PAROTID & SALIVARY PAROTID & SALIVARY GLANDSGLANDS

Dr. Hiwa Omer AhmedDr. Hiwa Omer AhmedAssistant professor in General Assistant professor in General

SurgerySurgery

anatomyanatomyThere are three main paired glands in the There are three main paired glands in the head and neck producing saliva. They are head and neck producing saliva. They are

the:the:parotid glands parotid glands

submandibular glands submandibular glands sublingual glands sublingual glands

The parotid glands are the largest and The parotid glands are the largest and overlie the angle of the jaw in front of the overlie the angle of the jaw in front of the

ear. A tube, known as Stensens duct, ear. A tube, known as Stensens duct, drains saliva from the glands into the drains saliva from the glands into the

mouth. The openings are inside the cheek mouth. The openings are inside the cheek opposite the upper molar teeth.opposite the upper molar teeth.

Areas of parotidAreas of parotid

anatomyanatomy

anatomyanatomy

parotidparotid

Facial palsyFacial palsy

anatomyanatomy The submandibular glands lie deep to the The submandibular glands lie deep to the

horizontal part of the lower jaw. Their ducts are horizontal part of the lower jaw. Their ducts are the longest and narrowest of all the salivary the longest and narrowest of all the salivary glands, and enter the mouth under the front of glands, and enter the mouth under the front of the tongue.the tongue.

The sublingual glands lie deep in the lining of the The sublingual glands lie deep in the lining of the mouth on each side of the tongue. These glands mouth on each side of the tongue. These glands have many short ducts entering the mouth have many short ducts entering the mouth directly through the mouth lining.directly through the mouth lining.

In addition to these major glands there are In addition to these major glands there are hundreds of minor salivary glands throughout the hundreds of minor salivary glands throughout the lining of the mouth and throat, with most on the lining of the mouth and throat, with most on the lips and soft palate lips and soft palate

physiologyphysiologySalivary glands produce saliva in Salivary glands produce saliva in

response to food being placed in the response to food being placed in the mouth. Even the thought or smell of mouth. Even the thought or smell of food can stimulate salivary flow and food can stimulate salivary flow and most people make about one litre of most people make about one litre of saliva per day. As well being 99.5% saliva per day. As well being 99.5% water, saliva has minerals and water, saliva has minerals and proteins that aid digestion and keep proteins that aid digestion and keep the mouth and teeth healthy. the mouth and teeth healthy.

Mumps & parotitisMumps & parotitisMumps is a viral infection that Mumps is a viral infection that

primarily affects the parotid primarily affects the parotid glands — one of three pairs of glands — one of three pairs of salivary glands, located below salivary glands, located below

and in front of your ears. and in front of your ears. It can cause swelling in one or It can cause swelling in one or both parotid glands both parotid glands

MumpsMumps

parotitisparotitis

Signs and symptomsSigns and symptoms About one-third of people infected with the About one-third of people infected with the

mumps virus have no signs or symptoms. mumps virus have no signs or symptoms. When signs and symptoms do develop, they When signs and symptoms do develop, they usually appear about two to three weeks usually appear about two to three weeks after exposure to the virus and may include:after exposure to the virus and may include:

Swollen, painful salivary glands on one or Swollen, painful salivary glands on one or both sides of the face both sides of the face

Pain with chewing or swallowing Pain with chewing or swallowing Fever Fever Weakness and fatigue Weakness and fatigue Tenderness and swelling of a testicle Tenderness and swelling of a testicle

(orchitis) (orchitis)

ComplicationsComplications

Complications of mumps are potentially serious, but Complications of mumps are potentially serious, but rare. These include:rare. These include:

Orchitis.Orchitis. This inflammatory condition causes This inflammatory condition causes swelling of one or both testicles. Orchitis is painful, swelling of one or both testicles. Orchitis is painful, but it rarely leads to sterility — the inability to but it rarely leads to sterility — the inability to conceive a child. conceive a child.

Pancreatitis.Pancreatitis. This disease causes swelling of the This disease causes swelling of the pancreas. Signs and symptoms of pancreatitis pancreas. Signs and symptoms of pancreatitis include pain in the upper abdomen, nausea and include pain in the upper abdomen, nausea and vomiting. vomiting.

Encephalitis.Encephalitis. Encephalitis is inflammation of the Encephalitis is inflammation of the brain caused by a viral infection, such as mumps. brain caused by a viral infection, such as mumps. Encephalitis can lead to neurologic problems and Encephalitis can lead to neurologic problems and become life-threatening. Although it's serious, become life-threatening. Although it's serious, encephalitis is a rare complication of mumps. encephalitis is a rare complication of mumps.

ComplicationsComplications

Meningitis.Meningitis. Meningitis is infection and Meningitis is infection and inflammation of the membranes and fluid inflammation of the membranes and fluid surrounding your brain and spinal cord. It can surrounding your brain and spinal cord. It can occur if the mumps virus spreads through your occur if the mumps virus spreads through your bloodstream to infect your central nervous bloodstream to infect your central nervous system. Like encephalitis, meningitis is a rare system. Like encephalitis, meningitis is a rare complication of mumps. complication of mumps.

Inflammation of the ovaries.Inflammation of the ovaries. Pain in the lower Pain in the lower abdomen in women may be a symptom of this abdomen in women may be a symptom of this problem. Fertility doesn't seem to be affected. problem. Fertility doesn't seem to be affected.

Hearing loss.Hearing loss. In rare cases, mumps can cause In rare cases, mumps can cause temporary or permanent hearing loss in one or temporary or permanent hearing loss in one or both ears. both ears.

PreventionPrevention

In general, you're considered immune to In general, you're considered immune to mumps if you've previously had the infection mumps if you've previously had the infection or if you've been immunized against mumps.or if you've been immunized against mumps.

The mumps vaccine is usually given as a The mumps vaccine is usually given as a combined measles-mumps-rubella (MMR) combined measles-mumps-rubella (MMR) inoculation, which contains the safest and inoculation, which contains the safest and most effective form of each vaccine. Doctors most effective form of each vaccine. Doctors recommend that children receive the MMR recommend that children receive the MMR vaccine between 12 and 15 months of age, vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — and again between 3 and 6 years of age — before entering school.before entering school.

TreatmentTreatment Because mumps is caused by a virus, Because mumps is caused by a virus,

antibiotics are not an effective antibiotics are not an effective treatment.treatment.

Like most viral illnesses, mumps Like most viral illnesses, mumps infection must simply run its course. infection must simply run its course. Fortunately, most children and adults Fortunately, most children and adults recover from an uncomplicated case recover from an uncomplicated case of mumps within two weeks' timeof mumps within two weeks' time

TreatmentTreatment If you or your child has mumps, time and If you or your child has mumps, time and

rest are the best treatments. There's little rest are the best treatments. There's little your doctor can do to speed recovery. But your doctor can do to speed recovery. But you can take some steps to ease pain and you can take some steps to ease pain and discomfort and keep others from becoming discomfort and keep others from becoming infected:infected:

Rest in bed until the fever goes away. Rest in bed until the fever goes away. Isolate yourself or your child to prevent Isolate yourself or your child to prevent

spreading the disease to others. spreading the disease to others. Take acetaminophen (Tylenol, others) or a Take acetaminophen (Tylenol, others) or a

nonsteroidal anti-inflammatory drug such as nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin, others) to ease ibuprofen (Advil, Motrin, others) to ease symptoms. Adults may also use aspirin. symptoms. Adults may also use aspirin. Don't give aspirin to children because of the Don't give aspirin to children because of the risk of Reye's syndrome, a rare but risk of Reye's syndrome, a rare but potentially fatal disease. potentially fatal disease.

Self-careSelf-care Use a cold compress to ease the pain of Use a cold compress to ease the pain of

swollen glands. swollen glands. Wear an athletic supporter to ease the Wear an athletic supporter to ease the

pain of tender testicles. pain of tender testicles. Avoid foods that require lots of chewing. Avoid foods that require lots of chewing.

Instead, try broth-based soups or soft Instead, try broth-based soups or soft foods, such as mashed potatoes or cooked foods, such as mashed potatoes or cooked oatmeal, for nourishment. oatmeal, for nourishment.

Avoid sour foods such as citrus fruits or Avoid sour foods such as citrus fruits or juices that stimulate saliva production. juices that stimulate saliva production.

Drink plenty of fluids. Drink plenty of fluids. Plan low-key activities. Plan low-key activities.

SALIVARY STONESSALIVARY STONES There are three main salivary glands in There are three main salivary glands in

the head and neck and hundreds of tiny the head and neck and hundreds of tiny ones. Stones usually occur in the ones. Stones usually occur in the submandibular glands, less frequently submandibular glands, less frequently in the parotid gland and very rarely in in the parotid gland and very rarely in the sublingual and minor salivary the sublingual and minor salivary glands. glands.

Stones form from mineral deposits in Stones form from mineral deposits in the gland ducts, causing swelling and the gland ducts, causing swelling and pain and sometimes becoming infected. pain and sometimes becoming infected.

symptoms of a salivary symptoms of a salivary stonestone

Stones in the affected gland or duct cause Stones in the affected gland or duct cause obstruction to the flow of saliva, resulting in obstruction to the flow of saliva, resulting in swelling of the gland. The swelling can be swelling of the gland. The swelling can be painful and usually occurs during eating or painful and usually occurs during eating or when thinking about food. It usually settles when thinking about food. It usually settles slowly after finishing a meal and can be aided slowly after finishing a meal and can be aided by massaging the gland, which will feel firm by massaging the gland, which will feel firm and be tender.and be tender.

Sometimes the swelling remains and Sometimes the swelling remains and occasionally the gland can become infected occasionally the gland can become infected and abscessed resulting in fever, severe pain and abscessed resulting in fever, severe pain and inflammation in the overlying skin and inflammation in the overlying skin

stonesstones

Intermittent of incomplete Intermittent of incomplete obstructionobstruction

diagnosisdiagnosisThe majority (80%) of these stones are The majority (80%) of these stones are

visible on plain x-ray, however some are visible on plain x-ray, however some are not seen on x-ray so are investigated not seen on x-ray so are investigated using ultrasound or a sialogram: using ultrasound or a sialogram:

An ultrasound scan is a painless An ultrasound scan is a painless procedure using high frequency echoes procedure using high frequency echoes where the gland and duct can be where the gland and duct can be identified by probe. Stones may be seen identified by probe. Stones may be seen as shadows within the gland or duct.as shadows within the gland or duct.

salivary stonesalivary stone

Parotid Tumors and Parotid Tumors and Other Salivary Gland Other Salivary Gland

TumorsTumorsSalivary gland tumors are rare: as Salivary gland tumors are rare: as

few as few as 3 out of 100,000 people3 out of 100,000 people develop salivary gland tumors develop salivary gland tumors per per

yearyear. Men are more likely to develop . Men are more likely to develop salivary gland tumors than women, salivary gland tumors than women,

and the peak incidence occurs and the peak incidence occurs between between thirty and fiftythirty and fifty years of years of

age. age. Eighty percentEighty percent of all salivary of all salivary growth tumors are growth tumors are benignbenign

parotid tumorparotid tumor

Benign Tumors of the Parotid Benign Tumors of the Parotid GlandGland

The The majoritymajority of salivary gland tumors of salivary gland tumors occur in the occur in the parotid glandsparotid glands, the pair , the pair of major salivary glands located in of major salivary glands located in front of the ears. Parotid gland front of the ears. Parotid gland tumors are usually tumors are usually benign benign pleomorphic adenomaspleomorphic adenomas. Although . Although often benign, a parotid gland tumor often benign, a parotid gland tumor can block the salivary gland and can block the salivary gland and cause a dry mouth cause a dry mouth

Mixed adenomaMixed adenoma

Malignant Salivary Gland Malignant Salivary Gland TumorsTumors

Salivary glandSalivary gland tumors that develop in tumors that develop in the submandibular, sublingual, and the submandibular, sublingual, and minor salivary glands are more likely minor salivary glands are more likely to be to be malignantmalignant than parotid gland than parotid gland tumors.tumors. MucoepidermoidMucoepidermoid carcinoma carcinoma is the most common type of is the most common type of malignant salivary gland tumor. malignant salivary gland tumor. Other salivary gland tumors include Other salivary gland tumors include adenoid cystic carcinomaadenoid cystic carcinoma, , acinic cell acinic cell carcinomacarcinoma, , adenocarcinomaadenocarcinoma, and , and squamous cell carcinomasquamous cell carcinoma..

Malignant tumorMalignant tumor

Risk FactorsRisk Factors

Salivary gland tumors have been linked to Salivary gland tumors have been linked to sunlight exposuresunlight exposure, , alcohol consumptionalcohol consumption, and , and hair dye chemicalshair dye chemicals. . Herpes and HIVHerpes and HIV may also may also increase the risk of salivary gland cancer. increase the risk of salivary gland cancer. Links have been discovered between Links have been discovered between breast breast cancer and salivarycancer and salivary gland tumors. While the gland tumors. While the exact connection is unclear, the presence of exact connection is unclear, the presence of breast cancer does increase the risk of breast cancer does increase the risk of salivary gland tumors.salivary gland tumors.

Symptoms of Salivary Gland Symptoms of Salivary Gland TumorsTumors

difficulty swallowing or chewingdifficulty swallowing or chewing difficulty speaking difficulty speaking pain (as the tumor grows) pain (as the tumor grows) swelling swelling lumps or growths in the mouth lumps or growths in the mouth dry mouth dry mouth facial paralysis (due to pressure on facial paralysis (due to pressure on facial nerves by the tumor).facial nerves by the tumor).

Diagnosis of Salivary Gland Diagnosis of Salivary Gland TumorsTumors

A biopsyA biopsyDiagnostic imaging tools, such as an Diagnostic imaging tools, such as an

MRI or CAT scan, provide information MRI or CAT scan, provide information on the location, size, and shape of on the location, size, and shape of the tumor. the tumor.

adenoid cystic carcinomaadenoid cystic carcinoma

PrognosisPrognosisdepends on tumor depends on tumor sizesize. Tumors larger . Tumors larger

than than fourfour centimeters tend to have a centimeters tend to have a worse prognosis than smaller growths. worse prognosis than smaller growths. Survival rates vary depending on the Survival rates vary depending on the type type of cancerof cancer. The . The five-year five-year survival rate for survival rate for parotid gland cancer is parotid gland cancer is 85 percent85 percent, even , even if the cancer has if the cancer has affected local lymph affected local lymph nodesnodes..

Treatment OptionsTreatment Options

Surgical removalSurgical removal of the tumor is the standard of the tumor is the standard treatment optiontreatment option whether whether the growth is a the growth is a benign parotid gland tumor or a malignant benign parotid gland tumor or a malignant cancer. cancer.

Radiation therapyRadiation therapy is used if the tumor is is used if the tumor is large large or if the cancer or if the cancer returnsreturns after initial treatment. after initial treatment. Radiation therapy carries the risk of Radiation therapy carries the risk of permanently damaging salivary glands.permanently damaging salivary glands.

ChemotherapyChemotherapy is occasionally used in is occasionally used in salivary gland tumor treatment, but its use is salivary gland tumor treatment, but its use is usually limited to usually limited to palliative pain management palliative pain management

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