the pharynx and salivary glands

8/9/2019 The Pharynx and Salivary Glands

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THE PHARYNX & SALIVARY GLANDS

Dr. Melita Jesusa UyFe ruary !"# !$%"

Notetakers: AAB, OSG, GMO(#TeamLouise)

THE PHARYNX 'i(isi)*s+

Nasopharynx or Epipharynx Oropharynx or Mesopharynx Hypopharynx or Laryngopharynx

Figure 1. regions of the pharynx

P,ary*- Free border of the soft palate divides the

nasopharynx from the oropharynx A hori ontal line at the level of the epiglottis

separates the oropharynx from the nasopharynx !osterior pharyngeal "all is #ontinuous in all

three divisions

Nas) ,ary*- $ontinuous "ith the nasal air"ays at the

posterior #hoanae

respiratory portion of the pharynx soft palate forms the %oor o##ipital bone and upper #ervi#al vertebrae

forms the roof posterior pharyngeal "all ma&e up the lateral

"alls

Nas) ,ary*- )r'ers'uperiorly( adenoidsLaterally( opening of E)* Fossa of +osenmuller* )orustubarius

Figure ,. the nasopharynx

/r) ,ary*- $ontinuous "ith the nasopharynx at the free margin

of the soft palate ,nd* -rd* th vertebral bodies form the posterior

"all and is the only solid "all of the oropharynx base of the tongue and the oral #avity form the

anterior limits in#ludes fa#ial or palatine tonsils and the pillars of

these tonsils Lining mu#osa of the oropharynx is strati/ed

s0uamous epithelium

Figure -. aldeyer2s ring

aldeyer2s ring 3 lymphati# en#ir#lement of thepharynx 4 #omposed of the palatine tonsils*adenoids and lingual tonsils

Figure -. )he oral #avity

Hy ) ,ary*- An imaginary hori ontal line at the level of the

valle#ulae separates the oropharynx fromhypopharynx

5alle#ulae 3 t"o shallo" depressions lo#atedbet"een the base of the tongue anteriorly and theepiglottis posteriorly

6lottis !yriform sinus

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Figure . the hypopharynx7iseases of the Nasopharynx

A'e*)i'sHyperplasia of the pharyngeal tonsils

-38 years old $lini#al Manifestations$hroni# air"ay obstru#tion 9mouth breathing:Nasal dis#harge'noringAnorexiaHyponasal voi#eFre0uently re#urring infe#tions of the nose andparanasal sinusesOtitis media3 from encroachment of opening of

ustachian tu!e pro"ucing e usion in mi""$e ear Eusta#hian tube dysfun#tion!rolonged #ondu#tive hearing loss ; delays in spee#hdevelopmentMaxillary deformity and dental malalignmentLevel , lymph nodes are involved

Figure .>


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3 !eni#illin3 Mild antisepti# solution gargles3 !ain reliever

Figure @. +aspberry tongue

A5ute I*6a22ati)*+ 7iphtheriaEti)l)0y

3 $ausative Organism3 -or ne!acterium "iphtheriae3 7roplet inhalation3 '&in3to3s&in #onta#t% 3er infectious3 n#ubation period( 13< days

Pat,)0e*esis3 'pe#ial endotoxin that #auses #ell ne#rosis and

ul#erations7li*i5al Ma*i8estati)*s

3 )"o main forms(3 Lo#al* benign pharyngeal diphtheria3 !rimary toxi#* malignant diphtheri3 Degins "ith moderate fever and mild s"allo"ing

diK#ulties3 Fully developed in ; , hours "ith severe

malaise* heada#he* and nauseaDia0*)sis

3 6rayish3yello" pseudomembranes /rmlyadherent to the tonsils and may spread to thepalate and pharynx

3 )issue bleeds "hen #oating removed3 'lightly s"eet breath smell3 'mear /ndings

Treat2e*t3 solation3 7iphtheria antitoxin ,>>31>>> =&g body

"eight= 5 or M 9after a negative s&in test:3 !eni#illin 63 7is#harge after - #onse#utive 13"ee& interval

smears sho" negative resutls3 ,? may #ontinue to #arry the ba#terium and

should undergo tonsille#tomy7)2 li5ati)*s

3 )oxi# myo#arditis 9usually "ith the primary toxi#malignant form:( #an be fatal

3 nterstitial nephritis3 E$6 and urinalysis follo"3ups should be

#ontinued for at least 8 "ee&s after onset ofdisease

Figure . !seudomembrane of 7iphtheria

A5ute I*6a22ati)*+ )uber#ulosisE i'e2i)l)0y

3 sually in advan#ed organ tuber#ulosis3 5ery rare

7li*i5al Ma*i8estati)*s3 !rimary #omplex3 $ommonly in #hildren3 )ypi#al ul#erative lesion of the oral mu#osa and

tonsil "ith regional #ervi#al lymphadenopathy3 Organ tuber#ulosis "ith ul#erative

mu#o#utaneous lesions3 n regions that may #ome into #onta#t

o Lesions may appear as mu#osalul#erations on the lips and dorsum ofthe tongue or as slightly raised* nodulareruptions on the palate

o '&eletal involvement 9 #old abs#esses :#ausing bulging of the posterior "all ofthe pharynx 9li&e retropharyngeal orparapharyngeal abs#ess:

3 Miliary tuber#ulosis3 Hematogenous spread* appearing as multiple

pinhead3si e papules* some hemorrhagi#* thatform on the oral mu#osa

Dia0*)sis3 A#id3Fast ba#illi smears* sputum* bron#hial

se#retions* gastri# Cui#e* or biopsy material3 Diplane #hest radiograph3 )uber#ulin s&in test3 $al#i/#ations by ultrasound in enlarged #ervi#al

lymph nodes ; pathognomoni#3 $ervi#al lymph node biopsy

Treat2e*t3 npatient antituber#ulous poly#hemotherapy3 )riple or 0uadruple regimen

A5ute I*6a22ati)*+ A#ute 5iral !haryngitis

Eti)l)0y# sy2 t)2s3 n%uen a or parain%uen a viruses3 'udden onset of fever* sore throat and

heada#he3 $oughing and #atarrhal symptoms3 $ervi#al adenopathy

Dia0*)sis3 !haryngeal mu#osa appears red and #oated on

mirror examination3 f ba#terial etiology is suspe#ted ; rapid

strepto#o##al testTreat2e*t

3 'upportive


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3 Analgesi#s* #old #ompresses* "arm li0uids

A5ute I*6a22ati)*+ nfe#tious Mononu#leosis kissing "isease

7ausati(e /r0a*is23 Epstein3Darr virus3 Adoles#ents and young adults3 n#ubation period( J3 days

7li*i5al 2a*i8estati)*s3 'ystemi# disease but #ommonly presents as

tonsillitis as the initial or #ardinal symptoms3 Fatigue* anorexia and moderate temperature

elevation3 'evere pain on s"allo"ing3 Heada#he3 Limb pains

Dia0*)sis+ 7li*i5al E-a2i*ati)*3 )onsillar* nu#hal* axillary and inguinal nodes are

enlarged3 Liver spleen enlargement3 )onsils are bright red* s"ollen* and #overed "ith

grayish /brin #oatingDia0*)sis+ La )rat)ry tests

3 nitially leu&openia follo"ed by lue&o#ytosis3 @>3 >? atypi#al lympho#ytes

3 ED5 serology3 Hepati# en ymes3 pper abdominal ultrasound and E$6

Treat2e*t3 'ymptomati# relief of pain and fever3 Aspirins not re#ommended as they #ause

bleeding problems if tonsille#tomy is re0uired3 Antibioti#s3 Ampi#illin and amoxi#illin avoided sin#e they

fre0uently indu#e a pseudoallergi# rash3 )onsille#tomy3 'evere #ourse

T)*sill)0e*i5 7)2 li5ati)*s+ !eritonsillar Abs#ess3 nilateral in%ammatory pro#ess that in#ludes

the peritonsillar tissue3 !ronoun#ed unilateral redness and s"elling of

the soft palate* muIed spee#h* and possibletrismus

3 vular edema3 May involve tongue base and lateral pharyngeal

"all

Figure 1>. )onsils in nfe#tious Mononu#leosis

3 !eritonsillar infe#tions may readily spread to theparapharyngeal spa#e.

3 +emoval or in#ision of the aBe#ted tonsil underantibioti# #overage

)onsillogeni# sepsis3 +are3 mmune3#ompromised patients3 Hematogenous or lymphogenous route

Figure 11. !eritonsillar abs#ess

T)*sill)0e*i5 7)2 li5ati)*s++etropharyngeal and parapharygeal abs#ess

3 n%ammation or abs#ess from prevertebral orparapharyngeal lymph nodes or byhematogenous spread as a result of minorforeign3body inCury or upper respiratoryin%ammation

7li*i5al ,all2ar9s3 'evere pain on s"allo"ing* progressive

dysphagia* muIed spee#h and possible trismusand dyspnea

3 +outes of entry( dire#t spread from theparapharyngeal spa#e* or lymphati# spread from

the paranasal sinuses or nasopharyngeal regionDia0*)sis3 !ronoun#ed s"elling in the oropharynx or

hypopharynx usually at prevertebral orparapharyngeal region

3 Leu&o#ytosis3 $ontrast $) s#an


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Figure 1,. Dulging of post. !haryngeal "all in xray3 NO)E( 7anger 'pa#e3 !otential 'pa#e* dangerous for rapid inferior

spread of infe#tion to the posterior mediastinumthrough its loose areolar tissue

% Bet&een retrophar ngea$ an" pre%'erte!ra$space

Figure 1-. 7anger spa#e #olored orange

3 +outes of entry( retropharyngeal*parapharyngeal* or prevertebral spa#es

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Treat2e*t3 'urgi#al in#ision and drainage under general

endotra#heal anesthesia3 )ransoral or external approa#h3 Antibioti#s3 'teroids3 ntubation or tra#heostomy

7,r)*i5 I*6a22ati)*s+ $hroni# !haryngitisEti)l)0y

3 Long term exposure to various noxious agents9ni#otine* al#ohol* #hemi#al* gaseous irritants:

3 $hroni# mouth breathing due to nasalobstru#tion

3 A##ompanying feature of #hroni# sinusitisSy2 t)2s

3 7ry3throat sensation "ith fre0uent throat#leaering and drainage of vis#ous mu#us

3 7ry #ough and foreign3body sensation in thepharyx

Dia0*)sis3 History3 !harygeal mu#osa appears red and grainy due

to the hyperplasia of lymphati# tissue on theposterior pharyngeal "all

3 n some #ases the mu#osa may appear smoothand shiny3 Nasal examination to ex#lude nasal air"ay

obstru#tionTreat2e*t

3 Avoid #ausing agents3 'age or #hamomile in steam inhalation to

moisten3 'urgery for those "ith nasal air"ay obstru#tion

7,r)*i5 I*6a22ati)*s+ $hroni# )onsillitisPat,)0e*esis

3 +e#urrent in%ammations of the tonsils andperitonsillar tissue #an lead to permanentstru#tural #hanges "ith s#arring

3 Da#teria #an gro" on #ellular debris in poorlydrained #rypts

Sy2 t)2s3 +e#urrent episodes of pain or asymptomati#3 Lethargy* poor appetite* bad taste in mouth and

fetid breath odorDia0*)sis

3 +eveals small* /rm immobile tonsils "ithasso#iated peritonsillar redness

3 O##asionally* purulent li0uid #an be expressedfrom the #rypts

3 'mears( group A 3hemolyti# strepto#o##i3 )onsillar lymph nodes may be enlarged3 Antistreptolysin titer P >> =mL

Treat2e*t3 )onsille#tomy

!eripheral Obstru#tive 'leep Apnea 'yndrome 9O'A':Eti)l)0y a*' Pat,)0e*esis

3 )enden#y for the velum* oropharynx* and=orhypopharynx to #ollapse during sleep narro"ingair"ay and #ausing periods of apnea orhypopnea

3 Fre0uent arousal from sleep and gasping for airpreventing normal sleep pattern

3 Long3term eBe#ts due to redu#tion in bloodoxygen levels "ith potential for damage to the#ardiopulmonary system

Si0*s i* t,e atie*t:s ,ist)ry t,at are su00esti(e)8 /SA

3 Loud* irregular snoring3 !eriods of apnea during sleep 9"itnessed:3 nusual daytime sleepiness or fatigue3 ntelle#tual deterioration 9poor #on#entration

and impaired memory:3 !ersonality #hanges3 Loss of libido* impoten#e3 Ny#turia* enuresis

)able 1. Fa#tors and $onditions that promote snoringand apnea

Classifcation Common Factors

!haryngealobstru#tion

Over"eight* obesity

Adenoids

)onsillar hyperplasia

)umors in oral #avity* pharynx*larynx* ne#&

7ysgnathia

A#romegaly

NasalObstru#tion

)urbinate hyperplasia

'eptal deviation

Nasal !olyps

7eformities of the external nose

)umors of the nose

7e#reasedMus#le )one

Al#ohol

Ni#otine

7rugs 9sedatives* hypnoti#s*mus#le relaxants:

'leep deprivation

'hift "or&

Other Se- ;2ale re')2i*ateere*tial Dia0*)sis )8 slee a *ea

3 O##asional or habitual nonobstru#tive snoring3 pper air"ay resistan#e syndrome3 Nar#olepsy3 nderlying hear disease "ith $heyne3'to&es

respiration3 No#turnal bron#hial asthma3 !eriodi# hypersomnia* hypersomnia# form of

endogenous depression3 nsomnia3 $hroni# al#ohol and drug abuse

Tu2)rs+ Denign )umors3 $an arise from all epithelial and mesen#hymal

tissues in the head and ne#& region3 !apillomas* pleomorphi# adenoma3 Fibromas* lipomas* #hondromas3 Hemangiomas and lymphangiomas

Treat2e*t3 6enerally surgi#al

3 Hemangiomas and lymphangiomas3 7ue to high rate of spontaneous remissionduring /rst years of life surgery is advised iftumor persist beyond that period or there arealready symptoms of dyspnea or dyphagia

Tu2)rs+ !re#an#erous Lesions%. Leu9) la9ia3 Most #ommon pre#an#erous lesion3 Asymptomati#3 Exogenous irritants su#h as denture pressure or

al#ohol=ni#otine abuse3 $omplete surgi#al removal

Figure 1 . Leu&opla&ia

!. 3)?e*:s Disease3 $hroni# in%ammatory disease #aused by an

intraepidermal #ar#inoma3 'imilar to leu&opla&ia

Tu2)rs+ Malignant )umors3 MaCority are s0uamous #ell #ar#inoma

3 @>? are lo#ated in the palatine tonsils or tonguebase3 Less #ommon sites are the soft palate and

posterior "all of the pharynxEti)l)0y

3 $hroni# ni#otine and al#ohol abuse3 'mo&eless toba##o use3 Detel nut use3 +everse smo&ing3 !oor oral hygiene* ill3/tting dentures

Sy2 t)2s3 'ome may remain #lini#ally silent3 7epend on lo#ation and extent3 7ysphagia* odynophagia3 Dlood3tinged saliva

3 Fetid breath odor3 trismus

Dia0*)sis3 )onsillar #ar#inoma may appear as exophyti#

lesions or an ul#erating in/ltrating type3 O##asionally not grossly visible3 $) and M+3 Diopsy

Treat2e*t3 For most #ases is surgi#al removal3 Ne#& disse#tion3 !ostoperative radiation3 Alternatively* primary radiotherapy or #ombined

radiation and #hemotherapy

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Figure 1


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THE SALIVARY GLANDS

T,e Ma4)r Sali(ary Gla*'s !arotid 'ubmandibular 'ublingual

There are 4 ma5orsa$i'ar g$an"s. The

paroti", su!man"i!u$ar an" su!$ingua$ g$an"s.These g$an"s a$ong&ith the numeroussma$$ g$an"sassociate" &ith theora$ ca'it , secretesa$i'a into the mouththru the "ucts (aftermechanica$, therma$,chemica$, ps chic, or

o$factor stimu$i "ue to presence, or anticipate" presence of foo")The minor sa$i'ar g$an"s($ocate" in the mucosa an"su!mucosa of the ora$ ca'it ) secrete 6%789 of the tota$

"ai$ sa$i'ar output, !ut the account for a!out 89 of the mucus secretion.

T,e Mi*)r Sali(ary Gla*'s Labial* bu##al* palatoglossal* palatal* and

lingual mu#osae Not present in gingivae and dorsum of

anterior ,=- of the tongue

EM3RY/L/GY 8 th 3@th ee&s of 6estationOral e#toderm!arotid First to develop Last to be#ome en#apsulatedAutonomi# Nervous 'ystem( $ru#ial

PAR/TID GLANDLargest; ,< grams

edge shaped 'uper/#ial

lobe 7eep lobe!arotid$ompartment 'uperior

Rygoma !osterior

EA$ nferior

'tyloid* $A* Sugular veins@>? overlies Masseter Mandible,>? +etromandibular7eep portion in #onta#t "ith parapharyngealspa#e!arapharyngeal 'pa#e !restyloid $ompartment

o Mus#les and fat !oststyloid $ompartment 9!aragangliomas:

o Neurovas#ular spa#eo S5* $A* #ranial nerves G to G

'tylomandibular ligamento separates parotid gland from

submandibular gland'tensen2s 7u#t Arises from anterior border ;131.< #m inferior to ygomati# ar#h !ier#es Du##inator at , nd upper molar 38 #m in length < mm in diameter$N 5 !es Anserinus

1.- #m )emperofa#ial

7ivision $ervi#ofa#ial

7ivision < )erminal

bran#heso )emporalo Rygomati#

-rosses the goma o'er the periosteum

o Du##alo Mandibularo $ervi#al

3ariations

Most common is t pe ;;; ( +9)Lo#ali ation of $N 5 )ragal pointer )ympanomastoid suture !osterior belly 7igastri# 'tyloid pro#ess +etrograde disse#tion Mastoide#tomyNeural #ompartment 5 * 6reat Auri#ular* Auri#ulotemporal

1>


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5enous #ompartment +etromandibular veinArterial #ompartment 'uper/#ial )emporal=)ransverse Fa#ial!arasympatheti# supply inferior salivatory nu#leusTglossopharyngeal

nerve then Sa#obson2s nerveToti# ganglion9synapses:

!ostganglioni# /bers 9auri#ulotemporalbran#h of 5-:Tgland

'ympatheti# 'upply 'pinal #ordTexit "ith superior thora#i#

nervesTsuperior #ervi#al ganglion !ostganglioni# /bersTarterial plexuses and

sensory nervesTsalivary and s"eat glandsand #utaneous blood vessels

!ostganglioni# sympatheti# andparasympatheti# nerves A#etyl#holine

/TI7 GANGLI/N S7HEMA

Lymphati#s !araparotid ntraparotid nodes 'uper/#ial 7eep $ervi#al nodes

SU3MANDI3ULAR GLAND )he U'ubmaxilla2'ubmandibular )riangleMylohyoid U$2Marginal Mandibular bran#h !asses through the super/#ial layer of deep

#ervi#al fas#ia and is dire#tly super/#ial tothe gland

$apsule from super/#ial layer of 7eep $ervi#alfas#ia

harton2s du#t Exits medial surfa#e Det"een Mylohyoid Hyoglossus < #m in length Opens lateral to the frenulum at %oor of

mouth Lingual nerve $N G

nnervation !arasympatheti#

o 'uperior salivatory nu#leus9pons:Tnervus intermedius and #hordatympani 9lingual nerve:Tsubmandibularganglion=gland

'ympatheti# 9superior #ervi#al ganglion:Artery( 'ubmental bran#h of Fa#ial a.5ein( Anterior Fa#ial v.Lymphati#s( 7eep $ervi#al and Sugular #hains Fa#ial artery nodes

SU3MANDI3ULAR GANGLI/N

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SU3LINGUAL GLANDDet"een Mandible 6enioglossusNo #apsule7u#ts of +ivinus V=3 Dartholin2s du#t'ialogram not possible

nnervation( 'ame as 'ubmandibularArtery=5ein( 'ublingual bran#h of Lingual 'ubmental bran#h of Fa#ialLymphati#s( 'ubmandibular nodes

Anatomy( 'ublingual 6land

Mi*)r Sali(ary Gla*'s

8>>31*>>>'imple du#tsDu##al* Labial* !alatal* Lingual

)umor sites( !alate* upper lip* #hee&Lingual !alatine nn.

I2a0i*0$) n%ammatoryM+ )umor$hildren( =' M+NO sialogram during a#tive infe#tion

Mi5r)a*at)2y )he 'e#retory nit 9MA 'E:

Myoepithelial #ells A#inus 9serous* mu#inous mixed: nter#alated du#t ' triated du#t

Ex#retory du#t

!arotid( serous #ells predominate'ubmandibular( mixed serous'ublingual( mixed mu#inousMinor salivary( seromu#inous'troma( !lasma #ells'triated nter#alated du#ts "ell developed inserous* NO) mu#ous glands'triated du#t( H$O- into* $l from lumen

nter#alated du#t( W into lumen* Na from lumen*produ#ing hypotoni# %uidEx#retory du#ts do NO) modify saliva

)he +eserve $ell= Di#ellular )heory nter#alated du#t

o 7iBerentiate into a#inar #ells*

inter#alated du#t #ells* striated du#t#ells* myoepithelial #ellso Adenoid #ysti# and a#ini# #ell #ar#inoma

Ex#retory du#t Ex#retory du#t #olumnar and s0uamous

#ells Mu#oepidermoid* s0uamous #ell #ar#inoma

)he Multi#ellular )heory Neoplasm arise from diBerentiated #ells

along the salivary unit '0uamous #ell $A from ex#retory du#t #ells4

a#ini# #ell #ar#inoma from a#inar #ells

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SALIVAFu*5ti)* )8 Sali(a

Lubri#ation Mu#in !hysi#al prote#tion of oral mu#osa

)asteAntiba#terial and immunity Lyso yme gA produ#ed by plasma #ells7igestion Amylase* lingual lipaseDuBering Minerals Helps in maintaining the integrity of enamel

ound healing and upper 6 mu#osal integrity Epidermal 6ro"th Fa#tor produ#ed and

se#reted by the submandibular salivaryglands

Dlood #oagulation Walli&rein

Sy*t,esis )8 Sali(aA#tive se#retory pro#ess

Not a blood ultra3/ltrate'erous #ells atery proteina#eous %uid #ontains

amylaseMu#ous #ells !roteins lin&ed to a greater amount of

#arbohydrates!lasma #ells gA

Pr)'u5ti)* )8 Sali(a!rimary se#retion7u#tal se#retion

)he se#retory potential 9hyperpolari es:n#reased %o" rate yields de#reased

hypotoni#ity W 'aliva is al"ays hypotoni# to plasma

Aut)*)2i5 I**er(ati)* !arasympatheti# Abundant* "atery saliva Amylase do"n'ympatheti# '#ant* vis#ous saliva Amylase up

Sali(ary Fl)?131.< L=day 91 ##=min:

nstimulated state 'ubmandibular'timulated state

!arotid'ublingual minor Mu#in

Fu*5ti)* )8 Sali(a'alivary hypofun#tion $andidiasis Durning Mouth Aphthous ul#ers 7ental #aries Gerostomia

1-


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EFFE7TS /F AGING )otal salivary %o" independent of ageA#inar #ells degenerate "ith age'ubmandibular gland more sensitive tometaboli#=physiologi# #hange

nstimulated salivary %o" more greatly aBe#tedby physiologi# #hanges

SUMMARY Par)ti' Su 2a*'i u

larSu li*0u

alA.L)5ati)*

belo"andanteriorto theear

%oor of themouthbeneath thebody of themandible

#olle#tionsofnumerousglandslying #loseto the

harton2sdu#t

3. Mai*Du5t

'tensen2s du#topensoppositethe , nd uppermolar

harton2sdu#t opensbeneath thetips of thetongue

open atthe base of the tongue

5. Ty e )8

Se5reti)*

serous mixed but

more serousarranged in#hara#teristi#s pattern 3serousdemilunes

mixed but

moremu#ous

D.Se5ret)ryPr)'u5t

highamylasea#tivity

"ea& amylasea#tivity

insigni/#ant

E.I*ter5alate'Du5ts &Striate'Du5ts

long prominent

shorter lessprominent

shortest leastprominentamong thethree

F. Si@e Largestsalivarygland,>3-> g

n bet"een1,31< g

'mallest,3- g

G. T)talsali(ary)ut ut

->? 8>?


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7 'EA'E' OF )HE 'AL 5A+X 6LAN7'

'ymptoms of 'alivary 6land 7isease!ain'"elling!urulent 7is#harge7ryness

!ainObstru#tion

At mealtimentermittent s"elling

nfe#tion'"elling

Neoplasmnilateral* non3painful* long term

Obstru#tionnilateral* painful* short term

'ystemi#bilateral

'ubmandibular 6land '"elling

!arotid 6land '"elling!urulent 7is#harge

nfe#tion!ossible obstru#tion

7ryness

Obstru#tion+adiation7ehydration$hroni# llness7rugs'CYgren2s 'yndrome

Evaluation and 7iagnosis!hysi#al Examination

Dimanual !alpationNormal Z non palpable

)enderness ; infe#tionFirm mass %oor of mouth

Amount of saliva$hara#ter of saliva

nfe#tion$ulture and sensitivity

'ialography'alivary #al#uli7u#tal stri#ture and irregularitiesFilling defe#tsA#inar destru#tion

I*'i5ati)*s+

1. !resen#e and = or position of #al#uli or otherblo#&ages

,. Extent of du#tal and glandular destru#tionse#ondary to an obstru#tion

-. )o determine the extent of glandular brea&do"n. Assessment of fun#tion in #ases of dry mouth


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Non3neoplasti# 'alivary 6land 7iseaseA. nfe#tious n%ammatoryD. Noninfe#tious n%ammatory$. Non in%ammatory

nfe#tious n%ammatory 7isease1. A#ute 5iral n%ammatory 7iseaseMumps 9paramyxovirus:3most #ommon

$hildren 38yon#ubation period 1 3,1 days 9#ontagious:

$lini#al /ndingsDilateral s"elling!ainErythema

)endernessFeverO##asional trismus

)reatment'elf3limiting'ymptomati#5a##ine

,. A#ute 'uppurative'ialadenitisDa#teria'tasis of salivary %o"7ehydration* immunosuppression* trauma*debilitation'"elling* erythema* pain* tenderness* trismus*purulent dis#hargeS. aureus, S. pneumoniae, . co$i,


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sialadenitis* sialolithiasis and radiationinCury

-. Mu#o#elesMu#ous retention #yst7ilatations of minor salivary gland du#ts

A##umulated mu#ous se#retionsMu#ous extravasation into the#onne#tive tissue

Fairly #ommon

Lip 98>3J>?:* bu##al mu#osa* %oor of mouth andpalate7iBerentials

$ysti# hygroma* lymphangioma*thyroglossal du#t #yst* dermoid #yst

$omplete surgi#al ex#ision+e#urren#es #an o##ur "ith inade0uate ex#ision

RANULA ;6))r )8 2)ut,

the pharynx and salivary glands

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