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Boies > Chapter 16: Diseases of the Salivary Glands > Flashcards

Chapter 16: Diseases of the Salivary Glands Flashcards

1
Q
  1. Largest of the major salivary glands
  2. Occupies the space anterior to the mastoid process and EAM
  3. Anterior: lies lateral to the ascending ramus of the mansible and masseter muscle
  4. Inferior: abuts on the SCM and covers the posterior belly of the digastric muscle
  5. Separated from the submandibular gland by the stylomandibular ligament
A

Parotid gland

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2
Q

Extends posteriorly and medial to the ascending ramus of the mandible (retromandibular extension)

A

Deep portion of the parotid gland

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3
Q

Artificially divides the parotid gland into superficial and deep portions

A

Facial nerve

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4
Q

2 major trunks of facial nerve

A
  1. Cervicofacial

2. Temporofacial

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5
Q

Separates into the temporal and zygomatic branches

A

Temporofacial division

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6
Q

Gives off the cervical branches, marginal mandibular division and buccal division

A

Cervicofacial division

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7
Q

Facial nerve divides the gland into

A
  1. Superficial

2. Deep

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8
Q

In close proximity to both the internal and external carotid arteries

A

Deep lobe of the parotid gland

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9
Q
  1. 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

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10
Q
  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
A

Submandibular (submaxillary) gland

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11
Q
  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
A

Submandibular duct (Wharton’s duct)

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12
Q
  1. Mixed glands

2. Both serous and mucous glandular elements

A

Sublingual and submandibular

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13
Q

Entirely serous

A

Parotid gland

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14
Q

Produces approximately 2/3 of the saliva at resting state

A

Submandibular gland

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15
Q

Produces approximetely 1/3 of the saliva in the resting state

A

Parotid gland

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16
Q
  1. Largest of the major salivary glands
  2. Occupies the space anterior to the mastoid process and EAM
  3. Anterior: lies lateral to the ascending ramus of the mansible and masseter muscle
  4. Inferior: abuts on the SCM and covers the posterior belly of the digastric muscle
  5. Separated from the submandibular gland by the stylomandibular ligament
A

Parotid gland

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17
Q

Extends posteriorly and medial to the ascending ramus of the mandible (retromandibular extension)

A

Deep portion of the parotid gland

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18
Q

Artificially divides the parotid gland into superficial and deep portions

A

Facial nerve

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19
Q

2 major trunks of facial nerve

A
  1. Cervicofacial

2. Temporofacial

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20
Q

Separates into the temporal and zygomatic branches

A

Temporofacial division

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21
Q

Gives off the cervical branches, marginal mandibular division and buccal division

A

Cervicofacial division

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22
Q

Facial nerve divides the gland into

A
  1. Superficial

2. Deep

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23
Q

In close proximity to both the internal and external carotid arteries

A

Deep lobe of the parotid gland

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24
Q
  1. 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

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25
Q
  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
A

Submandibular (submaxillary) gland

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26
Q
  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
A

Submandibular duct (Wharton’s duct)

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27
Q
  1. Mixed glands

2. Both serous and mucous glandular elements

A

Sublingual and submandibular

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28
Q

Entirely serous

A

Parotid gland

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29
Q

Produces approximately 2/3 of the saliva at resting state

A

Submandibular gland

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30
Q

Produces approximetely 1/3 of the saliva in the resting state

A

Parotid gland

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31
Q

Stimulation of salivary gland

A

Neural reflex carried along parasympathetic nervous system (begins in the inferior salivary nucleus)

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32
Q

A division of the 9th CN, passes across the promontory of the middle ear

A

Jacobson’s nerve

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33
Q

Stimulation of submandibular gland arises in the…

A

Superior salivary nucleus

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34
Q

The sympathetic nerve supply to the major salivary glands is from the…

A

Superior cervical ganglion by way of the arterial plexus

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35
Q

Most common form of acute parotid swelling

A

Mumps

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36
Q

Complications of mumps

A
  1. Orchitis
  2. Oophoritis
  3. Panceatitis
  4. Sensorineural hearing loss
  5. Encephalitis
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37
Q
  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
A

Recurrent sialadenitis

38
Q
  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
A

Acute suppurative parotitis

39
Q

Because a parotid abscess is often loculated…

A

A series of incisions into the glandular tissue parallel to the pathways of the facial nerve may be required

40
Q
  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
A

Acute submandibular gland sialadenitis

41
Q

Long standing, frequently recurring episodes of glandular swelling and discomfort to the major salivary glands

A

Chronic sialadenitis

42
Q

Associated with recurrent calculi, mucous plugs or strictures (sialodochiectasis)

A

Chronic sialadenitis

43
Q

Treatment of advance chronic sialadenitis that no longer responds to medical management

A
  1. Parotidectomy
  2. Tympanic neurectomy
  3. Parotid duct ligation (atrophy of the gland)
44
Q
  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
A

Salivary gland calculi (sialolithiasis)

45
Q

Surgical treatment of chronic submandibular gland sialadenitis requires…

A

Submandibular gland resection including the duct

46
Q

Systemic disease involving salivary glands

A
  1. Sarcoidosis
  2. Benign lymphoepithelial disease
  3. Sjögren’s syndrome
  4. DM
47
Q

Sarcoidosis involving the parotid glands is referred to as

A

Heerfordt’s syndrome or uveoparotid fever

48
Q

Other systemic manifestations of sarcoidosis

A
  1. Hypercalcemia
  2. Enlarged liver and spleen
  3. Enlarged cervical nodes
  4. Enlarged hilar nodes
49
Q

Definitive diagnosis of sarcoidosis

A

Biopsy

50
Q

Only treatment available for sarcoidosis

A

Administration of systemic steroids

51
Q
  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
A

Benign lymphoepithelial disease

52
Q
  1. Chronic parotitis
  2. Xerophthalmia or xerostomia
  3. Rheumatoid disorder (rheumatoid arthritis)
A

Sjögren’s syndrome

53
Q

Associated with a 44 times higher incidence of developing lymphoma (extraparotid nodal sites) than in general population

A

Sjögren’s disease

54
Q

Occurs in certain advanced neurologic disorders such as cerebral palsy, demyelinating disorders and Parkinson’s disease

A

Sialorrhea or drooling

55
Q

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

A

Sialorrhea

56
Q

Nonsurgical treatment of sialorrhea

A
  1. Atropine

2. Radiation therapy

57
Q

Surgical procedure to divert the flow of saliva

A

Rerouting the parotid and submandibular ducts through a submucosal tunnel to the region posterior to the tonsillar pillar

58
Q

Most effective surgical procedure to control drooling

A
  1. Bilateral submandibular gland resection

2. Parotid duct ligation

59
Q

Indications for sialography

A
  1. Chronic nonobstructive sialectasis
  2. Chronic obstructive disease
  3. Trauma
  4. Extraglandular masses
  5. Tumors
60
Q

Contraindications for sialography

A
  1. Presence of acute inflammation or suppuration

2. Allergy to contrast media

61
Q

This technique depends on the increased concentration of iodine in saliva compared to plasma

A

Radiosialographic scanning

62
Q
  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
A

Sialography

63
Q

Benign tumors of the salivary glands in children

A
  1. Parotid gland hemangioma
  2. Lymphangioma
  3. Pleomorphic adenoma
  4. Neurofibroma
  5. Lipoma
64
Q
  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
A

Parotid gland hemangioma

65
Q

3rd most common tumor and the most common solid tumor found in children

A

Pleomorphic adenoma

66
Q
  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
A

Pleomorphic adenoma (benign mixed tumor)

67
Q

When removing parotid tumors…

A

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
Q

Shelling out a pleomorphic adenoma in the superficial lobe of the parotid gland is not recommended because

A

High likelihood of recurrence

69
Q

Recurrent tumors may undergo malignant degeneration, but the incidence of this is…

A

Less than 6%

70
Q

Management of recurred and unresectable tumor

A

Irradiation therapy

71
Q
  1. Most common tumor of the submandibular gland

2. Tx: total surgical resection

A

Pleomorphic adenoma

72
Q
  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
A

Pleomorphic adenoma

73
Q
  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
A

Papillary adenocystoma lymphomatosum ( Warthin’s tumor)

74
Q

Other benign salivary gland in tumors in adults

A
  1. Oxyphil adenoma (acidophilic cell)
  2. Serous cell adenoma
  3. Oncocytoma
75
Q

May be the primary site of origin for benign tumors

A

Parapharyngeal space

76
Q

Most common tumor of the parapharyngeal space

A

Pleomorphic adenoma

77
Q

2nd most common tumor of parapharyngeal space

A

Malignant adenocystic carcinoma

78
Q

Tumor of neurogenic origin originate in parapharyngeal space

A

Schwannoma

79
Q

External, transcervical approach

A
  1. Any tumor of the parapharyngeal space

2. Prevents seeding of the tumor, which can occur through a transoral approach

80
Q

Benign

A 
Parotid
Younger age
Female
Facial nerve function intact
Cystic
Long duration (>2 yr)
Asymptomatic
No adenopathy
81
Q

Increasing likelihood of malignancy

A 
Submandibular
Paresis
Firm
Rapid growth
Discomfort
82
Q

Malignant

A 
Minor salivary gland
Older
Male
Paralysis
Rock hard
Recent onset (<1 yr)
Pain
Cervical adenopathy
83
Q

Most common malignant tumor in children

A

Mucoepidermoid carcinoma

84
Q

2nd most common childhood parotid malignancy

A

Adenocarcinoma

85
Q

High-grade malignant potential

A
  1. Mucoepidermoid carcinoma
  2. Squamous cell carcinoma
  3. Undifferentiated adenocarcinoma
  4. Adenocystic carcinoma (cylindroma)
86
Q
  1. Has a predilection for neural invasion

2. High 5-year survival rate

A

Adenocystic carcinoma

87
Q

Treatment of highly malignant tumor

A

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
Q

Malignant tumors of intermediate and low grade

A
  1. Mucoepidermoid carcinoma

2. Acinic cell carcinoma

89
Q

Treatment of tumors in submandibular gland

A

Total resection of the gland and adjacent tissues and radical or modified radical neck dissection

90
Q
  1. Most common malignant parotid tumor occur bilaterally

2. Occurs mote exclusively in the parotid gland

A

Acinic cell carcinoma

91
Q

Radical neck dissection is required when…

A
  1. Palpable cervical metastases are present

2. Recurrence of a malignant tumor in the parotid region

92
Q

Prognosis for adults with malignant parotid tumors depends on..

A
  1. Stage and size of tumor at presentation
  2. Presence of absence of facial nerve paralysis
  3. Evidence of cervical metastatic disease

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