Non-neoplastic Salivary Gland Disease

45 Non-neoplastic Salivary Gland Disease


45.1 Viral Infections (Mumps)


• Mostly children


• Usually paramyxovirus (Rubulavirus)


• Infection is systemic


• 2- to 3-week incubation period


• 3- to 5-day period of viremia—localizes in parotid, germinal tissues, and central nervous system


• Fever, malaise, headaches


• Trismus and dysphagia


• Bilateral involvement; may involve other major salivary glands


• Complications:


figure Orchitis—20 to 30% of males


figure Oophoritis—5% of females


figure Sterility rare


figure Aseptic meningitis 10%


figure Pancreatitis 5%


figure Sensorineural hearing loss 0.5 to 4% (rapid onset, profound, permanent, and unilateral)


• Confirm diagnosis with viral serology


• Frontal bullar cell shows raised white cell count (lymphocytes)


• Supportive treatment


45.2 Sjögren Syndrome (Fig. 45.1)


• Chronic autoimmune disorder


• 44× risk of developing lymphoma


• Schirmer test—documents lacrimation


• Slit lamp examination—corneal ulcerations


• SS-A (anti-Ro) 38 to 60%; ELISA—95%


• SS-B (anti-La) 25 to 40%; ELISA—87%


• Autoantibodies not specific


• Minor salivary gland biopsy used to diagnose—95% specificity


45.3 Acute and Chronic Bacterial Infections


• Bacterial sialadenitis most common in parotid


• Chronic picture with acute exacerbations possible


• Retrograde transmission from oral cavity or stasis of salivary flow


• Stone formation may be causative


• Elderly patients at risk due to medications that reduce salivary flow:


figure Diuretics


figure Antidepressants


figure β-blockers


figure Anticholinergics


figure Antihistamines


• Staphylococcus aureus most common organism; others:


figure β-haemolytic strep


figure H. influenzae


figure Pneumococcus


figure Gram–negative organisms


• May progress to abscess formation


• If failure to respond to ABx, consider:


figure Lymphoma


figure Cat-scratch disease


figure Sjögren syndrome


figure Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis).


• Antibiotics for gram-negative and anaerobes


• Sepsis and multiorgan failure possible in debilitated patients


45.4 Chronic Sialadenitis (Fig. 45.1)


• Recurrent low-grade inflammation and oedmea of the gland


• Strep. viridans = offending organism


• Need to encourage salivary flow


• Benign lymphoepithelial lesions may arise


• Identify any stones/strictures


• May have symptom-free periods


• Surgical excision for refractory cases (Fig. 45.2)


• Sialoendoscopy (see end of chapter)


45.5 Sialolithiasis (Fig. 45.1)


• 80% affect submandibular gland


• 1.2% general population


• Submandibular predisposing factors include:


figure More viscous consistency


figure Wharton duct has a superior course


figure Gland is dependent


• Imaging:


figure Most imaging modalities can detect calculi: plain radiograph (80–95% submandibular and 70% parotid stones); US (90% if >2 mm); CT—noncontrast (as vessels may mimic stones) is good for detecting multiple small stones



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  4. Laryngeal Anatomy and Physiology

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Non-neoplastic Salivary Gland Disease

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