Transcript ŽLIJEZDE SLINOVNICE

ŽLIJEZDE SLINOVNICE
doc.dr.sc. Željka Roje
Klinika za bolesti uha, nosa i grla s kirurgijom glave i vrata
KBC Split
SEKRECIJA SLINE
 Ukupno 1000 do 1500 ml u 24 sata
 60% u parotidnim žlijezdama, 30% u
submandibularnim, 5% u sublingvalnim i 5 % u
malim žlijezdama
 Stvara se iz plazme procesima difuzije i
osmoze između kapilara i acinusnih stanica
SASTAV SLINE
 99,42% voda
 0,22% Kalcijev fosfat i karbonat
 0,14% amilaza
FUNKCIJE SLINE
 Probavna (oblikovanje bolusa, amilaza)
 Zaštitna općenito(lizozimi)
 Zaštitna lokalno (obnova i održavanje cakline
zuba, mehaničko čišćenje zubala)
 “Epidemiološka”(virusi)
 Posreduje u osjetu okusa
 Sudjeluje u održavnju AB ravnoteže
FUNKCIONALNI POREMEĆAJI
SLINJENJA
 HIPOSALIVACIJA (HIPOPTIJALIZAM)
 Smanjeno stvaranje sline
 U kroničnim upalama, degenerativnim bolestima,
nakon iradijacije, dehidracije, uporabe lijekova s
antikolinergičnim učinkom (atropin), neuroleptika,
sedativa, antihistaminika
 Liječenje: palijativno
 HIPERSALIVACIJA (PTIJALIZAM)
 Nepoznate geneze
 Liječenje: atropin, zračenje – male doze
DIJAGNOZA
 Anamneza
 Klinički pregled (palpacija, inspekcija)
 Specijalne pretrage: sijalografija,
scintigrafija
 UZ, CT, NMR
 Citološka punkcija
 Infectious parotitis
 Acute bacterial parotitis: The patient reports
progressive painful swelling of the gland and fever;
chewing aggravates the pain.
 Acute viral parotitis (mumps): Pain and swelling of
the gland last 5-9 days. Moderate malaise,
anorexia, and fever occur. Bilateral involvement is
present in most instances.
 HIV parotitis: Nonpainful swelling of the gland
occurs; otherwise, patient is asymptomatic.
 Parotitis in tuberculosis: Chronic nontender swelling
of one parotid gland occurs, or a lump is noted
within the gland. Symptoms of tuberculosis are
found in some cases.
 Chronic punctate parotitis (chronic autoimmune
parotitis)
 Mikulicz disease: This is a historical disease only; it
should not be diagnosed today.
 Sjögren syndrome: Recurrent or chronic swelling of
one or both parotid glands with no apparent cause is
noted. It is frequently associated with autoimmune
disease. Discomfort is modest in most cases and is
related to dry mouth and eyes.
 Lymphoepithelial lesion of Godwin: This is a
historical category that is not used today.
 Diseases of uncertain etiology
 Recurrent parotitis of childhood: Repetitious
episodes of unilateral or bilateral mumps like
episodes in a young child are indicative.
 Sarcoidosis: Chronic nontender swelling of parotid
gland occurs.
 Chronic nonspecific parotitis: Most commonly,
patients experience episodes of painful parotid
inflammation that last for hours to weeks with
relative asymptomatic periods between. Pain varies
from mild to incapacitating.
Ca fosfat 74%
Ca karbonat 11%
ostalo
TUMORI
TUMORI
 Najčešći u parotidi
 Što je žlijezda manja šansa da se radi o
malignom tumoru je veća!
TERAPIJA
kirurgija
radioterapija
KIRURGIJA
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Superficijalna parotidektomija
Totalna parotidektomija
TP s disekcijom vrata
TP sa žrtvovanjem ličnog živca (ev.
rekonstrukcija živca)