Chapter 308 Diseases of the Salivary Glands and Jaws
With the exception of mumps (Chapter 240), disease of the salivary glands is rare in children. Bilateral enlargement of the submaxillary glands can occur in AIDS, cystic fibrosis, Epstein-Barr virus infection, and malnutrition and, transiently, during acute asthmatic attacks. Chronic vomiting can be accompanied by enlargement of the parotid glands. Benign salivary gland hypertrophy has been associated with endocrinopathies: thyroid disease, diabetes, and disorders of the pituitary-adrenal axis.
Recurrent idiopathic swelling of the parotid gland can occur in otherwise healthy children. The swelling is usually unilateral, but both glands can be involved simultaneously or alternately. There is little pain; the swelling is limited to the gland and usually lasts 2-3 wk. The incidence appears to be higher in the spring.
Suppurative parotitis is usually caused by Staphylococcus aureus and can be primary or a complication of parotitis from another cause. It is usually unilateral and may be accompanied by fever. The gland becomes swollen, tender, and painful. Suppurative parotitis responds to appropriate antibacterial therapy based on culture obtained from the Stensen duct or by surgical drainage, which is infrequently required.
A ranula is a cyst associated with a major salivary gland in the sublingual area. It is a large, soft, mucus-containing swelling in the floor of the mouth. It occurs at any age, including infancy. The cyst should be excised, and the severed duct should be exteriorized.
Mucocele is a salivary gland lesion caused by a blockage of a salivary gland duct. It is most common on the lower lip and has the appearance of a fluid-filled vesicle or a fluctuant nodule with the overlying mucosa normal in color. Treatment is surgical excision, with removal of the involved accessory salivary gland.
Congenital lip pits are caused by fistulous tracts that lead to embedded mucous glands in the lower lip. They leak saliva, especially with salivary stimulation. Lip pits can be isolated anomalies, or they can be found in patients with cleft lip or palate. Treatment is surgical excision of the glandular tissue.
Eruption cyst is a smooth, painless swelling over the erupting tooth. If bleeding occurs in the cyst space, it may appear blue or blue-black. In most cases, no treatment is indicated and the cyst resolves with the full eruption of the tooth.
Also known as dry mouth, xerostomia may be associated with fever, dehydration, anticholinergic drugs, chronic graft versus host disease, Mikulicz disease (leukemia infiltrates), Sjögren syndrome, or tumoricidal doses of radiation when the salivary glands are within the field. Long-term xerostomia is a high-risk factor for dental caries.
Ossifying fibroma is a common benign tumor of the jaw. It is often asymptomatic, being discovered on routine radiographic examinations. Treatment is enucleation or curettage. Central giant cell granuloma is another common lesion thought to be reactive rather than neoplastic. Although usually asymptomatic, it can be expansile, with or without divergence of teeth. Treatment is complete curettage or surgical excision. Dentigerous cysts are common lesions associated with the crown of an impacted or unerupted tooth. Although usually asymptomatic, they can become large and destructive. Treatment is surgical removal.
The malignant primary tumors of the jaw in children include Burkitt lymphoma, osteogenic sarcoma, lymphosarcoma, ameloblastoma, and, more rarely, fibrosarcoma.