Makindo Medical Notes.com

NBM does not mean no oral fluid as saliva is still produced and swallowed

Anatomy

• Parotid (releases a watery discharge)
• Submandibular (releases more seromucinous fluid)
• Sublingual - releases more seromucinous fluid and Minor salivary glands

Saliva Production

• Produce about 1-2 L of saliva produced per day
• Salivation: Stimulated by the salivary nucleus in the brainstem via the facial and glossopharyngeal nerves.
• Salivation: Inhibited by Sympathetic drive and anticholinergic drugs result in a dry mouth.

Saliva function

• Taste and lubrication of food
• Assists speech
• Maintaining oral health preventing drying of mucosa
• Slightly alkaline maintains oral pH
• Reduces tooth decay
• Kissing (well relationships are important for human existence)

Saliva contents

• Water 99.5 %
• Mucus
• Amylase
• Lysozymes
• Immunoglobulin
• Electrolytes

Pathology

• Infiltration: Sjogrens, Sarcoid and other diseases
• Salivary Tumours: Pleomorphic adenoma - Commonest and usually affects parotid. Benign painless masses. Resection. Warthin's tumour benign affects parotid occasionally bilateral and resection is treatment. Mucoepidermoid carcinoma is malignant - High and low grade with Facial nerve VII lesion and Lymphadenopathy. Resection if possible. Adenocarcinoma - Facial nerve VII lesion and Lymphadenopathy.
• Parotid swelling - Liver disease/Alcohol abuse, Sarcoidosis (Mikulicz syndrome when lacrimal glands also enlarged), Sjogren's syndrome, Lymphoma, Malignancy - a VII nerve palsy on the same side is worrying
• Parotitis: Bacterial - poor oral care, dehydration, salivary duct stones, Viral - Mumps often with orchitis
• Xerostomia "dry mouth": Causes include Drugs e.g. anticholinergics, antidepressants, lithium, antiparkinsonian medications, Sjogren's syndrome (enlarged salivary glands), Radiation treatment, Dehydration, renal failure. Complications include Dental caries, Candidiasis
• Sialadenitis: Bacterial e.g. Staph aureus, Streptococcus pyogenes, Streptococcus pneumonia, Viral, Sarcoidosis, Salivary gland involvement alone with systemic sarcoid, Heerfordt's syndrome - uveoparotid fever
• Mikulicz's syndrome - Salivary + lacrimal glands