Granulomatous disease

1. Sarcoidosis

Uncommon chronic multisystem disease, unknown cause

Epidemiology: Adult females of African origin

Clinical:

• Granuloma formation in:
  • Lungs lymph nodes (particularly hilar nodes)
  • Salivary glands
  • Oral sites

• Systematic features:
  • Erythema nodosum
  • Lymphadenopathy
  • Lung involvement

• Oral features:
  • Enlarged salivary glands
  • Xerostomia
  • Gingival hyperplasia
  • Labial swelling

NB: Heerfordt’s syndrome (salivary and lacrimal swelling, facial palsy and uveitis) is rare

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2. TB

• Primary TB of the salivary glands:
  • Uncommon, usually unilateral, parotid most common affected
  • Believed to arise from spread of a focus of infection in tonsils
• Secondary TB – may involve the salivary glands but tends to involve the SMG

3. Cat Scratch Disease

• Does not involve the salivary glands directly, but involves the periparotid and
  submandibular triangle lymph nodes
• May involve SG by contiguous spread
• Bacteria is Bartonella Henselae(G-R)

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Cysts

True cysts of the parotid account for 2-5% of all parotid lesions

1. Congenital:

• Type 1 – Branchial arch cysts
• Type 2 – Cysts are a duplication anomaly of the membranous and cartilaginous EAC

2. Acquired:

• Mucus extravasation vs. retention
• Traumatic
• Benign epithelial lesions
• Association with tumors:
  • Pleomorphic adenoma
  • Adenoid Cystic Carcinoma
  • Mucoepidermoid Carcinoma
  • Warthin’s Tumor

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Pneumoparotitis

• Aka: pneumosialadenitis, wind parotitis, pneumatocele glandulae parotis
• In the absence of gas-producing bacterial parotitis, gas in the parotid duct or gland is assumed to be due to the reflux of pressurized air from the mouth into Stenson’s duct.
• May occur with episodes of increased intrabuccal pressure – glass blowers, trumpet players
• Crepitations on palpation of gland
• Swelling may resolve in minutes to hours, in some cases, days.
• US and CT show air in the duct and gland
• Antibiotics to prevent superimposed infection