salivary-glands

Pathology of salivary glands

There are three pairs of large salivary glands in the body: parotid, submandibular and sublingual glands. Saliva drains into the mouth from each gland through channels called ducts.

The most common pathological conditions associated with the salivary glands are:

(a) sialedinitis, the acute or chronic, infective or autoimmune inflammation of the glands,
(b) sialolithiasis, the stone-related disease within the ductal system of the glands,
(c) sialectasis, the dilation of a duct due to stones or strictures and
(d) sialadenosis, the non-neoplastic non-inflammatory swelling with acinar hypertrophy and ductal atrophy.

Malignant tumors of salivary glands are rare and the majority of the neoplasms are benign. Among the salivary gland tumors, 70% originates from parotids where 75% of the tumors are benign. Malignant salivary gland tumors account for slightly more than 50% of those found in submandibular and more than 80% of those occurring in minor salivary glands.  Pleomorphic adenomas (benign mixed tumors) are the most common benign salivary glands tumors and they represent the 85% of all salivary gland neoplasms.

anatomia

For the diagnosis and treatment of both inflammatory and obstructive pathology related to the ductal system, sialendoscopy is indicated. It involves the use of a small flexible tube containing a tiny camera (endoscope) that allows transluminal visualization of the major salivary glands.

Sialendoscopy can be both diagnostic and therapeutic. Its most common indication includes the treatment of nonneoplastic disorders of the salivary glands such as sialolithiasis, where the 80% of sialoliths can be found in the submandibular gland. Sialolithiasis is most frequently found in adults, but it may also present in children. With this device, small instruments can be inserted into the glands to remove salivary stones and debris, medications can be injected and stretching for enlargement of the gland tubes is possible. The major advantage of this technique is the preservation of the gland. Despite being a technically challenging procedure, proper application by an experienced surgeon can exceed 85% success rates.

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