Salivary Gland disorders

Objectives • At the end of this presentation the student well be

able to: Define salivary gland disorders. Enlist causes & signs and symptom of salivary gland

disorders. Explain diagnosis and treatment of salivary gland

disorders. Discuss prevention of salivary gland disorders. Identify nursing diagnosis and nursing intervention

for salivary gland disorders.

Salivary Gland • The salivary glands make saliva and release it into the

mouth. There are three pairs of relatively large, major salivary glands:

1. Parotid glands2. Submandibular glands3. Sublingual glands

Cont….

• Parotid glands: Located in the upper part of each cheek, close to the ear. The duct of each parotid gland empties onto the inside of the cheek, near the molars of the upper jaw.

Cont…

• Submandibular glands: Under the jaw. They have ducts that empty behind the lower front teeth.

• Sublingual glands: Beneath the tongue. They have ducts that empty onto the floor of the mouth.

Cont…

• In addition to these major glands other minor salivary glands are scattered throughout the mouth and throat.

Salivary Gland DisordersCommon salivary gland disorders include: Sialolithiasis Sialadenitis Viral infections e.g. mumps Cysts Benign tumors Malignant tumors Sjogren's syndrome Sialadenosis

Sialolithiasis Sialolithiasis (salivary gland stones) Tiny, calcium-rich

stones sometimes form inside the salivary glands. • Etiology: The exact cause of these stones is unknown.

Some stones may be related to:o Dehydration, which thickens the saliva.o Decreased food intake, which lowers the demand for

saliva.o Medications that decrease saliva production,

including certain antihistamines, anti-hypertensive drugs and psychiatric medications.

Cont…• Some stones sit inside the gland without causing any

symptoms. In other cases, a stone blocks the gland's duct, either partially or completely. When this happens, the gland typically is painful and swollen, and saliva flow is partially or completely blocked. This can be followed by an infection called sialadenitis.

• Signs & Symptoms The most common symptom are dry mouth and a painful lump, usually in the floor of the mouth. Pain may worsen during eating.

Conti….

• Treatments If the stone is located near the end of the duct, the doctor may be able to press it out gently. Deeper stones can be removed with surgery.

Sialadenitis Sialadenitis: (infection of a salivary gland)

Sialadenitis is a painful infection. It is more common among elderly adults with salivary gland stones. Sialadenitis also can occur in infants during the first few weeks of life.

• Etiology It is usually caused by bacteria. • Sign and symptoms Symptoms may include:

o A tender, painful lump in the cheek or under the chin.

o In severe cases, fever, chills and general weakness.

Conti….

Treatment Treatment includes:o Drinking fluids or receiving fluids intravenouslyo AntibioticsoWarm compresses on the infected glando Encouraging saliva flow by chewing gums,

sugarless candies or by drinking juice.• If these methods do not cure the infection, surgery

can be done to drain the gland.

Viral infections Viral infections: Systemic (whole-body) viral

infections sometimes settle in the salivary glands. This causes facial swelling, pain and difficulty in eating. The most common example is mumps.

• Etiology These infections are caused by viruses.• Sign and symptoms The first symptoms often

include:o Fever and poor appetiteo Headache,oMuscle acheso Joint pain and malaise.

Conti….

• Treatment: These infections almost always go away on their own. Treatment focuses on relieving symptoms through:o Resto Drinking fluids to prevent dehydrationo Taking acetaminophen (Tylenol) to relieve pain

and fever

Cysts Cysts: (tiny fluid-filled sacs) Babies sometimes are born with cysts in the parotid

gland because of problems related to ear development before birth. Later in life, other types of cysts can form in the major or minor salivary glands.

• Etiology They may result from traumatic injuries, infections, or salivary gland stones or tumors.

Conti….

• Sign and symptoms: A cyst causes a painless lump. It sometimes grows large enough to interfere with eating.

• Treatment : A small cyst may drain on its own without treatment. Larger cysts can be removed by surgery.

Benign tumors Benign tumors: (noncancerous tumors) Most salivary gland tumors occur in the parotid gland.

The majority are benign. The most common type of benign parotid tumor usually appears as a slow-growing, painless lump at the back of the jaw, just below the earlobe.

• Etiology Risk factors include radiation exposure and possibly smoking.

Conti…

• Sign and symptoms A slow-growing lump is the most common symptom. The lump is sometimes painful. This lump may be found in the cheek, under the chin, on the tongue or on the roof of the mouth.

• Treatment Non cancerous tumors usually are removed surgically. In some cases, radiation treatments are given after surgery to prevent the tumor from recurrence.

Malignant tumors

• Malignant tumors: (cancerous tumors) Salivary gland cancers are rare. They can be more or

less aggressive. • Etiology The only known risk factors for salivary

gland cancers are Sjogren's syndrome and exposure to radiation. Smoking also may play some role.

Conti….• Sign and symptoms A slow-growing lump is the most

common symptom. The lump is sometimes painful. This lump may be found in the cheek, under the chin, below the tongue or on the roof of the mouth.

• Treatment Smaller, early stage, low-grade tumors often can be treated with surgery alone. However, larger, high-grade tumors usually require radiation following surgery. Inoperable tumors that cannot be operated are treated with radiation or chemotherapy.

Sjogren's syndrome Sjogren's syndrome Sjogren's syndrome is a chronic

autoimmune disorder. The body's immune defenses attack the salivary glands, the lacrimal glands (glands that produce tears), and occasionally the skin's sweat and oil glands.

• Etiology Over activity of the immune system.• Sign and symptoms The main features of Sjogren's

syndrome are swelling of the salivary glands, dry eyes and a dry mouth.

Conti….

• Treatment The main symptom related to the salivary glands is a dry mouth. Options include: oMedication to stimulate more saliva secretion, such as

pilocarpine (Salagen) and cevimeline (Evoxac).o Sugarless gum and candy to stimulate saliva

production.o Avoiding medications that can make dry mouth worse.o Avoid smoking.• Good oral hygiene is must. People with Sjogren's have

teeth and gum problems because of low saliva secretion.

Sialadenosis Sialadenosis (nonspecific salivary gland

enlargement) Sometimes, the salivary glands become enlarged

without evidence of infection, inflammation or tumor. This nonspecific enlargement is called sialadenosis. It most often affects the parotid gland.

• Etiology Its cause remains unknown.

Conti….

• Sign and symptoms This condition typically causes painless swelling of the parotid glands on both sides of the face.

• Treatment Treatment is aimed at correcting any underlying medical problem. Once the medical problem improves, the salivary glands should shrink to normal size.

Medical Diagnosis• Medical history.• Physical examination.• Current medications.• Blood tests. • X-rays.• Magnetic resonance imaging (MRI).• Computed tomography (CT) scans. • Salivary gland biopsy.

Complications

• Abscess of salivary gland.• Spread of infection. • Facial nerve injury (Sialorrhea).• Dry mouth (xerostomia).

Prevention• We can lower our risk of viral infections of the

salivary glands. To do so, get immunized against mumps and influenza.

• There are no specific guidelines to protect against other types of salivary gland disorders. However, it is helpful to:

o Avoid smoking.o Eat a healthy diet.o Drinking plenty of water daily to avoid dehydration.o Practice good oral hygiene, with regular tooth

brushing and flossing.

Nursing Diagnosis

• Dry mouth related to blockage of saliva.• Pain related to tumor & inflammation in the mouth.• Difficulty in eating related to painful lump in the

mouth.• Poor appetite related to disease.• Fever related to infection of salivary gland.

Nursing Interventions• Give medication to stimulate more saliva secretion,

such as pilocarpine (Salagen) and cevimeline (Evoxac).

• Give sugarless gum and candy to stimulate saliva production.

• Avoiding medications that can make dry mouth worse.

• Provide analgesic to relief pain.• Administer tube feeding.• Give acetaminophen (Tylenol) to relieve fever.• Cold sponging to relieve from fever.

References

• Elluru RG. Physiology of the salivary glands. In: Cummings CW, Flint PW, Haughey BH, et al, eds.Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 84.

• Rogers J, McCaffrey TV. Inflammatory disorders of the salivary glands. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 86.