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Salivary gland neoplasms arise most commonly in the parotid glands, followed by submandibular, sublingual, and minor salivary glands

Bilateral parotid gland masses Usually due to lymphadenopathy (e.g. HIV), Sjogren's syndrome, or acinic cell adenocarcinoma

Parotid gland disorders Superficial and deep lobe based on facial nerve course Most benign tumors in superficial lobe Signs of malignancy: Facial nerve paralysis, Cranial nerve palsy, Hardness, Fixation, Tenderness, Infiltration of local lymph nodes, Overlying skin ulceration

Clinical examination of salivary glands 1. Mucosal dryness, Candidiasis, Enlargement of salivary gland, Viscous or scant secretions 2. Enlargement (inflammatory, infectious, or neoplastic) 3. Cloudy exudates (bacterial infection) 4. Evaluation of facial nerve function (parotid tumors) 5. Ulceration of overlying mucosa (suspicion of malignancy)

Sjogren's syndrome A patient's report of eye, throat, nasal, skin, or vaginal dryness, in addition to xerostomia, indicates a systemic condition

Causes of salivary gland hypofunction Medications (antidepressants, anticholinergics, antispasmodics, antihistamines, antihypertensives, sedatives, diuretics, bronchodilators) Other agents (caffeine, alcohol, cigarette smoking, irradiation to head and neck) Systemic disease (diabetes mellitus, salivary gland masses) Psychological conditions (depression) Malnutrition Autoimmune disease (Sjogren's syndrome) Anxiety

Hypersalivation (ptyalism) Increase in production of saliva and/or decrease in oral clearance of saliva

Xerostomia Subjective complaint of dry mouth, may or may not be associated with hyposalivation and can be due to changes in salivary composition

Minor salivary glands Labial Buccal Lingual Palatal Retromolar

Sublingual glands Drained by 8-20 excretory ducts called the ducts of Rivinus, the largest one (Bartholin) joins the submandibular duct to drain through the sublingual caruncle

Submandibular gland saliva Secreted through Wharton's duct, which exits at the sublingual caruncles on either side of the lingual frenulum

Parotid saliva Secreted through Stensen's ducts, the orifices on the buccal mucosa near the maxillary first or second molar

Part 1 Salivary glands The major groups are: Parotid gland (primarily serous cells, produce watery, enzyme-rich saliva) Sublingual gland (mucous type, secrete viscous fluid with mucins) Submandibular gland (mix of mucous and serous types)

SALIVARY GLAND DISEASES

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Treatment for osteosarcoma is local surgery and the use of adjuvant chemotherapy

Osteosarcoma Presents as a mass in jaw, pain, and trigeminal sensory disturbances Mobile teeth, toothache, and nasal obstruction Radiographic appearance: border of the lesion is not well defined, sun ray appearance (opaque lesion, with bony trabeculae directed perpendicularly to the outer surface), loss of follicular cortices of unerupted teeth, widening of the mandibular canal

Osteosarcoma The most common bone-originating jaw malignancy<|>Characterized by the formation of bone or osteoid by tumor cells<|>Often in the mandible than in the maxilla<|>Also develop in a patient affected by Paget's disease or in a patient who has been irradiated

Types of sarcomas of the soft tissues Fibrosarcoma Malignant fibrous histiocytoma Liposarcoma Rhabdomyosarcoma Leiomyosarcoma Angiosarcoma Alveolar soft part sarcoma

Sarcomas of the soft tissues Rare, 1% of all oral malignancies