49. Obstructive diseases of the salivary glands, Flashcards
Obstructive diseases of the salivary glands
- Flow of saliva blocked=>
- Salivary stones (sialoliths) or strictures in the ducts
Etiology and pathogenesis of salivary stones
- Development Unclear=>
- Nidus of Debris=> hypothesized to form from nidus of debris
- Duct Kinks=> Stones congregate in 90-degree bends in the duct system
- Microcalculi=>neutralize active phospholipids in damaged cells=> obstruction
- Calcium Precipitation=>Microcalculi lodged in duct kinks=>
- Nidus for calcium precipitation=> stones
-Stone Composition=> Submandibular stones have a high inorganic component (80%) and are mostly radiopaque (94%), while parotid stones are 50% organic and 43% radiopaque.
Clinical features of obstructive diseases of the salivary glands
- Mealtime Syndrome=> Repeated preprandial swelling=>indicative of stones
- Swelling Post-Rest=> after periods of inactivity=>
- Sleeping=> mucus plug formation and stagnant saliva flow=>
- Indicative of strictures
How obstructive diseases of the salivary glands diagnosed
- History
- Ultrasonography
- Sialography
- Plain Film Radiography
- CT and MRI Scans
1) Mealtime Syndrome, Post-Rest Swelling
2) Detection: Stones >2mm appear as echo-opaque with distal shadowing.
3) Stone Details=> Identifies size, position, and mobility.
Strictures=> Provides detailed information on number and shape
4) Submandibular Stones=> Detects average stones with mandibular true lower occlusal view. Not useful for small stones <2mm or in obstructive diseases
5) Demonstrates stones and chronic inflammation
Treatment options for obstructive diseases of the salivary glands
- Instrumental Treatment=>stone removal
- Intervention Sialography=>Duct walls are washed out with 1% lidocaine or articaine
- Stone Retrieval=>Antibiotics
- Sialoendoscopy
- Shockwaves:=>ECL generates compressive waves=> stress fractures in the calculus
Mucus plug and its clinical presentation
- Thick, gelatinous mass of saliva =>Structure=>
- Obstructs the salivary ducts
- Symptoms =>upon waking or after periods of dehydration =>stagnation of saliva.
- Treatment=> Sialogogues and massage
Polyps in the context of salivary gland obstructive diseases
- Pedunculated lesions arising from the duct lining
- Asymptomatic until detected by sialendoscopy
Foreign body impaction in the salivary glands and how it is managed
- Objects in salivary ducts
- Removal => endoscopic procedures
Pneumoparotid
- Aka trumpet blower’s syndrome
- Insufflation of air into the parotid gland=>
- Valve-like structure of the parotid duct and the tight punctum incompetent=>air and bacteria to enter the duct
- Linked to parotitis of childhood and coincide wi/ playing wind instruments
Characteristics and treatment options for simple cysts of the salivary glands
- Identified by Bluish spherical appearance or via aspiration
- Ranulae=> lesser sublingual gland=>
- Extend into the submandibular space
- Treatment=> Removal of the sublingual gland=>
- Ranula sac can be left in place
-Common Types: 90% are extravasation mucoceles.
-Ranula=>mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth
Polycystic disease of the parotid gland and how is it managed
- Very rare, only women
- Cystic changes usually do not involve the main parotid duct.
- Diagnosis=> sialography or sonography
- Conservative management
How HIV-associated salivary gland disease clinical presentation and what is the treatment
- 5% of HIV cases=> bilateral parotid cystic enlargement
- Mimics Sjögren’s syndrome on ultrasound
- Treatment=>highly active antiretroviral therapy (HAART).
Dermoid cysts and congenital duct cysts of the salivary glands
- Dermoid Cysts=> parotid or floor of the mouth
- Congenital Duct Cysts=>Rare retention cysts of the parotid gland
Salivary gland fistulae
- Abnormal, epithelial-lined tracts involving Parotid gland or duct=>
- Fistula can communicate with the mouth (usually asymptomatic), the paranasal sinuses (causing rhinorrhea), or the facial skin (draining saliva onto the skin).
- Trauma, surgery or due to duct obstruction w/ a calculus
- Heal spontaneously within a few weeks
