Chapter 16: Diseases of the Salivary Glands Flashcards
1
Q
- Largest of the major salivary glands
- Occupies the space anterior to the mastoid process and EAM
- Anterior: lies lateral to the ascending ramus of the mansible and masseter muscle
- Inferior: abuts on the SCM and covers the posterior belly of the digastric muscle
- Separated from the submandibular gland by the stylomandibular ligament
A
Parotid gland
2
Q
Extends posteriorly and medial to the ascending ramus of the mandible (retromandibular extension)
A
Deep portion of the parotid gland
3
Q
Artificially divides the parotid gland into superficial and deep portions
A
Facial nerve
4
Q
2 major trunks of facial nerve
A
- Cervicofacial
2. Temporofacial
5
Q
Separates into the temporal and zygomatic branches
A
Temporofacial division
6
Q
Gives off the cervical branches, marginal mandibular division and buccal division
A
Cervicofacial division
7
Q
Facial nerve divides the gland into
A
- Superficial
2. Deep
8
Q
In close proximity to both the internal and external carotid arteries
A
Deep lobe of the parotid gland
9
Q
- 6 cm long, arises from the anterior portion of the gland
2. Crosses the masseter muscle and turns sharply over the anterior border of the muscle to pierce the buccinator muscle
A
Parotid duct
10
Q
- Lies beneath the horizontal ramus of the mandible and is enclosed by a thin layer of CT
- Lies entirely within the digastric triangle (anterior and posterior bellies of the digastric muscle)
- Medial: styloglossus and hyoglossus muscles
- Anterior: mylohyoid muscle
A
Submandibular (submaxillary) gland
11
Q
- 6 cm
- Passes between the mylohyoid and hyoglossus muscles just medial to the sublingual gland and enters the mouth just lateral to the lingular frenulum
A
Submandibular duct (Wharton’s duct)
12
Q
- Mixed glands
2. Both serous and mucous glandular elements
A
Sublingual and submandibular
13
Q
Entirely serous
A
Parotid gland
14
Q
Produces approximately 2/3 of the saliva at resting state
A
Submandibular gland
15
Q
Produces approximetely 1/3 of the saliva in the resting state
A
Parotid gland
16
Q
- Largest of the major salivary glands
- Occupies the space anterior to the mastoid process and EAM
- Anterior: lies lateral to the ascending ramus of the mansible and masseter muscle
- Inferior: abuts on the SCM and covers the posterior belly of the digastric muscle
- Separated from the submandibular gland by the stylomandibular ligament
A
Parotid gland
17
Q
Extends posteriorly and medial to the ascending ramus of the mandible (retromandibular extension)
A
Deep portion of the parotid gland
18
Q
Artificially divides the parotid gland into superficial and deep portions
A
Facial nerve
19
Q
2 major trunks of facial nerve
A
- Cervicofacial
2. Temporofacial
20
Q
Separates into the temporal and zygomatic branches
A
Temporofacial division
21
Q
Gives off the cervical branches, marginal mandibular division and buccal division
A
Cervicofacial division
22
Q
Facial nerve divides the gland into
A
- Superficial
2. Deep
23
Q
In close proximity to both the internal and external carotid arteries
A
Deep lobe of the parotid gland
24
Q
- 6 cm long, arises from the anterior portion of the gland
2. Crosses the masseter muscle and turns sharply over the anterior border of the muscle to pierce the buccinator muscle
A
Parotid duct
25
1. Lies beneath the horizontal ramus of the mandible and is enclosed by a thin layer of CT
2. Lies entirely within the digastric triangle (anterior and posterior bellies of the digastric muscle)
3. Medial: styloglossus and hyoglossus muscles
4. Anterior: mylohyoid muscle
Submandibular (submaxillary) gland
26
1. 6 cm
2. Passes between the mylohyoid and hyoglossus muscles just medial to the sublingual gland and enters the mouth just lateral to the lingular frenulum
Submandibular duct (Wharton's duct)
27
1. Mixed glands
| 2. Both serous and mucous glandular elements
Sublingual and submandibular
28
Entirely serous
Parotid gland
29
Produces approximately 2/3 of the saliva at resting state
Submandibular gland
30
Produces approximetely 1/3 of the saliva in the resting state
Parotid gland
31
Stimulation of salivary gland
Neural reflex carried along parasympathetic nervous system (begins in the inferior salivary nucleus)
32
A division of the 9th CN, passes across the promontory of the middle ear
Jacobson's nerve
33
Stimulation of submandibular gland arises in the...
Superior salivary nucleus
34
The sympathetic nerve supply to the major salivary glands is from the...
Superior cervical ganglion by way of the arterial plexus
35
Most common form of acute parotid swelling
Mumps
36
Complications of mumps
1. Orchitis
2. Oophoritis
3. Panceatitis
4. Sensorineural hearing loss
5. Encephalitis
37
1. Another form of parotid swelling which occurs in children
2. Pus can be expressed from Stensen's duct
3. Sialographic studies: dilatation of the peripheral ducts
Recurrent sialadenitis
38
1. Sudden onset of pain, redness and swelling of the parotid region
2. Debilitated and elderly persons who may be partially dehydrated
3. Poor oral hygiene
4. Coagulase-positive S. aureus
5. Tx: IV antibiotics, correction of dehydration, warm packs, analgesic
Acute suppurative parotitis
39
Because a parotid abscess is often loculated...
A series of incisions into the glandular tissue parallel to the pathways of the facial nerve may be required
40
1. Secondary to calculus or trauma to the gland
2. Dental evaluation is necessary
3. Obtained culture
4. Excision of the submandibular gland in the presence of acute inflammation is difficult
Acute submandibular gland sialadenitis
41
Long standing, frequently recurring episodes of glandular swelling and discomfort to the major salivary glands
Chronic sialadenitis
42
Associated with recurrent calculi, mucous plugs or strictures (sialodochiectasis)
Chronic sialadenitis
43
Treatment of advance chronic sialadenitis that no longer responds to medical management
1. Parotidectomy
2. Tympanic neurectomy
3. Parotid duct ligation (atrophy of the gland)
44
1. Occur more commonly in the submandibular gland
2. 90% of stones are radiopaque
3. Sudden onset of swelling and pain over the submandibular region, usually short after a meal
4. Tx: surgical removal of the calculus from the duct, stone may be milked out of the duct
Salivary gland calculi (sialolithiasis)
45
Surgical treatment of chronic submandibular gland sialadenitis requires...
Submandibular gland resection including the duct
46
Systemic disease involving salivary glands
1. Sarcoidosis
2. Benign lymphoepithelial disease
3. Sjögren's syndrome
4. DM
47
Sarcoidosis involving the parotid glands is referred to as
Heerfordt's syndrome or uveoparotid fever
48
Other systemic manifestations of sarcoidosis
1. Hypercalcemia
2. Enlarged liver and spleen
3. Enlarged cervical nodes
4. Enlarged hilar nodes
49
Definitive diagnosis of sarcoidosis
Biopsy
50
Only treatment available for sarcoidosis
Administration of systemic steroids
51
1. Is a specific type of chronic punctuate parotitis
2. Women and an autoimmune disease process
3. Associated with rheumatoid disorders
4. Sialogram: little dots of contrast material distributed throughout the parenchyma of the gland
5. Dilated ducts with lymphocytic infiltration and acinar atrophy
Benign lymphoepithelial disease
52
1. Chronic parotitis
2. Xerophthalmia or xerostomia
3. Rheumatoid disorder (rheumatoid arthritis)
Sjögren's syndrome
53
Associated with a 44 times higher incidence of developing lymphoma (extraparotid nodal sites) than in general population
Sjögren's disease
54
Occurs in certain advanced neurologic disorders such as cerebral palsy, demyelinating disorders and Parkinson's disease
Sialorrhea or drooling
55
Not an increase in the actual amount of saliva formed, but there is an inability of the patient to handle the saliva that builds up in the anterior mouth and eventually flows over the lip
Sialorrhea
56
Nonsurgical treatment of sialorrhea
1. Atropine
| 2. Radiation therapy
57
Surgical procedure to divert the flow of saliva
Rerouting the parotid and submandibular ducts through a submucosal tunnel to the region posterior to the tonsillar pillar
58
Most effective surgical procedure to control drooling
1. Bilateral submandibular gland resection
| 2. Parotid duct ligation
59
Indications for sialography
1. Chronic nonobstructive sialectasis
2. Chronic obstructive disease
3. Trauma
4. Extraglandular masses
4. Tumors
60
Contraindications for sialography
1. Presence of acute inflammation or suppuration
| 2. Allergy to contrast media
61
This technique depends on the increased concentration of iodine in saliva compared to plasma
Radiosialographic scanning
62
1. This technique requires injection of water or oil soluble contrast material directly into the submandibular or parotid gland
2. Always obtain a scout film before injection of contrast
3. Persistence of contrast medium within the gland 24 hours after is definitely abnormal
4. Never inject contrast during an acute inflammation
Sialography
63
Benign tumors of the salivary glands in children
1. Parotid gland hemangioma
2. Lymphangioma
3. Pleomorphic adenoma
4. Neurofibroma
5. Lipoma
64
1. Skin overlying the mass may have bluish discoloration
2. Fluctuation in the size of the mass when the child cries
3. Gradual increase in size during the 1st 4-6 months of life but should begin to show evidence resolution by age 2
Parotid gland hemangioma
65
3rd most common tumor and the most common solid tumor found in children
Pleomorphic adenoma
66
1. Accounts for 75% of parotid gland tumors
2. Most common in the parotid region
3. Painless swelling of long duration in the preauricular area or the region of the tail of the parotid gland
4. May continue to increase in size and become locally destructive
5. Tx: complete surgical resection
Pleomorphic adenoma (benign mixed tumor)
67
When removing parotid tumors...
Entire superficial lobe, or that portion of the gland lateral to the facial nerve is removed en bloc for biopsy purposes, dissecting out and preserving the facial nerve
68
Shelling out a pleomorphic adenoma in the superficial lobe of the parotid gland is not recommended because
High likelihood of recurrence
69
Recurrent tumors may undergo malignant degeneration, but the incidence of this is...
Less than 6%
70
Management of recurred and unresectable tumor
Irradiation therapy
71
1. Most common tumor of the submandibular gland
| 2. Tx: total surgical resection
Pleomorphic adenoma
72
1. Most common benign tumor of the minor salivary glands
2. Location: palate near the midline at the junction of the hard and soft palate (most common for malignant salivary gland tumors of the palate)
Tx: wide local resection
Pleomorphic adenoma
73
1. Benign salivary gland tumor
2. Most common in 50 to 60 year old males
3. Most common tumor to occur bilaterally
4. Tumor is encapsulated and recurrence is unlikely
5. Tx: surgical resection with facial nerve preservation
Papillary adenocystoma lymphomatosum ( Warthin's tumor)
74
Other benign salivary gland in tumors in adults
1. Oxyphil adenoma (acidophilic cell)
2. Serous cell adenoma
3. Oncocytoma
75
May be the primary site of origin for benign tumors
Parapharyngeal space
76
Most common tumor of the parapharyngeal space
Pleomorphic adenoma
77
2nd most common tumor of parapharyngeal space
Malignant adenocystic carcinoma
78
Tumor of neurogenic origin originate in parapharyngeal space
Schwannoma
79
External, transcervical approach
1. Any tumor of the parapharyngeal space
| 2. Prevents seeding of the tumor, which can occur through a transoral approach
80
Benign
```
Parotid
Younger age
Female
Facial nerve function intact
Cystic
Long duration (>2 yr)
Asymptomatic
No adenopathy
```
81
Increasing likelihood of malignancy
```
Submandibular
Paresis
Firm
Rapid growth
Discomfort
```
82
Malignant
```
Minor salivary gland
Older
Male
Paralysis
Rock hard
Recent onset (<1 yr)
Pain
Cervical adenopathy
```
83
Most common malignant tumor in children
Mucoepidermoid carcinoma
84
2nd most common childhood parotid malignancy
Adenocarcinoma
85
High-grade malignant potential
1. Mucoepidermoid carcinoma
2. Squamous cell carcinoma
3. Undifferentiated adenocarcinoma
4. Adenocystic carcinoma (cylindroma)
86
1. Has a predilection for neural invasion
| 2. High 5-year survival rate
Adenocystic carcinoma
87
Treatment of highly malignant tumor
Radical surgical resection of the primary tumor, when necessary, adjacent vital structures such as the mandible, maxilla and even a portion of the temporal bone
In order to completely excise the malignant tumors, division of the facial nerve adjacent to the tumor have to b excised
88
Malignant tumors of intermediate and low grade
1. Mucoepidermoid carcinoma
| 2. Acinic cell carcinoma
89
Treatment of tumors in submandibular gland
Total resection of the gland and adjacent tissues and radical or modified radical neck dissection
90
1. Most common malignant parotid tumor occur bilaterally
| 2. Occurs mote exclusively in the parotid gland
Acinic cell carcinoma
91
Radical neck dissection is required when...
1. Palpable cervical metastases are present
| 2. Recurrence of a malignant tumor in the parotid region
92
Prognosis for adults with malignant parotid tumors depends on..
1. Stage and size of tumor at presentation
2. Presence of absence of facial nerve paralysis
3. Evidence of cervical metastatic disease
