PAROTID & SALIVARY

GLANDS

Dr. Hiwa Omer Ahmed

Assistant professor in General
Surgery
 anatomy
There are three main paired glands in the
head and neck producing saliva. They are
the:
parotid glands
submandibular glands
sublingual glands
The parotid glands are the largest and
overlie the angle of the jaw in front of the
ear. A tube, known as Stensens duct,
drains saliva from the glands into the
mouth. The openings are inside the cheek
opposite the upper molar teeth.
Areas of parotid
anatomy
anatomy
parotid
Facial palsy
 anatomy
 The submandibular glands lie deep to the
horizontal part of the lower jaw. Their ducts are
the longest and narrowest of all the salivary
glands, and enter the mouth under the front of
the tongue.
 The sublingual glands lie deep in the lining of the
mouth on each side of the tongue. These glands
have many short ducts entering the mouth
directly through the mouth lining.
 In addition to these major glands there are
hundreds of minor salivary glands throughout the
lining of the mouth and throat, with most on the
lips and soft palate
 physiology
 Salivaryglands produce saliva in
response to food being placed in the
mouth. Even the thought or smell of
food can stimulate salivary flow and
most people make about one litre of
saliva per day. As well being 99.5%
water, saliva has minerals and
proteins that aid digestion and keep
the mouth and teeth healthy.
 Mumps & parotitis
Mumps is a viral infection that
primarily affects the parotid
glands — one of three pairs of
salivary glands, located below
and in front of your ears.
It can cause swelling in one or
both parotid glands
Mumps
parotitis
 Signs and symptoms
 About one-third of people infected with the
mumps virus have no signs or symptoms.
When signs and symptoms do develop,
they usually appear about two to three
weeks after exposure to the virus and may
include:
 Swollen, painful salivary glands on one or
both sides of the face
 Pain with chewing or swallowing
 Fever
 Weakness and fatigue
 Tenderness and swelling of a testicle
(orchitis)
 Complications

 Complications of mumps are potentially serious,

but rare. These include:
 Orchitis. This inflammatory condition causes
swelling of one or both testicles. Orchitis is
painful, but it rarely leads to sterility — the
inability to conceive a child.
 Pancreatitis. This disease causes swelling of the
pancreas. Signs and symptoms of pancreatitis
include pain in the upper abdomen, nausea and
vomiting.
 Encephalitis. Encephalitis is inflammation of the
brain caused by a viral infection, such as mumps.
Encephalitis can lead to neurologic problems and
become life-threatening. Although it's serious,
encephalitis is a rare complication of mumps.
 Complications

 Meningitis. Meningitis is infection and

inflammation of the membranes and fluid
surrounding your brain and spinal cord. It can
occur if the mumps virus spreads through your
bloodstream to infect your central nervous
system. Like encephalitis, meningitis is a rare
complication of mumps.
 Inflammation of the ovaries. Pain in the lower
abdomen in women may be a symptom of this
problem. Fertility doesn't seem to be affected.
 Hearing loss. In rare cases, mumps can cause
temporary or permanent hearing loss in one or
both ears.
 Prevention

 In general, you're considered immune to

mumps if you've previously had the
infection or if you've been immunized
against mumps.
 The mumps vaccine is usually given as a
combined measles-mumps-rubella (MMR)
inoculation, which contains the safest and
most effective form of each vaccine.
Doctors recommend that children receive
the MMR vaccine between 12 and 15
months of age, and again between 3 and 6
years of age — before entering school.
 Treatment
 Because mumps is caused by a virus,
antibiotics are not an effective
treatment.
 Like most viral illnesses, mumps
infection must simply run its course.
Fortunately, most children and adults
recover from an uncomplicated case
of mumps within two weeks' time
 Treatment
 Ifyou or your child has mumps, time and
rest are the best treatments. There's little
your doctor can do to speed recovery. But
you can take some steps to ease pain and
discomfort and keep others from
becoming infected:
 Rest in bed until the fever goes away.
 Isolate yourself or your child to prevent
spreading the disease to others.
 Take acetaminophen (Tylenol, others) or a
nonsteroidal anti-inflammatory drug such
as ibuprofen (Advil, Motrin, others) to ease
symptoms. Adults may also use aspirin.
Don't give aspirin to children because of
the risk of Reye's syndrome, a rare but
 Self-care
 Use a cold compress to ease the pain of
swollen glands.
 Wear an athletic supporter to ease the
pain of tender testicles.
 Avoid foods that require lots of chewing.
Instead, try broth-based soups or soft
foods, such as mashed potatoes or cooked
oatmeal, for nourishment.
 Avoid sour foods such as citrus fruits or
juices that stimulate saliva production.
 Drink plenty of fluids.
 Plan low-key activities.
 SALIVARY STONES
 There are three main salivary glands
in the head and neck and hundreds
of tiny ones. Stones usually occur in
the submandibular glands, less
frequently in the parotid gland and
very rarely in the sublingual and
minor salivary glands.
 Stones form from mineral deposits in
the gland ducts, causing swelling and
pain and sometimes becoming
infected.
 symptoms of a salivary
stone
 Stones in the affected gland or duct cause
obstruction to the flow of saliva, resulting
in swelling of the gland. The swelling can
be painful and usually occurs during eating
or when thinking about food. It usually
settles slowly after finishing a meal and
can be aided by massaging the gland,
which will feel firm and be tender.
 Sometimes the swelling remains and
occasionally the gland can become
infected and abscessed resulting in fever,
severe pain and inflammation in the
overlying skin
stones
Intermittent of incomplete
obstruction
 diagnosis
 The majority (80%) of these stones
are visible on plain x-ray, however
some are not seen on x-ray so are
investigated using ultrasound or a
sialogram:
 An ultrasound scan is a painless
procedure using high frequency
echoes where the gland and duct can
be identified by probe. Stones may
be seen as shadows within the gland
or duct.
salivary stone
 Parotid Tumors and
Other Salivary Gland
Tumors
Salivary gland tumors are rare: as
few as 3 out of 100,000 people
develop salivary gland tumors per
year. Men are more likely to develop
salivary gland tumors than women,
and the peak incidence occurs
between thirty and fifty years of
age. Eighty percent of all salivary
growth tumors are benign
parotid tumor
Benign Tumors of the Parotid
Gland

The majority of salivary gland tumors
occur in the parotid glands, the pair
of major salivary glands located in
front of the ears. Parotid gland
tumors are usually benign
pleomorphic adenomas. Although
often benign, a parotid gland tumor
can block the salivary gland and
cause a dry mouth
Mixed adenoma
 Malignant Salivary Gland
Tumors
 Salivary
gland tumors that develop in
the submandibular, sublingual, and
minor salivary glands are more likely
to be malignant than parotid gland
tumors. Mucoepidermoid carcinoma
is the most common type of
malignant salivary gland tumor.
Other salivary gland tumors include
adenoid cystic carcinoma, acinic cell
carcinoma, adenocarcinoma, and
squamous cell carcinoma.
Malignant tumor
 Risk Factors


Salivary gland tumors have been linked to

sunlight exposure, alcohol consumption,
and hair dye chemicals. Herpes and HIV
may also increase the risk of salivary
gland cancer.
Links have been discovered between
breast cancer and salivary gland tumors.
While the exact connection is unclear, the
presence of breast cancer does increase
the risk of salivary gland tumors.
 Symptoms of Salivary Gland
 Tumors
difficulty swallowing or chewing
difficulty speaking
pain (as the tumor grows)
swelling
lumps or growths in the mouth
dry mouth
facial paralysis (due to pressure on
facial nerves by the tumor).
 Diagnosis of Salivary Gland
Tumors
A biopsy
 Diagnostic imaging tools, such as an
MRI or CAT scan, provide information
on the location, size, and shape of
the tumor.
adenoid cystic carcinoma
 Prognosis
 depends on tumor size. Tumors
larger than four centimeters tend to
have a worse prognosis than smaller
growths. Survival rates vary
depending on the type of cancer. The
five-year survival rate for parotid
gland cancer is 85 percent, even if
the cancer has affected local lymph
nodes.
 Treatment Options


Surgical removal of the tumor is the
standard treatment option whether the
growth is a benign parotid gland tumor or
a malignant cancer.
 Radiation therapy is used if the tumor is
large or if the cancer returns after initial
treatment. Radiation therapy carries the
risk of permanently damaging salivary
glands.

 Chemotherapy is occasionally used in

salivary gland tumor treatment, but its use
is usually limited to palliative pain
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