Page 24 - 64 head&neck36-40_opt

Salivary Gland Diseases in Children and Adolescents 257

Diagnosis is usually from parental history and a report of recurrent
unilateral or bilateral parotid gland infections. Sialographic studies
show a pattern of sialectasis similar to Sjogren’s syndrome strictures,
dilations, and kinks. Salivary chemistry is usually altered as it also is
in adult patients: increased amounts of sodium, and protein, IgA, IgG,
IgM, albumin, transferrin, and myeloperoxidase.
Treatment is conservative by lavage, ductal dilatation and
hydrocortisone (100 mg) injection via sialoendoscopy, glandular
massage salivary stimulation with sugarless sour candy, and antibiotics
augmentin (25 mg/kg) or clindamycin (150 mg, 8-hourly, for 7 days).
In an African setting, glandular massage of the parotid with antibiotics
may be very helpful.
Masseteric hypertrophy Figure 39.3: Simple ranula in a 6-year-old boy.
This is an asymptomatic bilateral enlargement of the masseter muscles
as a result of hypertrophy. It is associated with bruxism and clenching
of the teeth. Treatment usually involves debulking the masseter.
Cysts
Ranula
A ranula is a cyst-like soft swelling in the mouth. It presents as a trans-
lucent bluish colour under the tongue (Figure 39.3). The appearance is
that of a frog’s belly. Its aetiology is as a result of mucous extravasation
of the sublingual gland following trauma, and obstruction or infection
of the gland ducts, resulting in leakage and escape of secretion into
the surrounding tissue. Simple ranula occurs when the extravasation
is into the oral aspect of the mylohyoid muscle, whereas involvement
of the hernited sublingual gland through the mylohyoid muscle results
in a plunging ranula manifesting extraorally in the neck (Figure 39.4). Figure 39.4: Plunging ranula.
Simple ranulas are noted more commonly in females, and plunging
ranulas noted more frequently in males. CT scan demonstrates a cystic Signs of xerostomia are dryness of the oral mucosa, mucositis,
mass in the suprahyoid anterior neck. angular chelitis, dental plaques, dental smooth surface caries and
Marsupialisation of the simple intraoral ranula involves deroofing of demineralisation of the enamel, inflamed gingivae with periodontal
the cyst, suturing of its wall to the surrounding mucosa with packing of diseases, and candidiasis. Diagnosis is based on history, clinical
lumen. Plunging ranula is excised with the involved sublingual gland. examination, sialometry (salivary flow is decreased), sialography,
Recurrence usually necessitates excision of the involved sublingual scintigraphy, sialochemistry (sodium and chloride lactofarrin levels),
gland (see Figure 39.4).
gland biopsy, and whole saliva immunotesting for antinuclear antibodies.
Mucoceles Treatment is conservative. The use of stimulants, sugarless candies
A mucocele (mucous extravasation cyst) develops mostly in children and gums, artificial saliva; increased fluid intake; oral lubricants; and
and young adults and mainly from the minor salivary glands following nonirritating toothpastes is recommended. Oral rehabilitation may be
trauma and leakage of saliva into the surrounding submucosal tissue. required to correct rehydration in some cases. Comprehensive dental
The most common sites are the lower lip and inner aspect of the cheek, management is strongly advocated.
which are areas susceptible to trauma during oral function. A mucocele Sialorrhea
has no epithelial lining; rather, it is contained within a wall of fibrous
Sialorrhea (ptyalism) is a persistent increase in salivary flow rate. It
and inflammatory tissue. It typically presents as a slow-growing and
differs from drooling. In children, the most common cause is teething.
superficial soft wall fluctuant fluid containing mass of diameter 1.0–2.0
Other causes are childhood epilepsy, HIV parotid enlargement, mental
cm.
retardation, cerebral palsy, and herpes infection. In children, it requires
The overlying mucosa is usually of a translucent bluish color.
the constant change of clothing and the use of bibs.
A mucocele causes little or no discomfort. Marsupialisation of the
Treatment for sialorrhea is usually conservative, involving the use
cyst with overlying mucosa leads to recurrence of this pseudocyst.
of anticholinergic agents (atropine) and antidepressants. However,
Occasionally, it ruptures spontaneously and forms again because of the
surgical management such as parotid duct rerouting (Wilkie procedure),
accumulation of secretions beneath the healed surface. Excision of the
submandibular duct rerouting, tympanic neurectomy, or excision of the
cyst with the overlying mucosa lining is the treatment of choice.
glands may be carried out when conservative management fails.
Salivary Gland Dysfunctions Neoplastic Epithelial Tumours
Xerostomia The parotid gland is the most common site of tumours (85.1%), fol-
Xerostomia is dryness of the mouth. The major cause in children is lowed by the submandibular (11.7%) and the sublingual (3.2%). In
dehydration. Other causes are the use of antihistamine-containing drugs the minor salivary gland, the most common site is the palate. Overall,
or decongestants; autoimmune diseases such as Sjogren’s syndrome, salivary gland tumours occur more in girls than in boys.
sarcoidosis, and HIV; agenesis/aplasia or salivary gland hypofunction; The majority of salivary gland neoplasms in children are benign.
and ectodermal dysplasia. The pleomorphic adenoma is the most common benign neoplasm, and
Symptoms of xerostomia include dryness of the oral cavity, burning the most common malignant tumour is mucoepidermoid carcinoma.
sensation, soreness of the lips, difficulty with speech, difficulty with About 11.5–35% of salivary gland tumours in children are malignant,
mastication and swallowing of solid foods, and altered taste sensations. and 60–90% of these are mucoepidermoid carcinomas; adenoid cystic