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CHAPTER 39

Salivary Gland Diseases in

Children and Adolescents

Sunday Olusegun Ajike
Kokila Lakhoo

Introduction Table 39.1: Classification of salivary gland diseases in children.
Salivary glands are found in and around the oral cavity, and they are Nonneoplastic tumours
divided into major and minor salivary glands. The major salivary Congenital/developmental
glands are the parotid, submandibular, and sublingual glands; the minor
salivary glands are located in the lips, buccal mucosa, palate, and throat. Agenesis/aplasia, hypogenesis/hypoplasia
Generally, salivary gland diseases are not common in the paediat- Aberrant/ectopic salivary gland
ric population. The classification of salivary gland diseases is very Haemangioma
complex because it encompasses different entities; however, precise Lympangioma
classification and terminology are necessary for accurate diagnosis Inflammatory and infection.
and management. As in adults, diseases of the salivary glands may be
nonneoplastic or neoplastic (tumours) (Table 39.1). The pattern of inci- Acute sialadentis
dence in the paediatric population differs greatly from that in the adult Mumps, cytomegalovirus, Coxasackie A or B or parainfluenza virus)
group. Most salivary gland lesions in children are either inflammatory Human immunodeficiency virus (HIV)-associated salivary glands
or vascular in origin. Of the developmental salivary gland diseases, Recurrent parotitis in children (RPC)
haemangiomas are the most common. In the African paediatric popula- Autoimmune
tion, mumps is the most common in the inflammatory/infection group,
but in the developed world, only sporadic cases of mumps are now Sjogren’s syndrome
reported, and rhabdomyosarcomas are the most common nonodonto- Cysts
genic mesenchymal tumours in children. Ranula mucocele (mucous retention cyst)
Neoplastic changes in the paediatric population are very rare Salivary gland dysfunction
compared to the inflammatory groups. In the population as a whole, Xerostomia
salivary gland neoplasms constitute 2.8% of all head and neck tumours, Sialorrhea/ptyalism
but in children it accounts for about 10% of all childhood neoplasms
and between 3% and 22% of epithelial salivary gland neoplasms. The
majority (88.5%) of salivary gland tumours are benign; the remaining Neoplastic tumours
11.5% being malignant. In children, the most common benign epithelial Benign
tumour is pleomorphic adenoma, and the most common malignant Pleomorphic adenoma
tumour is mucoepidermoid carcinoma. Warthin’s tumour
Salivary gland tumours in children have the same clinical and
biologic behavior as those in the adult. The majority (76.7%) occur Malignant
in the major glands, with the remainder in the minor glands, a ratio of Mucoepidermoid carcinoma
3.3:1. The ratio of occurrence of parotid to submandibular to sublingual Acinic cell carcinoma
tumours in the major salivary glands is 30:6:1. Globally, these tumours Adenoid cystic carcinoma
occur predominantly in girls and at any childhood age. A detailed Mesenchymal tumours
clinical history with imaging features narrows the differential diagnosis
while providing useful information for management and prognosis. Neural tissue
Incisional biopsy must be avoided due to the possibility of tumour Neurofibroma
spillage and facial nerve damage. Muscular tissue
The treatment of salivary gland diseases is categorised into medical Rhabdomyosarcoma
and surgical, depending on the nature of the disease condition. The
neoplastic lesions usually require surgical intervention, with or without
radiation and chemotherapy, whereas the nonneoplastic/inflammatory
diseases are managed symptomatically and conservatively. A protracted
conservative medical management is strongly advised, however, before
surgical ablation is considered in children.
Investigations
Salivary gland enlargement is a diagnostic challenge to the attending sur-
geon because the glands could be involved in a wide spectrum of diseases.