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7: Digestive System > Chapter 88 Salivary Glands > Flashcards

Chapter 88 Salivary Glands Flashcards

1
Q

What method can be used to improve visualisation of parotid salivary gland intra op

A

Injection of new methylene blue

(0.25 ml in 3 ml of 0.9% saline, inject 1.5-3ml diirectly or via parotid duct - Gordo, JSAP, 2020)

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2
Q

Name a non-sx treatment option described for sialocoele

A

Injection of N-acetylcysteine

(10% solution injected via duct until retrograde flow seen)

22% recurrence

Ortilles, JAVMA, 2020

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3
Q

What are the major and minor salivary glands

A

Major:

  • Parotid
  • Mandibular
  • Sublingual
  • Zygomatic

Minor:

  • Buccal
  • Lingual
  • Labial
  • Tonsillar
  • Palatine
  • Molar (well deveopled in cats, sit just deep to buccal mucosa at angle of mandible)

(BLLT with Potato Mash)

  • Molar
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4
Q

By what structures is parotid salivary gland bounded?

A

Caudally:

  • Sternomastoid m
  • Cleidocervicalis m

Cranial:

  • Masseter m

Ventral:

  • Mandibular salivary gland

Superficial:

  • Platysma
  • Parotidoauricularis

Deep:

  • Auricular cartilage of ear

(Surrounding structures: facial nerve, maxillary and temporal arteries, internal maxillary vein, and regions surrounding the external acoustic meatus and the stylomastoid foramen)

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5
Q

Label the diagram

A
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6
Q

Where does parotid duct open?

A

Oral vestibule lateral upper 4th premolar (carnassial)

Travels over ventral 1/3rd of masseter

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7
Q

Which LNs does parotid salivary gland drain into?

A
  • Medial retropharyngeal
  • Parotid

N.B. All major salivary glands drain into medial retropharyngeal and parotid gland also drains into parotid glands

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8
Q

What is the arterial supply to parotid salivary gland?

And venous drainage

A

Arterial: Parotid artery (branch of external carotid - runs along medial aspect vetral to external ear canal)

Venous: Superficial temporal and great auricular veins

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9
Q

Which nerve supplies parasympathetic innervation to the following salivary glands:

Parotid

Zygomatic

Mandibular

Sublingual

A
  • Parotid: Trigeminal (auriculotemporal n.)
  • Zygomatic: Glossopharyngeal
  • Mandibular: Trigeminal (lingual n) + facial
  • Sublingual: Trigeminal (lingual n) + facial
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10
Q

How many ducta are there from the zygomatic salivary gland

A

One major, up to 4 minor

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11
Q

Where does zygomatic salivary gland sit reltive to LN in orbital space

A

Salivary gland is lateral

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12
Q

Where do zygomatic salivary ducts open

A

Oral vestibule, caudal to upper last molar (usually 1cm caudal to parotid papilla)

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13
Q

What is the arterial supply and venous drainage of zygomatic salivary gland

Draining LN?

A

Arterial: Infraorbital artery

Venous: Deep facial vein (–> superficial temporal –> maxillary)

Ln: medial retropharyngeal

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14
Q

What anatomical structure can be used to locate mandibular salivary gland?

A

Junction between maxillary and linguofacial vein

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15
Q

Where does mandibular LN sit relative to mandibular salivary gland?

A

Ventromedially

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16
Q

Where does mandibular salivary duct open?

And sublingual?

A

Both open at sublingual caruncle, sublingual duct opens just caudal tomandibular duct.

(Ducts travels between styloglossus and mylohyoideus)

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17
Q

What is arterial supply to mandibular salivary gland.

And venous drainage

And to sublingual gland:

A

Mandibular:

  • Arterial: Glandular branch of facial artery
  • Venous: Lingual vein

Sublingual:

  • Aretrial: Glandular branch of facial artery to monostomatic part, sublingual branch of lingual artery to polystomatic part
  • Venous: Satellite veins alongside arteries
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18
Q

Whatare the portions of the sublingual salivary gland

A

Monostomatic:

  • Found within the capsule shared by the mandibular salivary gland
  • External to the capsule the gland continues rostrally in close association with the mandibular duct but is packaged in loose clusters of glandular tissue deep to the digastricus and mylohyoideus muscles. Sublingual salivary tissue caudal to the lingual nerve empties into the sublingual duct and is considered a monostomatic salivary gland

Polystomatic

  • The polystomatic salivary tissue consists of small clusters of glandular tissue rostral to the lingual nerve that typically empty directly into the oral cavity.
19
Q

Which salivary glands produce more serous secretion (vs more mucous)

A

Parotid + mandibular = more serous

20
Q

riefly explain pathophys of salivary gland secretion (i..e composition of what is excreted)

A
  • Phase one: Production of saliva within the acinus. The acinar cells absorb Na+, which helps to draw water in, creating sodium-rich saliva. Saliva flows into the collecting ducts.
  • Phase two: Active reabsorption of Na+ and secretion of HCO3−.This process occurs mainly in the intralobular duct epithelium, which is formed by tall columnar epithelial cells. The resultant saliva excreted into the oral cavity is rich in HCO3− and K+
21
Q

List 5 functions of saliva

A
  • Lubrication
  • Themroregulation
  • Cleansing
  • Buffering of weak acids
  • Reduction of oral bacterial growth
22
Q

List 2 non surgical ddx for salivary gland disease. How is one distinguished form the other

A
  • Sialadenosis (limbic epilepsy) –> bilat non-painful, non-inflammatory SG swelling.
    • Tx pheno
  • Non-infecetious sialadenitis and necrotising sialometaplasia –> painful. Dx with histo (not cyto as easy to confuse).
    • Histo = lobular necrosis, inflammation, squamous metaplasia, infarction, hypertrophy of ductal epithelium.
    • Often associated with underlying GI disease
    • Tx adrress any underlying GI issues and pheno
23
Q

Name the four sialocoele locations - which gland is usually responsible. Most common presenting sign?

A
  • Zygomatic - zygomatic gland - exophtalmos
  • Pharyngeal - mandibular/sublingual complex - laboured breathing
  • Cervical - sublingual - intermandibular/cervical swelling
  • Sublingual (ranula) - rostral sublingual - dysphagia
24
Q

Where is most common source of sialocoele?

A

Sublingual gland/duct –> cervical sialocoele

25
Q

List 4 breeds predisposed to sialocoeles

A

GSD

Austrlian Silky terrier

Poodle

Dachshund

26
Q

What is usual cytology from a sialocoele

What additional test can be run

A
  • Non-degenerate neutrophils
  • Macrophages with abundant, foamy cytoplasm
  • Proteinaceous background
  • (Plasma cells, few lymphocytes)

PAS (periodic acid Schiff staining for mucin)

27
Q

On top of the usual - what additinal test can be used to investiagte sialocoeles

A

Sialography

28
Q

What breed is pedisposed to pharyngeal sialocoeles

Concurrent findings?

A

Mini poodles

Males

43% also had cervical sialocoeles

29
Q

How shoudl pharyngeal sialocoeles be managed?

A

Marsupialization + removal of offending gland/duct (usually mandibular/sublingual complex)

Often need immediate interventions due to airway compromise. Be prepeared for tach

30
Q

List a non neoplastic ddx for cervical sialocoele

A

Branchial cleft cyst

31
Q

How is sublingual sialocoele managed

A

Marsupialization + removal of mandibular/sublingual saloivary gland complex

32
Q

List 5 post-op complications after cervical sialadenectoym

A
  • Seroma
  • Recurrence (<5%)
  • Infection
  • Sublingual swelling
  • Bleeding
33
Q

Where are sialoliths most commonly found

ddx?

A

Parotid duct

ddx: mineralised folds of sialocoele lining that have sloughed

34
Q

Comment on image

A

Transverse T2-weighted magnetic resonance image with fat saturation of the head at the level of the zygomatic arch (yellow outline). This image demonstrates a normal zygomatic salivary gland (yellow star) as well as a zygomatic sialocele (black star).

35
Q

List 4 methods for sialolith tx

A
  • R+A
  • Removal of gland/duct complex
  • Open + primary repair
  • Marsupialization
36
Q

What is most common salivary gland neoplasia?

Which galnds most commonly affected

A

Adenocarcinoma

Mandibular and parotid

37
Q

What % of dogs has LN mets with salivary gland neoplasia?

And cats?

A

17% dogs

39% cats

38
Q

In dogs with salivary gland neplasia, what factor affects prognosis

A

Disease stage (not grade)

39
Q

Name 2 approaches for mandibular/sublingual sialadenectomy

Describe ventral apporach to mandibular/sublingual sialadenectomy

A

Can do ventral or lateral apprach

Ventral

  • Incision from a point 4 to 5 cm caudal to the mandibular ramus on the affected side and extending rostrally toward the mandibular symphysis (midline if bilateral sialadenectomy)
  • Platysma muscle incised to facilitate identification of the external jugular bifurcation (to maxillary v and linguofacial v); the mandibular gland sits at or just cranial to this bifurcation.
  • Tissues are bluntly dissected to expose the capsule covering the mandibular and sublingual salivary glands (N.B. ensure not LNs)
  • The capsule over both glands is incised and bluntly dissected off the glandular tissue to facilitate ligation of vessels on the medial side of the gland.
  • The gland complex is then retracted caudally to allow blunt dissection of the sublingual gland under (dorsal to) the digastricus muscle.
  • With a hemostat placed from rostral to caudal under the digastricus muscle, the ducts are clamped just rostral to the large glandular complex, and the mandibular and main sublingual gland are excised.
  • The remaining ducts and sublingual glands are pulled under the digastricus muscle.
  • Blunt and sharp dissection are continued rostrally to the level of the lingual nerve. The the mylohyoideus muscle is incised for best exposure of the rostral glandular tissue and lingual nerve (see Figure 88.14). Most intermandibular, cervical, or pharyngeal sialoceles resolve if duct and glandular tissue is removed up to the lingual nerve.
  • If a ranula is present, however, dissection should continue rostral to the lingual nerve under the mylohyoideus to remove all of the glandular tissue up to the sublingual caruncle. The duct is ligated as rostrally as possible and transected.
40
Q

Briefly decribe procedure for zygomatic sialadenectomy

A
  • incision is made horizontally tover the dorsal aspect of zygomatic arch.
  • The aponeurosis of the masseter muscle is reflected off of the ventral aspect of the zygomatic arch, and the orbital fascia is reflected dorsally.
  • A portion of the rostrolateral zygomatic arch is removed, as necessary, with a bone saw or rongeurs to gain access to the region of the zygomatic gland.
  • Orbital fat is dissected and retracted to gain access to glandular tissue. The gland resides medial to the zygomatic arch and adjacent to the globe on the rostroventrolateral aspect. However, careful dissection is required due to sensitive structures in that area and anatomic changes caused by the presence of the sialocele. The gland is gently retracted and dissected free from surrounding tissue. A branch of the infraorbital (malar) artery supplying the salivary gland is accessed for ligation by dorsal retraction of the gland.
41
Q

What 2 muscles are inscised to get access to parotid salivary gland?

What vein has to be liagted and divided?

A

Platysma

Parotidoauricularis

Caudal auricular vein

42
Q

How do things change if a parotid salivary gand problem includes a lateral cheek swelling

A

If clinical presentation included lateral cheek swelling, the accessory parotid gland just dorsal to the parotid duct should also be dissected free and removed.

During wound closure, superficial muscles and subcutaneous tissues are reapposed to minimize dead space.

43
Q

look at this lovely diagram

A
44
Q

look at this lovely diagram

A

7: Digestive System (12 decks)

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