A brief presentation of salivary gland related diseases for undergraduates

1. SALIVARY GLAND & ITS DISORDERS
DR UTKAL MISHRA

2. CASE 1
 5 year old child presented with fever and right parotid swelling for 2 days. Serum and urinary
amylase found to be raised.
1. What is the most probable diagnosis ?
2. What is the causative agent ?
3. How will you manage this case ?

3. ANSWER
 1. Mumps
 2. Paramyxovirus
 3. Analgesics, Adequate hydration. No role of antibiotics

4. CASE 2
 55 year old male presented with fever & acute tender swelling over left parotid area. On examination,
stenson’s duct swelling is inflamed and pus could be expressed on gentle pressure over gland. CBC
showed leukocytosis.
1. What is the most probable diagnosis ?
2. What is the causative agent ?
3. How will you manage this case ?

5. ANSWER
 1. Acute Suppurative parotitis
 2. Staphylococcus aureus
 3. Amoxycillin/Clindamycin, Adequate hydration, If fluctuation present then lazy s incision and drainage
of pus.

6. CASE 3
 45 year old male who is a known case of Type II DM and alcoholic cirrhosis presented with diffuse
nontender enlargement of both parotids.
1. What is the most probable diagnosis ?
2. What is the most probable etiology ?
3. How will you manage this case ?

7. ANSWER
 1. Sialoadenosis
 2. Defect in aquaporin channels
 3. Reassurance

8. CASE 4
 Lymphoepithelial sialadenitis
 Primary Sjogren’s (Mikulicz
disease)– Xerostomia
 Secondary Sjogren’s –
Keratoconjuctivitis sicca,
Xerostomia, RA/SLE
 Lip mucosal biopsy – Infiltration of
lymphocytes in minor salivary
glands
 Detection of SS-A & SS-B
antibodies in serum.

9. PLEOMORPHIC ADENOMA
 Most common benign tumour of salivary glands.
 Usually arises from tail of parotid.
 Slow-growing
 Usually seen in females 30-40 yr
 Tumour is encapsulated but sends pseudopods into surrounding tissue.
 So removal of tumour with a cuff of normal parotid tissue is essential.
 Management – superficial parotidectomy / adequate parotidectomy
 Malignant transformation occurs in – 3 - 5%

10. WATHINS TUMOUR
 Second commonest benign tumour
 Common in men
 Smoking is a risk factor
 Usually cystic

11. MUCOEPIDERMOID CARCINOMA
 Commonest malignancy affecting parotid gland.
 Low grade, High grade
 Management ?

12. ADENOID CYSTIC CARCINOMA
 Cylindroma
 It invades perineural space & lymphatics.
 Lymph node metastasis common.
 Management – Total parotidectomy + Neck dissection + PORT

13. MCQ
 Sialolithiasis is commonly found in which salivary gland ?
Ans- Submandibular 90%
 Submandibular stones are radioopaque or radioluscent ?
Ans- Radio-opaque 80%

14. MCQ
 Major salivary gland tumor are mostly
Ans- Benign
 Minor salivary gland tumor are mostly
Ans- Malignant
 In children >50% salivary gland tumors are
Ans- Malignant (Mucoepidermoid carcinoma) , 2nd commonest – Acinic cell carcinoma
 Commonest benign salivary gland tumor in children
Ans- Hemangioma
 Most common radiation induced neoplasm of salivary gland
Ans- Mucoepidermoid carcinoma

15. MCQ
 Most common tumor of major salivary glands
Ans- Pleomorphic adenoma
 Most common malignant tumor of major salivary glands
Ans- Mucoepidermoid carcinoma
 Most common malignant tumor of minor salivary glands
Ans- Adenoid cystic carcinoma.
 Salivary gland tumours showing Tc99m uptake
Ans- Warthins, Oncocytoma

16. MCQ
 Most common site of minor salivary glands tumor
Ans- Hard palate
 Squamous cell carcinoma of salivary gland commonly affects
Ans- Submandibular
 Imaging modality of choice for salivary gland tumor
Ans- CECT & Gd enhanced MRI
 How is the response of radiotherapy for salivary malignancy
Ans- Radioresistant

17. THANK YOU