salivary gland diseases

1. By Priyankesh
1st year post graduate
Department of oral medicine and radiology

2. 
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Introducion
Evaluation of salivary gland
-clinical examination
-radiological evaluation
Classification of salivary gland diseases
-staging of salivary gland tumour
Description of salivary gland diseases
References

3. 
Salivary glands and saliva plays a very important role in maintaining oral
and systemic health.

Saliva is constituted by the secretions of the three paired major salivary
glands. It also contains the secretions of the minor salivary glands, of
which there are hundreds contained within the submucosa of the oral
mucosa and some gingival crevicular fluid.

Saliva aids in speech and deglutition and serves as a diagnostic fluid

4. 1.
2.
3.
4.
History : Symptoms indicative of salivary gland disorders are
limited in number and generally nonspecific. Patients usually
complain of swelling, pain, xerostomia, foul taste, and sometimes
excessive salivation.
Gender : sjogrens syndrome common in menopausal women
Age group : paramyxoviral infection is most common occurring in
the children between age group of 4-10 yrs.
Medical profile :-diabetes mellitus, arteriosclerosis, hormonal
imbalances and neurologic disturbances.

5. 4.
5.
6.
Drug history: xerostomia is often caused by the diuretics and antihypertensive drugs....
A careful dietary and nutrition history should be obtained. Patients who
are dehydrated chronically from bulimia or anorexia or during
chemotherapy are at risk for parotitis.
Swelling and pain during meals followed by a reduction in symptoms
after meals may indicate partial ductal stenosis.
7.
Radiation history
….
8.
Current medications …..

6. 
signs of mucosal dryness

Lips-cracked, peeling and atrophic

Buccal mucosa-pale and corrugated in appearance

Tongue-smooth and reddened

Marked increase in erosion and caries.

Erythematous form of candidiasis commonly occurs

Viscous,scant saliva suggest chronically reduced function

7. 
Visual examination by standing behind the Pt

Palpate the gland

Stand in front of pt

2-3 fingers over the posterior border of ascending ramus

Back word & inward movement with light pressure

Slightly rubbery Painless unless infected/inflamed

Check motor function of facial nerve

Intraoral examination to check papilla if inflamed

Compress the gland to see saliva flow

8. •Palpate below angle & body of mandible
•Bimanual palpation
•Intraoral examination to
check papilla if inflamed
•Compress the gland to see saliva

9. 
To measure salivary flow rate (resting / stimulated)

provide essential information for diagnostic and research purposes

Calculated from the individual major salivary gland or from a mixed
sample of the oral fluids, termed “whole saliva”.

10. 1.
Passive drool
2.
salimetrics oral swab
3.
Infant swab
4.
Spitting method
5.
Suction method

11. 
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Analyte
Passive
Drool
Aldosterone
yes
Alpha-amylase*
yes
Androstenedione
yes
Blood Contamination
yes
Chromogranin A
yes
Cortisol
yes
yes
Cotinine
yes
yes
C-Reactive Protein
yes
DHEA
yes
DHEA-S*
yes
Epstein-Barr Virus Antibody
Estradiol
yes
Estriol
yes
Estrone
yes
IL-1β
yes
yes
IL-6 yes
yes
Melatonin
yes
yes
Neopterin
yes
NGF
yes
17-OH Progesterone
yes
Progesterone
yes
Secretory IgA*
yes
yes
Testosterone
yes
yes
TNF-α
yes
Total Protein
yes
*Note: concentrations are affected by saliva flow rate
**Note: Levels are slightly higher, but highly correlated
SOS/SCS/SIS
yes
yes**
yes
yes
yes

12. 
Avoid having alchol,caffenine,prescribed medication 12 hours
before collection of saliva.

Avoid eating major meal within 60 min of sample collection
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Avoid dairy products for 20 min before sample collection .

Participants should not brush their teeth within 45 minutes prior
to sample collection.

13. 
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Rinse mouth with water to remove food residue before
sample collection. Wait at least 10 minutes after
rinsing before collecting saliva to avoid sample
dilution.
Also while pipetting saliva, greater accuracy is
obtained by aspirating slowly in order to avoid
formation of bubbles.

14. 
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Contamination of saliva samples with blood can also
be a concern
Blood can leak into saliva under certain conditions.
Dental work should not be performed within 24
hours prior to sample collection.
Research participants should be screened for oral
health problems or .
Saliva samples visibly contaminated with blood
should be discarded and recollected.

15. 
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Passive drool - highly recommended because it is both cost
effective and approved for use with almost all analytes. To avoid
problems with analyte retention or the introduction of
contaminants, use only high quality polypropylene vials for
collection .
The vials used must seal tight and be able to withstand
temperatures down to -80ºC.

16. 

participants should allow saliva to pool in the mouth.
Some find it helpful to imagine eating their favorite
food. At this time, unwrap the Saliva Collection Aid
(SCA) and insert it into the top of the cryovial .
With head tilted forward, participants should drool
down the SCA to collect saliva in the cryovial. (It is
normal for saliva to foam, so we advise using a vial
with twice the capacity of the desired sample volume.)

17. 
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an excellent alternative to passive drool .
SOS also helps filter large macro molecules and other
particulate matter from the sample.
Not recommended for children below 6 yrs of age.

19. 
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Carlson-Crittenden collector method used for individual gland.
Stimulated saliva is obtained by applying sialagogue as citric acid
to the dorsal surface of tongue.
Flow rate of the saliva is also affected by the many factors such as
patient position, hydration, diurnal variations ,time stimulation

Stimulated whole saliva flow rate <1.0ml/min

Unstimulated whole saliva flow rate <0.1 ml/min

20. 
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To differentiate inflammatory from neoplastic
diseases.
To differentiate from diffuse and focal
suppurative disease
To identify and localise sialoliths
To demonstrate ductal morphology

21. 1.
Plain-film radiography
2.
Sialography
3.
Ultrasonography
4.
Scintigraphy (Radioisotope imaging)
5.
Computed tomography (CT)
6.
Magnetic resonance (MRI)

22. 
1.
Used for calculi.
Parotid
1.
2.
2.
OPG / Oblique - lateral
Rotated anterior-posterior
Submandibular
1.
Occlusal
2.
OPG
3.
Lateral oblique

23. 
First mentioned by carpy in 1902.
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Barsony and uslenghi –a diagnostic tool in 1925.
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It is specialised radiographic view of salivary gland taken by
introduction of soluble contrast media into the ductal system.the
radiographs are called sialographs.
Recommended method for intrinsic & acquired abnormalities of ductal
system.
Helps in viewing –ductal stricture
- obstruction
- dilatation
- ductal rupture
- stones

24. 
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Oil & water based contrast media is available.
Demonstrate 3 phases:
1.
Preoperatively
2.
3.
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Filling phase
Emptying phase
C.I - allergy to contrast media
- active infection
- patient with iodine sensitive

25. 
Disadvantages:
Irradiation dose

High skill is needed to conduct the procedure
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Pain with procedure

Possible perforation

Might force bacteria throughout the ductal structure.

26. 
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dynamic & minimal invasive diagnostic technique.
Technetium is a pure gamma ray-emitting radionuclide taken up
by the salivary gland, transported through the glands and then
secreted into oral cavity.
Uptake of Tc 99m indicated presence of epithelial tissue present.
Serves as a measurement of fluid movement in salivary acinar
cells.

27. 
Pass through 3 stages:
1.
Flow phase 15-20 sec
2.
Concentration phase up to 10-15
min
Symmetrical distribution in parotid,
submandibular
3.
Washout phase
Pt is given a lemon juice drop
Prompt, uniform & symmetric emptying

28. 
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Non-invasive & cost effective imaging modality used in the
evaluation of masses occurring in superficial lobe of parotid
gland.
Indicated :intra & extra glandular masses.
solid & cystic lesion.
Recent studies have established sonographic diagnostic criteria for
sjogren‟s syndrome.

29. 
Shows superficial part of gland
Echogenic sialolith
Hypoechoic benign tumour

30. 
Indications:
1.
2.

Osseous erosions & sclerosis
3.

Sialolith
To differentiate cysts from abscess
Retromandibular vein,carotid artery
& deep lymph nodes are identified.
Especially useful in inflammatory
condtions associated with sialoliths.

31. 
Advantages :-
1.
excellent ability to differentiate soft tissue .
2.
Provide multiplanar imaging.
3.
No exposure to radiation
4.
No intravenous contrast media required.
5.
Minimal artifact from dental restorations.

32. Imaging Modality
Indications
Advantages
Disadvantages
Ultrasonography
Biopsy guidance; mass
detection
Noninvasive; costeffective
limited visibility of deeper
portions of gland; no
morphologic information
Sialography
Stone, stricture; R/O
autoimmune orradiationinduced sialadenitis
Visualizes ductal
anatomy/blockage
Invasive; requires iodine
dye; no quantification
Radionuclide imaging
R/O autoimmune
sialadenitis; sialosis,
tumor
Quantification of function
Radiation exposure; no
morphologic information
Computed tomography
R/O calcified structure;
tumor
Differentiates osseous
structures from soft tissue
No quantification;
contrast dye injection;
radiation exposure
Magnetic resonance
imaging
R/O soft-tissue lesion
Soft-tissue resolution
excellent, with ability to
differentiate osseousstructures from soft tissue;
Dental scatter;
contraindicated with por
metal implant; no
quantificationace maker

33. •
•
•
•
•
Developmental disturbances
Saliva and salivary flow
Inflammatory condition
Non inflammatory condition
Tumors

34. •
Aplasia/Agenesis
•
Hyperplasia of minor salivary glands

35. •
•
•
•
•
Saliva
Hypofunction
Xerostomia & salivary gland hypofunction due
to medicaions/radiations
Sjogren syndrome
Benign lymphoepithelial lesion

36. 
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Mucocele
Ranula
Sialolithiasis
Sialadenstis
Non specific sialadenitis
Bacterial sialadenitis
Sub acute necrotizing sialadenitis
Necrostizing sialometaplasia
Mumps

37. 
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Sialadenosis
Anorexia-related sialadnosis
Sialadenosis associated with alcoholic cirrhosis
diabetes mellitus
Medication –induced sialadenosis
sarcoidosis

38. 
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Plemorphic adenoma
Canalicular adenoma
Basal cell adenoma
Papillary cystadenoma lumphomatosum
(warthin‟s tumour)

39. 
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Mucoepidermoid carcinoma
Acinic cell mucoepidermoid carcinoma
Acinic cell carcinoma
Malignant mixed tumor
Metasizing mixed tumor

40. Congenital absence of salivary gland
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Aplasia occurs in combination with congnital anomalies such as
LADD SYNDROME,TREACHERS COLLINS

Hypoplasia in patient with melkerson rosenthal syndrome.
Clinical feature
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one or group of gland missing unilaterally or bilaterally
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Xerostomia
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Dental caries

Dry n smooth oral mucosa


41. Causes:
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hormonal & metabolic
Usually occurs at minor salivary gland of he
palate
Asymptomatic
surface firm, sessile & normal in colour.

42. aberrant salivary gland
 an aberrant or ectopic salivary gland is a
salivary gland tissue that develops at a site
where it is not normally found.
Clinical feature
 Site- cervical region near parotid gland or he
body of mandible
 No clinical signifiance
 Usually its site for development of retention
cyst or neoplasm.

43. 
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Congenital occlusion or absence of one or two
major salivary gland
Site-submandibular duct in the floor of the
mouth.
Causes severe xerostomia

44. Sialorrhea
 Increase in salivary secretion.
 Stimulation of parasympathetic causes profuse
secretion of saliva.
Clinical feature
 Drooling from mouth
 Occurs with various neurologic disorder
 Traumatic ulceration.
 Heavy metal poisiong.
 Drug induced as anti-pshycotic.
 Gastroesophagel reflux
 pregnancy

45. Medications that can cause overproduction of saliva include:

clozapine
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pilocarpine
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ketamine
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potassium chlorate
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Risperidone.
Metals that can cause hypersalivation include:
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iron
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lead
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Mercury
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Arsenic
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Thallium
Neurologic diseases
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Parkinson‟s diseases
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Wilson‟s diseases
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Down syndrome
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Cerebral palsy
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Fragile Xsyndrome

autism

46. 
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Pharmaceuticals
External beam irradiation to the head and neck and internal
radionuclides (eg, 131I)
Systemic diseases
Sjögren syndrome, primary and secondary
Granulomatous diseases (sarcoidosis, tuberculosis)
Graft-versus-host disease
Cystic fibrosis
Bell palsy
Diabetes (uncontrolled)
Amyloidosis
Human immunodeficiency virus infection
Thyroid disease (hypo- and hyperthyroidism)
Late-stage liver disease
Salivary gland disease (tumors)
Psychologic factors (anxiety,depression)
Malnutrition (anorexia, bulemia, dehydration)
Idiopathic

47. 
Dryness of the mouth .
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Not associated with salivary hypofunction
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Sensory or cognitive disorders
Pt usually complains of bad taste, abnormal
sensation, burning mouth
Associated with salivary hypofunction

Need to investigate causes of hypofunction

48. History:
1.
Does the amount of saliva in your mouth feel too
little? Too much? Not notice it?
1.
Does your mouth feel dry while eating?
2.
Do you frequently sip liquids while eating?
3.
Do you have difficulties swallowing food?

49. Symptoms

Thirst
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Difficulty eating, speaking, wearing denture
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Need sips of water while eating

Soreness and Burning sensation of mouth

Abnormal taste & halitosis
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Cracked lips and soreness of corners of mouth

Dry, atrophic, pale and translucent mucosa

50. Preventive therapy
1.
1.
2.
Flouride rinses & gel
Oral hygiene
Symptomatic treatment
2.
1.
2.

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Water
Artificial saliva
Avoid products containing sugar, alcohol
Vaseline ointment to relief cracking
Topical antifungal
Regular check ups
Salivary stimulation
3.
1.
Local / topical stimulation (detectable salivary gland function)
1.
2.
Chewing (flavoured, sugar free, xylitol)
Systemic stimulation (Pilocarpine).

51. Submandibular salivary gland is common site of calculus
formation mainly because of the saliva flowing against
gravity.
Stone composition:
 Organic- glycoproteins.,
Inorganic - Calcium carbonate,
Mucopolysaccarides
calcium phosphates in the
bacteria,
form of hydroxyapatite
cellular debris .

52. The exact mechanism of stone formation is unclear, but it
appears to be related to the following conditions:
 Salivary stagnation-inflammation,irregularities in the duct
system,local irritants and anticholinergic medications


Epithelial injury along the duct- sialolith formation, which
acts as a nidus for further stone formation
Precipitation of calcium salts, altered salivary hydrogen
ion concentraion.

53. sialolithiasis more often in submandibular gland saliva
a.more alkaline.
b.Higher concentration of calcium and phosphate in the
saliva
c.Higher mucous content
d.Longer duct
e.Anti gravity flow
Treatment:
 Acute infections-antibiotics. Stones in the distal
portion of duct can often be removed manually.
 Deeper stones require surgery. Lithotripsy has been
described as a non-invasive method of disintegrating
sialoliths

54. 
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Reduced salivary gland function.
Also referred as surgical parotitis.
More frequently occurrence involving parotid
gland.
clinical feature
Unilateral or bilateral salivary gland
enlargement
Indurated, painful and tender to palpation.
Overlying skin-erythematous
Purulent discharge may be expressed from
duct orifice.

55. 
Treatment


Antibiotics after culture and sensitivity,
Milk the gland several times a day (not during acute
phase)
Increase hydration & use of Sialogogue
 Improve oral hygiene
 Remove predisposing factor if possible (calculus)
 Excision of severely damaged gland (chronic/
recurrent)


56. 
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Painless non-inflammatory, non-neoplastic
swelling of salivary glands
Parotid is most commonly affected and
commonly bilateral
Unknown mechanism
Histologically presented as hypertrophy of
serous acini

57. 
Predisposing factors:
1.
Drug induced (antirheumatic, idoine containing
drugs, adrenergic)
2.
Hormonal (Diabetes, acromegaly)
3.
Nutritional deficiency induced by anorexia nervosa
4.
Chronic alcoholism
5.
Medication induced salivary dysfunction

58. 
Management:
1.
Detailed drug history
2.
Liver function test
3.
Blood glucose level
4.
Growth hormone level
5.
CBC and full blood investigation

59. 


Non neoplastic inflammatory self healing reaction of salivary gland
tissue, which both clinically and histologically mimics a salivary
gland malignancy.
Etiology: trauma
radiation
vascular ischemia
tobacco use.
C/F: The lesion generally presents as an ulcer
Seen- Posterior hardpalate, is due to necrosis of
minor saliary glands.

60. Chronic granulomatous disorder affecting
several organs


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Lungs
Skin
Eyes
Parotid glands
Severity and duration of disease varies
Saliva flow would be affected
Mild improvement noticed with steroid
therapy

61. Swelling caused by the pooling of saliva at the site of
injuries salivary gland.
 Mucus extravasation cyst-spillage of mucin into the
surrounding tissues.
Clinical feature
 Site inner aspect of lower lip,floor of the mouth,tongue
 Painless swelling which frequently reoccurs.


Fluctuant,dome shaped,non ulcerated.

63. 
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Latin rana means frog, and a ranula- a frog's underbelly.
Term used for mucocele for the floor of the mouth.
Associated with ducts from the submandibular or sublingul
gland.
Spherical or dome shaped.
Translucent blue colour in apperance .
Can cause elevation of the tongue.
Slow enlarging swelling on the floor of the mouth can
cause difficulty in speech or eating.
When deep lesion tat herniates through mylohyoid muscle
and extend along the fascial planes it is referred plunging
ranula.

64. Contagious viral infection caused by para myxo virus.

The more common symptoms of mumps are:Parotid
inflammation in 60–70% of infections.
 The incubation period(time until symptoms begin) can be
from 14–25 days

Parotitis causes swelling and local pain, particularly when
chewing
Clinical feature
 Unilateral or bilateral parotid enlargement gland.
 Fever ,headache, malaise or anorexia
 Pain below the ear.
 Glands are tender on percussion.


65. 

Chronic autoimmune disease affecting exocrine glands,primarily
salivary and lacrimal glands.
It can exist as a disorder in its own right (Primary Sjögren's
syndrome) or it may develop years after and associated rheumatic
disorder such as rheumatoid arthritis,SLE, scleroderma, primary
biliary cirrhosis etc (Secondary Sjögren's syndrome).

66. Clinical feature

Persistent xerostomia & keratoconjunctivits sicca.

Hyposalivation or reduced salivary flow rate.

Thick or frothy saliva

Difficulty in chewing and swallowing, wearing denture

Dryness of eyes.

67. Revised International Classification Criteria for
Sjogren’s syndrome:
Criteria
I Ocular symptoms: at least one of the following

1. Daily dry eyes for >3 months

2. Persistent sensation of sand or gravel

3. Use of tear substitutes >3 times daily
II Oral symptoms: at least one of the following

1. Dry mouth daily >3 months

2. Recurrent salivary gland swellings

3. Use of liquid to aid in swallowing food
II Ocular signs: at least one of the following

I1. Schirmer‟s I test (5 mm in 5 min)

2. Rose Bengal score (4)
IV Histopathology: focal lymphocytic sialoadenitis with focus

score 1 per 4 mm2 of tissue
V Salivary gland involvement: at least one of the following

1. Unstimulated salivary flow 1.5 ml ⁄ 15 min

2. Abnormal parotid sialography

3. Abnormal salivary scintigraphy
VI Autoantibodies

68. Testing for opthalmic involvement

Schirmer‟s I test: quantitative measure of tear production over a
specific period of time
Rose Bengal eye stain: reveals breaks in the corneal-epithelial surface

to evaluate ocular surface irritation

Patient history of opthalmic symptoms
Testing for oral involvement

Salivary sialometry: low salivary flow is defined as less than 1.5 ml
of saliva per 15 minutes

Labial minor salivary gland biopsy: showing lymphocytic
sialoadenitis with a focus score of ‡1 per 4 mm2 of tissue

Examination for salivary gland enlargement: parotid and ⁄ or
submandibular

Patient history of oral symptoms
Systemic tests

Presence of auto antibodies.

Presence of rheumatoid factor in patients serum
BK ayetto, RM Logan,Sjogren‟s syndrome: a review of aetiology,
pathogenesis,diagnosis and management, Australian Dental Journal 2010;
55:(1 Suppl): 39–47

69. Treatment:
- Treat recurrent infection
- Salivary substitutes/sprays
- cholinergic drugs (Pilocarpine)
- Avoid alcohol, tobacco.
- Immunosuppressive therapy; corticosteroids or
cytotoxic drug have been proven effective.

70. 


uveitis, parotid swelling, and facial nerve paralysis.
It usually begins with a prodrome of constitutional
symptoms and involvement of the submandibular,
sublingual, and lacrimal glands may occur. last
months to years and resolves spontaneously.
Treatment is usually symptomatic with steroids being
most beneficial when administered in the acute phase
of the illness

71. Benign tumors with low propensity for recurrence
Oncocytoma
Papillary cystadenoma lymphomatosum
Basal cell adenoma
Canalicular adenoma
Benign tumors with a propensity for recurrence
Pleomorphic adenoma (major glands)
Malignant tumors with high-grade behavior
Adenoid cystic carcinoma
Salivary duct carcinoma
Epithelial-myoepithelial carcinoma of intercalated ducts
High-grade mucoepidermoid carcinoma
Squamous cell carcinoma of salivary origin
Malignant tumors with low-grade behavior
Polymorphous low-grade adenocarcinomas
Low- and intermediate-grade mucoepidermoid carcinoma
Cystadenocarcinomas

72. 
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Tx
To
T1
T2
T3
T4
Primary tumor can not be assessed
No evidence of primary tumor
Tumor < 2 cm in greatest dimension
Tumor 2–4 cm in greatest dimension
Tumor 4–6 cm in greatest dimension
Tumor >6 cm in greatest dimension
T=
N=
tumour size well as
extension into adjacent tissue
Nodal involvement
Nx Regional nodes cannot be assessed
M= Metastases
N0 No regional lymph node metastases
N1 Single ipsilateral node < 3 cm in diameter
N2a Single ipsilateral node 3–6 cm in diameter
N2b Multiple ipsilateral node, none > 6 cm
N2C Bilateral or contralateral nodes, none > 6 cm
N3 Metastasis in a lymph node > 6 cm
Mx
Presence of distant metastases cannot be assessed
M0 No distant metastases
M1
Distant metastases

73. 



Stage I
T1a
T2a
T1b
T2b
T3a
T3b
T4a
N0
M0
N0
M0
Stage II
N0
M0
N0
M0
N0
M0
Stage III
N0
M0
N0
M0
Any T (except T4b) Nl
M0
Stage IV
T4b
Any N
M0
Any T
N2N3
M0
Any T
Any N
M1
Adapted from the American Joint Committee for Cancer
Staging and End Results

74. Also called benign mixed tumour
 Most common salivary neoplasm. can involve any major or minor
salivary gland
Clinical feature
 Seen 4th-6th decade of life.
 Slight female predilection.
 Slow- growing, painless, firm n non –tender
 Mobile in early stages. with increases in size irregular n nodular
upon palpation.
 Intermittent growth period.
 Histologically epithelial cells make up a
Trabecular patterncalled stroma


75. Treatment:
The treatment for salivary gland tumor is
surgical resection.
Benign tumors of the parotid gland are treated
with superficial or total parotidectomy

76. 






PAPILLARY CYSTADENOMA
LYMPHOMATOISM/adenolymphoma
Type of benign tumor of the parotid gland.
etiology is unknown, but there is a strong association with
cigarette smoking.
clinical feature:
Parotid gland.
(age 50–70years), male predilection.
slow growing, painless, and usually appears in the tail of the
parotid gland near the angle of the mandible.
Painless until superinfected.
Visible on Tc 99m scintiscans.

77. TREATMENT
 Most of these tumors are treated with surgical
removal.
 Superficial parotidectomy in case of large
tumours.

78. 


Differentiated from mixed tumour:
monophasic histology
composed of cells of one type.
absence of connective tissue changes.
But in cases where background stroma contains myxoid,
chondroid, or mesenchymal derivatives, the term
„monomorphic‟ should not be applied rather „mixed
tumor‟ should be used.

79. 





Clinical features:
Male predilection.
primarily in major salivary gland –
parotid.
painless, slow growing, firm
swelling which may be cystic and
compressable.
Upper lip -the most common site
Neoplasm of uniform population
of basaloid epithelial cells arranged
in soild, tubular,or trabecular
patterns.

80. 
Cannot be distinguished from mixed tumor. Although,
BCA may be found in all salivary gland preferably
parotid, and minor salivary glands of upper lip
Histological features:
 1)Solid type
 2)Tubular
 3)Trabecular type
 4)Membranous type
 Consist of island or sheets of basaloid sheets.
TREATMENT:
Excision. Recurrence is seldom seen.

81. 








most common type of malignant salivary gland tumour.
clinical feature
painful and ulceration of overlying tissue.
Female predilection.
Extra orally – parotid gland is affected.
Intra orally - palate
Presents as painless, slow-growing mass that is firm or
hard.
Metastasis is seen in high grade tumour.
Poor prognosis.
Tumour is composed of mucus – secreting cells and
epidermoid type of cells in varying proportions

82. TREATMENT:
Malignant salivary tumors
usually require wide local
resection of the primary
tumor.An adjuvant
radiotherapy should be added
to improve local control.

83. Second most common malignant salivary gland tumor o occur in
children.
Clinical feature:

90-95%locted in parotid gland

Encapsulated

Female predilecion.

Superficial lobe and inferior lobe of parotid gland are common site
of occurrence.

Slow growing, mobile / fixed mass, asymptomatic.

Facial muscle weakness reported.

Characterized by the late distant metastasis and local
reoccurences.
h/f:
Cells – acinar differentiation ie, duct formation.


84. Treatment:
Surgical excision.
Poor prognosis include gross invasion,painor fixation, atypia.

85. 



Rare type of CANCER that can exist in many different body sites.
It most often occurs in the areas of the head and neck, in particular the
salivary glands.
Patients may survive for years with metastases because this tumor is
generally well-differentiated and slow growing.
It is the second most common malignant salivary gland tumor overall
(after mucoepidermoid carcinoma)

86. TREATMENT
Primary treatment -surgical removal with clean margins.
Paliative radiotherapy is commonly given following
surgery.

87. 






Malignant epithelial neoplasm of major salivary gland, composed of
squamous cells.
C/f
Mostly occurs in parotid gland.
Previous exposure to ionizing radiation, increases the risk
present as a firm enlarging mass that is not uncommonly fixed to the
surrounding tissue.
Pain , facial weakness present.
Tumor most commonly seen in plummer vision syn.
Histological findings:

presence of neoplastic squamous cells.
Metaplastic changes, with varying degree of nuclear a typia.
Treatment :

Surgical resection.

Prognosis poor.


90. 
General anatomy of head and neck Chaurasia

Oral medicine Burkits

Oral medicine ravikiran ongole

Oral pathology shafers

ANATOMY AND PHYSIOLOGY OF THE SALIVARY GLANDS Resident
Physician: Frederick S. Rosen, MD Faculty Physician: Byron J. Bailey, MD ,
January 24, 2001

The Pathology of the Salivary GlandsR. A. Cawson, M. J. Gleeson, J. W. Eveson

The Journal of Contemporary Dental Practice, Volume 9, No. 3, March 1, 2008

The anatomy and physiology of salivary glands by Helen Whelton