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Otolaryngology > 9. Salivary Gland Tonsils > Flashcards

9. Salivary Gland Tonsils Flashcards

1
Q

What is involved in examination of the salivary ducts?

A

Bimanual palpation
Facial nerve function
Oropharynx

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2
Q

Describe the suite of investigations most used in the dx of salivary gland disease?

A

FBC/UEC/LFT/RF/ANA/Anti rho/ACE

Sialogram
CT
MRI

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3
Q

What are the three types of Infectious Parotitis?

A

Viral
Bacterial
TB

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4
Q

What are the clinical features of infectious parotitis?

A 
Hx/Symptoms 
Likely viral (mumps, tender bilateral enlarged parotids + trismus, Self limiting, supportive treatment at home, Can lead to serious complication = pancreatitis which can be very acute)

(HIV, chronic enlargement, lymphoepithelial cysts)

(Coxsaki can also cause)

Bacterial (Staphylococcal)
TB always Ddx for any lump anywhere.
Red tender ulcerative mass = U/S

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5
Q

What are the main causative organisms in viral infectious parotitis? Signs of Each?

A

Mumps

  • Paramyxovirus
  • Tender bilaterally enlarged and trismus
  • Complications

HIV

  • Chronic enlargement
  • Lymphoepithelial cysts
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6
Q

What are the main causative organisms in bacterial infectious parotitis? Signs of Each?

A

Staphylococcal

Elderly and immunocompromised

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7
Q

What is Sjogren Syndrome?

A

AI disorder defined by periductal lymphocytes in multiple organs

40% have salivary gland involvement.

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8
Q

How is Sjogren Syndrome classified?

A

Classified into
Primary Sjögren syndrome(sicca complex)
- Xerostomia, xerophtalmia and no connective tissue abnormality

Secondary Sjögren syndrome
= Associated with autoimmune diseases such as lupus erythematosus or rrheumatoid arthritis

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9
Q

What is the Dx work-up for Sjogren Syndrome?

A

Work up – autoimmune screen (rheumatology really)

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10
Q

What is Sialolithiasis?

A 
Calculi in salivary ducts
Usually in mucous secreting gland 
80% in SMG
65% are radiopaque
Swelling on eating + pain
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11
Q

What is the treatment for sialolithiasis? How is it Dx?

A

Removal under LA (most) or GA/ Resection of the gland (if recurrent, incision through neck)

Stitch behind the stone to make sure it doesn’t fall down before removing.

Dx using a sialogram, or a sialolscope (prof current mainly performs these, usually when not amenable to GA)

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12
Q

What is the 80 rule in Salivary Gland Neoplasms?

A

80% n parotid, 80% these benign, 80% of benigns are pleomorphic adenomas.

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13
Q

How does the Submandibular gland differ?

A

1/3 of tumours arising in the SMG malignant

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14
Q

Who does salivary gland neoplasms commonly affect?

A

Generally in >60yo

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15
Q

What are the two most common benign tumours of the salivary glands?

A

Pleomorphic

Warthins

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16
Q

What are the characteristics of Pleomorphic Adenoma?

A

Painless, slowly enlarging, smooth masses

Peak incidence in 5th decade

Arise from intercalated and myopethelial cells

Pseudocapsule-pseudopodia

Carcinoma ex pleomarphic carcinoma

Facial Nerve Involvement only happens with malignant!

Recurrency v. hard to deal with as it occurs dispersed manner in small numerous growths

17
Q

What are the charateristics of Warthins Duct Tumour?

A

Adenolymphoma or cystadenoma
Male
10% bilateral
60-70yrs

18
Q

What is the Tx for Pleomorphic Adenoma?

A

Take all out if ≤55 as small percentage will become malignant.

In parotid lump Examine all skin of face as may be a mets from another CC

19
Q

What are the most common types of malignant salivary gland tumour?

A

Adenoid Cystic Carcinoma

Adenocarcinoma

Mucoepidermoid Carcinoma

20
Q

What are the characteristics of adenoid cystic carcinomas?

A

Occurs more frequently in minor salivary glands
Slow growing
Spreads along nerve sheaths

21
Q

What is the prevalence of adenocarcinomas?

A

3% parotid tumours and 10% SMG

22
Q

What are the characteristics of mucoepidermoid carcinoma?

A

Mainly parotid

Variable maligancy depending on degree of differentiation

23
Q

Describe the Staging of Salivary Gland Tumours?

A

T0-no clinical evidence of tumour

T1-6cm

24
Q

What is the treatment for Malignant Salivary Gland Tumours

A

Dependent on stage
Surgical
Adjuvant chemotherapy
Adjuvant Radiation

25
Q

What are the potential complication of salivary gland surgery?

A

Surgical Complications

Facial nerve injury
Haematoma
Salivary fistula
Freys syndrome

26
Q

What is the function of the Thyroid?

A

Increases protein catabolism
Increases fat metabolism
Increases gluconeogenesis, glycogenolysis
Regulation of gut, skin and hair development

27
Q

Describe how you would assess the thyroid?

A

Hx

Neck examination
MNG/Diffusely enlarged/single nodule
Compressive symptoms???
Thyroid status

28
Q

How might thyroid pathology present?

A

Diffuse enlarge goitre (unless compressive symptoms, management is endodrine, can occur psychological goitre esp in preg with no hypo/hyper function)

Nodule, again come to ENT if compression problems, esp to airway.

29
Q

What investigations may indicate thyroid pathology?

A 
TFTS
Autoantibodies
US 
Fine needle aspiration
CT neck and thorax if retrosternal extension
30
Q

What are the malignant thyroid tumour features which may appear on U/S?

A 
Hypoechoic Nodule
Microcalcifications
Irregular Border
AP>TD
Intranodular Flow
31
Q

What are the features of benign thyroid tumour which may appear on U/S

A
  • Cystic
  • Peripherlal calcification
  • Peripheral vascularity
  • Hyperechoic ring around nodule
32
Q

What are the risk factors for malignancy of the thyroid?

A

Male/>45yrs/previous irradiation
Assoc lymphadenopathy
Systemic features

Compressive symptoms? Difficulty breathing? Dysphonea (recurrent laryngeal nerve supplies the vocal chords) Any family history of thyroid cancer (MENS, any adrenal/other mens cancers), previous radiation ( childhood cancer?, Eastern Europe.

33
Q

Extending lymph nodes, systemic features (weight loss + fatigue) = ?

A

Suggests lymphoma as opposed to carcinoma as tc is slow growing and indolent , refere to haematology and full work up involveing ct, bloods,

34
Q

How are the possible results of FNA classified?

A

Type 1= Non dx, repeat
Type 2 non-neoplastic
Type 3 Worrying features but cells too scanty to qualify as type 4
Type 4 Suspicious of malignancy (75% but only 25% will be malignant)
Type 5 Diagnositc of malignany

All discussed as part of a MD team

35
Q

What are the characteristics of Papillary TC?

A 
75%
Younger
Irradiation
Mulitfocal
Cervical LN Spread
36
Q

What are the characteristics of Follicular TC?

A

20%
Unifocal
Haematogenous and lymphatic spread

37
Q

What are the characteristics of Anaplastic TC?

A

5.00%

38
Q

What are the characteristics of Medullary TC?

A

5%
• C-cells
• Night sWEATS
• Lmphadenompathy

39
Q

What are the complications of Thyroidectomy?

A

Always divide into general/thyroidectomy specific
Can also divide into intermediate, early delayed

TS = Hypothyroidism, if total, synthetic hormone rest of life.
Alos Hypoparathyroidism blood pressure cuff = wrist spasm = trusos? LOVE ASKING THESE

Recurrent Laryngeal Nerve = Usually temporary (neuropraxic injury), Dysphonia, emergency trach if vocal chords shut, usually happens in extendive cancers.

Haematoma = always stitch cutter by the bed, as any swelling will cause pressure of the airway, oedema of the larynx may still occur, call anaesthesis immediately. 3 layers to get to the haematoma Skin, plati

Neck swelling post Thyroidectomy a favourite, if any midline lump comes up.

Scar
Infection
Haematoma
Recurrent laryngeal nerve injury
Unilateral-dysphonia
Bilateral-airway obstruction
Hypothyroidism
Hypoparathyroidism

Otolaryngology (9 decks)

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