اورام الغدة اللعابية - كتبته بنفسى salivary gland swelling

[mohamed_ameer]

اورام الغدد اللعابية - لغة انجليزية - كتبته بنفسى - salivary gland swellings

grandular swellings

1) acute epidemic parotitis (mumps) is a highly infectious virus disease, usually seen in children. the incubation period is about three weeks and the attack is characterized by fever, painful enlargement of one or both glands and difficulty in mastication. in adults, infection of the testis, ovary or breast may occur and is usually unilateral.

2- acute suppurative parotitis may follow abdominal operations on dehydrated patients or debilitating diseases, such as typhoid fever. there is severe pain and swelling of the gland with dysphagia, headache, fever and malaise... on examination, the gland is acutely inflamed and tender and purulent discharge may be expressed from the orifice of the duct.. owing to the high tension within the parotid fascia, the infection often proceeds rapidly to necrosis and abscess formation.

3- sialectasis ( recurrent parotitis) is a rare condition which occurs in children and young adults... it is characterized by recurrent attacks of painful swelling of the gland... sialography shows diltation of the ducts and acini and excludes calculous obstruction... the aetiology is unknown but the condition is often regarded as an auto-immune disease.

4- parotid calculus is rare. it causes a painful swelling of the gland with attacks of colicky pain at meal times (salivary colic)... the stone is rarely palpable and is difficult to visualize by radiography... sialography is necessary for the diagnosis...

5- endemic parotitis is a bilateral painless enlargement of the parotid occasionally seen in egyptian farmers suffering from parasitic infestations and nutritional deficiencies.


6- Mickulicz's disease is a symmetrical , usually progressive enlargement of the lacrimal and salivary glands with replacement of the glandular tissue by lymphocytes... it occurs between 20 and 40 years and usually starts in one gland only,, commonly the lacrimal ...in established cases, dryness of the mouth is a marked feature... the Sjogren syndrome is a similar condition associated with arthiritis and other manifestations or pictures of systemic lupus erythematosus.


7- parotid cysts are rare and probably most cases are examples of adenolymphoma... true cysts occur in the region overlying the angle of the mandible and are probably derived from the first branchial cleft.


8- adenolymphoma is much commoner in men than in women and most patients are over 40 years of age.. it may be multiple or bilateral ( the only bilateral tumour of the parotid)... the tumour presents as a slow-growing soft swelling situated usually at the angle of the mandible... it feels soft and fluctuant and more superficial on palpation than a mixed tumour.


9- mixed parotid tumour is the commonest salivary neoplasm.. though commonest in the fourth decade,,, it may occur at any age and in either sex... the tumour forms a rounded slowly growing swelling... typically situated at the angle of the mandible and raising the lobule of the ear... it has a well-defined edge,, a smooth surface and a firm or a hard consistency... the swelling is painless and of long duration,, being present for several years before the patient seeks medical advice... the tumour is benign but sometimes it breaks its confines and exhibits malignant characters, pain , rapid growth, fixity, facial palsy, cutaneous infiltration and glandular metastases... unless removed early and adequately ,, it tends to recur, usually within two years.

10- mucoepidermoid tumour is much less common than mixed tumour and adenolymphoma... the swelling is lobulated with an ill- defined infiltrating edge.. it spreads late by the lymphatics and may produce distant metastases.


11- cylindroma is rare in the parotid ( commonest in the minor salivary glands of the palate, larynx, trachea and bronchi)... the tumour forms a localized lump but infiltrates a long the sheaths of adjacent nerves.


12- Adenocarcinoma is commonest after the age of 50 ... it forms a rapidly growing, stony hard swelling with an ill-defined edge and knobbly surface... pain and facial palsy are common and the tumour becomes fixed and immobile at an early stage... in late cases , the cervical glands are enlarged but distant metastases are rare.


periglandular swellings


1- preauricular lymphadenitis is differentiated from inflammatory swellings of the parotid by the following signs: a) The swelling is situated immediately in front of the tragus and the normal depression behind the angle of the jaw is not obliterated....

b) a primary focus may be found in the region of the forehead, eyelids or conjunctiva or within the external auditory meatus.

c) the duct orifice is normal d) The sialogram shows no abnormality


2-lymphosarcoma does not take the shape of the parotid gland and does not affect facial nerve... other lymphomatous deposits are usually present.


3- subcutaneous lipoma forms a lobulated swelling with dimpling, uniformly soft consistency and slippery edge.


4- Neurofibroma is usually associated with other neurofibromata. the tumour is elongated in shape and uniformly firm in consistency.


5- hypertrophy of the masseter may affect one or both sides. the swelling does not extend beyond the angle of the mandible and hardens on clinching the teeth.

[mohamed_ameer]

Differential diagnosis

1- salivary gland swellings :- a) chronic sialadenitis is common and usually due to calculus in the gland, its duct or both.. recurrent attacks of pain and swelling at mealtimes is pathognomic of the condition… the gland is palpably enlarged and tender and the orifice of Wharton's duct may be swollen, patulous or discharging mucopus… the stone may be detected in the floor of the mouth by direct palpation and is always demonstrable by radiography….



b) mixed tumour arises most often in the cervical lobe of the gland… the patient presents with a painless submandibular swelling of long duration… the swelling has a well-defined edge, a nodular surface and hard consistency… the sublingual papilla is normal and x-ray examination is negative…



ابحث فى الانترنت عن هذه الصور او الرسومات

Search for these images or drawings on the internet

(chronic submandibular sialadenitis)

(tuberculosis submandibular lymphadenitis)



c) carcinoma of the submandibular gland is rare but highly malignant …..



2- Enlarged lymph nodes :- they are differentiated from salivary gland swellings by their closer relation to the mandible ,, the absence of intrabuccal swelling, the freedom of the sublingual papilla,, the presence of other enlarged glands in the neck or of a primary focus and the negative x-ray examination…. In difficult cases, sialography and excision biopsys are necessary ….





3- Cystic swellings in the submandibular triangle are not uncommon…they include tuberculosis cold abscess, lymphatic cyst, haemangioma, plunging ranula (Thompson's ranula) and lateral dermoid cyst