Inflammatory diseases of salivary glands Flashcards
The most common cause of bilateral enlargement of the parotid gland and causative pathogen
Mumps
Parmyxovirus
Symptoms of mumps
include swelling of the gland, pain, erythema and swelling of the duct, without purulent secretions and displacement of the auricle
Glands involved in mumps
The parotid glands primarily, but the submandibular and sublingual glands may be involved on occasion
Mumps immunisation given to children after 12 months of age.
Live attenuated mumps vaccine as part of mumps, measles and rubella
Aetiology of Acute bacterial infections of salivary glands
by retrograde transmission of bacteria from the oral cavity or by stasis of salivary flow
Clinical features of Acute bacterial infections
pain, swollen gland, pyrexia, and systemic upset.
The skin above the gland may be erythematous and fluctuation may be felt.
The purulent exsudate can be seen coming from the opening of the duct, which is erythematous and oedematous; trismus may be present
Acute parotitis commonly affects
older, weakened, dehydrated patients with poor oral hygiene
The most common microorganism causing acute bacterial parotitis
Staphylococcus aureus
Chronic sialadenitis
Characterised by recurring inflammation and swelling of the gland, minor pain, and sialorrhoea (which may be slightly purulent)
usual infecting microorganism in Chronic sialadenitis
Streptococcus viridans
Common symptoms of Chronic sialadenitis
pain and swelling after a meal. Trismus
Sialosis
Diffuse, non-inflammatory, non-neoplastic recurrent enlargement of the major salivary glands
A variety of systemic causes of sialosis
Sjögren’s syndrome
Mikulicz disease
Heerfordt syndrome
Sjögren’s syndrome
chronic autoimmune disorder of many organ systems, including the exocrine glands, which affects predominantly the salivary glands
Sx of Sjögren’s syndrome
Xerostomia (dry mouth) and keratoconjuctivitis sicca (dry eyes) are characteristic;
diffuse enlargement of the parotid gland affects a large number of patients.
chronic recurring joint disorders,
rheumatic purpura,
periarteritis nodosa
and scleroderma
Treatment of Sjögren’s syndrome
Symptomatic
Dx. of Sjögren’s syndrome
according to clinical findings supplemented by biopsy of the mucous gland of the lower lip
Mikulicz disease
affects salivary and lacrimal glands, but it is not systemic. It is characterised by slow-growing, soft, painless swelling of the parotid gland
Mikulicz syndrome
symmetrical swelling of salivary and lacrimal glands and any of the following:
lymphadenopathy,
chronic lymphatic leukaemia,
Hodgkin’s and non-Hodgkin’s lymphoma, and
haematogenous metastases
Heerfordt syndrome
parotid swelling and swelling of the lacrimal glands,
facial nerve paralysis,
uveitis,
and meningoencephalitis
Pathogenesis of Heerfordt syndrome
and treatment
sarcoid tissue changes in the gland parenchyma. Steroids are used for treatment.
Sialolithiasis
formation of calculi within the salivary gland or duct into which the salivary gland drains
%s of which glands are affected by Sialolithiasis
(85% of cases in the submandibular gland, 15% in the parotid gland)
Salivary duct calculi
accumulation of calcium and phosphate crystals
Aetiology and pathogenesis of Sialolithiasis
when the water content of saliva is decreased.
Certain medications also predispose to the formation of calculi.
These medications include antihistamines, antidepressants and diuretics
Clinical feaTures of Sialolithiasis
Pain and swelling of the affected gland are typical. The pain usually worsens at mealtimes, when more saliva is produced
Treatment of Sialolithiasis
The calculus may be pushed or milked out of the duct by a firm massage if it is small enough.
However, for larger calculi that cannot completely pass from the opening of the duct, a small incision may be made to remove it or the salivary duct may be probed
extraction and excision
