9. Salivary Gland Tonsils Flashcards
What is involved in examination of the salivary ducts?
Bimanual palpation
Facial nerve function
Oropharynx
Describe the suite of investigations most used in the dx of salivary gland disease?
FBC/UEC/LFT/RF/ANA/Anti rho/ACE
Sialogram
CT
MRI
What are the three types of Infectious Parotitis?
Viral
Bacterial
TB
What are the clinical features of infectious parotitis?
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
What are the main causative organisms in viral infectious parotitis? Signs of Each?
Mumps
- Paramyxovirus
- Tender bilaterally enlarged and trismus
- Complications
HIV
- Chronic enlargement
- Lymphoepithelial cysts
What are the main causative organisms in bacterial infectious parotitis? Signs of Each?
Staphylococcal
Elderly and immunocompromised
What is Sjogren Syndrome?
AI disorder defined by periductal lymphocytes in multiple organs
40% have salivary gland involvement.
How is Sjogren Syndrome classified?
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
What is the Dx work-up for Sjogren Syndrome?
Work up – autoimmune screen (rheumatology really)
What is Sialolithiasis?
Calculi in salivary ducts Usually in mucous secreting gland 80% in SMG 65% are radiopaque Swelling on eating + pain
What is the treatment for sialolithiasis? How is it Dx?
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)
What is the 80 rule in Salivary Gland Neoplasms?
80% n parotid, 80% these benign, 80% of benigns are pleomorphic adenomas.
How does the Submandibular gland differ?
1/3 of tumours arising in the SMG malignant
Who does salivary gland neoplasms commonly affect?
Generally in >60yo
What are the two most common benign tumours of the salivary glands?
Pleomorphic
Warthins
What are the characteristics of Pleomorphic Adenoma?
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
What are the charateristics of Warthins Duct Tumour?
Adenolymphoma or cystadenoma
Male
10% bilateral
60-70yrs
What is the Tx for Pleomorphic Adenoma?
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
What are the most common types of malignant salivary gland tumour?
Adenoid Cystic Carcinoma
Adenocarcinoma
Mucoepidermoid Carcinoma
What are the characteristics of adenoid cystic carcinomas?
Occurs more frequently in minor salivary glands
Slow growing
Spreads along nerve sheaths
What is the prevalence of adenocarcinomas?
3% parotid tumours and 10% SMG
What are the characteristics of mucoepidermoid carcinoma?
Mainly parotid
Variable maligancy depending on degree of differentiation
Describe the Staging of Salivary Gland Tumours?
T0-no clinical evidence of tumour
T1-6cm
What is the treatment for Malignant Salivary Gland Tumours
Dependent on stage
Surgical
Adjuvant chemotherapy
Adjuvant Radiation
What are the potential complication of salivary gland surgery?
Surgical Complications
Facial nerve injury
Haematoma
Salivary fistula
Freys syndrome
What is the function of the Thyroid?
Increases protein catabolism
Increases fat metabolism
Increases gluconeogenesis, glycogenolysis
Regulation of gut, skin and hair development
Describe how you would assess the thyroid?
Hx
Neck examination
MNG/Diffusely enlarged/single nodule
Compressive symptoms???
Thyroid status
How might thyroid pathology present?
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.
What investigations may indicate thyroid pathology?
TFTS Autoantibodies US Fine needle aspiration CT neck and thorax if retrosternal extension
What are the malignant thyroid tumour features which may appear on U/S?
Hypoechoic Nodule Microcalcifications Irregular Border AP>TD Intranodular Flow
What are the features of benign thyroid tumour which may appear on U/S
- Cystic
- Peripherlal calcification
- Peripheral vascularity
- Hyperechoic ring around nodule
What are the risk factors for malignancy of the thyroid?
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.
Extending lymph nodes, systemic features (weight loss + fatigue) = ?
Suggests lymphoma as opposed to carcinoma as tc is slow growing and indolent , refere to haematology and full work up involveing ct, bloods,
How are the possible results of FNA classified?
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
What are the characteristics of Papillary TC?
75% Younger Irradiation Mulitfocal Cervical LN Spread
What are the characteristics of Follicular TC?
20%
Unifocal
Haematogenous and lymphatic spread
What are the characteristics of Anaplastic TC?
5.00%
What are the characteristics of Medullary TC?
5%
• C-cells
• Night sWEATS
• Lmphadenompathy
What are the complications of Thyroidectomy?
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
