Salivary Gland Dysfunction

Types and Common Causes

• Ptyalism (drooling): neurological (Parkinson's disease, epilepsy), sialorrhea, swallowing disorders (relative ptyalism)

• Xerostomia: central (rare), primary salivary disorders (Sjogren's disease, radiation sialadenosis), dehydration, medications (psychotropics, general anesthesia, ^-blockers), mouth breathing from nasal obstruction

• Sialorrhea (excessive saliva production): central, psychogenic, parasympathicomimetic medications (pilocarpine), diseased gland (tumor, inflammation)

TABLE 2—1. Computed Tomography versus Magnetic Resonance Imaging of the Parotid Gland

Computed Tomography

Magnetic Resonance Imaging iy e y better for bone imaging less expensive quicker image less sensitive to patient motion may differentiate deep tumors by identifying a fat strip identifies calcific stones distinguishes cystic nature of Warthin's tumors contrast allows differentiation of vascular channels and abnormal lymph nodes

• better for soft tissue imaging (distinguish parotid tumors from parapharyngeal lesions, identifies capsule)

• multiplanar views

• no radiation required (less invasive)

• facial nerve or retromandibular vessels may be used to distinguish deep and superficial lobes

• cannot be used with pacemakers and metallic implants (aneurysm clips, cochlear implants)

• better determines involvement of the facial nerve and parapharyngeal masses

Ti weighted: enhances fat, water appears dark, TR <1000, TE <25 ms

T2 weighted: enhances water, fat appears dark, TR >1000, TE >40 ms

Management

• Ptyalism/Sialorrhea: chorda tympani transection (Jacobson's nerve neurectomy), ductal rerouting procedure to the posterior cavity, ligation of Stenson's duct, submandibular gland excision

• Xerostomia: artificial saliva, frequent small drinks, pilocarpine hydrochlorate drops, aggressive dental care

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