they do occur they are
multiple i.e. poly cystic disease of the parotid
gland
Mucus retention cyst
Mucus retention cyst
CLINICAL FEATURES:
• Encountered in adults from 3rd -5th decade.
• The lesion is painless and fluctuant and bluish in
appearance.
SITE:
Parotid cysts are located in the superficial lobe as
fluctuant well defined mass.
Floor of the mouth is the most common place.
-Lip
-Buccal mucosa
Mucus retention cyst
HISTOPATHOLOGY:
• The epithelium of the cyst is stratified cuboidal or
columnar duct like epithelium.
• The cytoplasm in the of these cells is either clear or
eosinophlic and my show some features mucous
differentiation
• 70% of these cyst are unilocular rest of the 30% have
multilocular pattern.
Mucus retention cyst
TREATMENT:
• Simple excision is the treatment of choice with
caution of rupturing the cystic sacs.
• Recurrence is rare.
Ranula
Ranula
• Is a term used for mucoceles that occur in the
floor of the mouth.
• The name is derived form the word rana,
because the swelling may resemble the
translucent underbelly of the frog.
Ranula
Ranula
Ranula
• Although the source is usually the
sublingual gland,
– may also arise from the submandibular duct
– or possibly the minor salivary glands in the
floor of the mouth.
Ranula
• Presents as a blue dome shaped swelling in the
floor of mouth.
• They tend to be larger than mucoceles & can
cover floor of the mouth & elevate tongue.
• Located lateral to the midline, helping to
distinguish it from a midline dermoid cyst.
Plunging or Cervical Ranula
• Occurs when spilled mucin dissects through
the mylohyoid muscle and produces swelling
in the neck.
• Concomitant floor of the mouth swelling may
or may not be visible.
Plunging or Cervical Ranula
Ranula Treatment
• Marsupialization
• Sublingual gland removal via intraoral
approach