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Clin Med I - ENT > Disorders of Salivary Glands > Flashcards

Disorders of Salivary Glands Flashcards

1
Q

What are the major salivary glands?

A
  • parotid
  • submandibular
  • sublingual
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2
Q

Describe the parotid gland

A
  • largest

- anterior to the ear

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3
Q

What courses through the parotid gland?

A
  • CN VII (facial n.)
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4
Q

What is the duct associated with the parotid gland and where does it enter the mouth?

A
  • Stensen’s duct

- opposite the upper 1st and 2nd molar (inside the cheek)

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5
Q

Describe the submandibular gland

A
  • second largest

- anterior and inferior to the angle of the mandible

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6
Q

What is the duct associated with the submandibular gland and where does it enter the mouth?

A
  • Wharton’s duct

- bilaterally to the frenulum

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7
Q

Describe the sublingual gland

A
  • smallest (of the major salivary glands)

- inferior to the tongue (floor)

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8
Q

What are some disorders of the salivary glands?

A
  • xerostomia
  • muicocele/ranula
  • parotitis/sialadenitis
  • sialolithiasis
  • tumors
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9
Q

What is xerostomia?

A
  • dry mouth
  • less than 50% salivary flow
  • regardless of hydration/dehydration
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10
Q

What are the signs and symptoms of xerostomia?

A
  • dry mouth, lips, tongue
  • difficulty chewing, swallowing, and speaking
  • oral pain
  • medication list
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11
Q

What question should be asked in the examination for xerostomia and why?

A
  • dryness in other areas of the body

- Sjogrens disease

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12
Q

What will be observed in the physical exam for xerostomia?

A
  • cracked/peeling lips
  • pale mucosa
  • smooth/red tongue with loss of papilation
  • dental caries
  • candidiasis
  • angular cheilitis
  • (+) tongue blade sign
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13
Q

What is the work-up for xerostomia?

A
  • check inflammatory markers if ? sjogrens

- review current rx list

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14
Q

What are the 1st line treatments for xerostomia?

A
  • preventative measures to prevent caries/erosion
  • symptomatic (decrease risk factors)
  • local salivary stimulant
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15
Q

What are the 2nd line treatments for xerostomia?

A
  • systemic salivary stimulation

- tx underlying dz

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16
Q

What are disorders specific to the parotid gland?

A
  • parotitis (sialadenitis)
  • sialolithiasis
  • tumors
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17
Q

What do you look for on the physical exam from salivary gland enlargement?

A
  • 5 cardinal signs of infection
  • palpate for masses
  • check openings of ducts
  • dry mucous membranes
  • cervical LAD (lymphadenopathy)
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18
Q

What is indicative of a bacterial infection in the salivary glands?

A
  • pus from Wharton’s or Stenson’s ducts
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19
Q

What does decreased facial n. function with palpable salivary gland mass suggest?

A
  • malignancy
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20
Q

What will an XR of the salivary glands r/o?

A
  • stones
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21
Q

What will an US of the salivary glands assess?

A
  • masses v. abscess

- stones

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22
Q

What will sialography assess?

A
  • stones
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23
Q

What imaging should be done when a tumor is suspected?

A
  • CT/MRI
24
Q

What is mumps parotitis?

A
  • parotitis caused by parmyxovirus (mumps)
25
Q

When will mumps parotitis present?

A
  • 4-6 y/o
26
Q

How is mumps parotitis spread?

A
  • respiratory droplets
27
Q

What is the incubation period of mumps parotitis?

A
  • 2-3w
28
Q

T/F: mumps parotitis has a long prodrome.

A
  • False: short prodrome
29
Q

Which is the most commonly affected gland in mumps parotitis?

A
  • parotid
30
Q

Describe the salivary gland enlargement in mumps parotitis

A
  • sudden and painful

- worsens for 3 days then resolves in 1 w

31
Q

How is the diagnosis made of mumps parotitis?

A
  • virus antibody screened by immunoassay
32
Q

What is the treatment for mumps parotitis?

A
  • symptomatic
33
Q

What is bacterial parotitis/sialadenitis?

A
  • acute and sudden onset of unilateral swollen and painful salivary gland
34
Q

Who is most commonly affected with bacterial parotitis/sialadenitis?

A
  • elderly
35
Q

What is the most common pathogen of bacterial parotitis/sialadenitis?

A
  • S. aureus including MRSA
36
Q

What are the risk factors for bacterial parotitis/sialadenitis?

A
  • retrograde contamination by oral cavity bacteria

- obstruction

37
Q

What are the risk factors for bacterial parotitis/sialadenitis?

A
  • dehydration
  • chronic illness
  • advance age
  • post op
  • immunocompromised
  • poor oral hygiene
  • Rx meds
  • trauma to duct
  • oral cavity neoplasm
38
Q

How does bacterial parotitis/sialadenitis present?

A
  • sudden onset, unilateral or (B) parotid gland enlargement
  • painful, tender, indurated, and erythematous overlying tissue
  • purulent d/c from Stensen’s duct
39
Q

What should be done with the d/c from Stensen’s duct in bacterial parotitis/sialadenitis?

A
  • culture
40
Q

How can mumps and bacterial parotitis be ddx’d?

A
  • prodrome, none in bacterial
41
Q

How is a diagnosis made for bacterial parotitis/sialadenitis?

A
  • clinical
  • culture d/c
  • labs (not necessary)
  • imaging when ? abscess
42
Q

What is the treatment for bacterial parotitis/sialadenitis?

A
  • stimulate salivary flow
  • abx
  • I&D
43
Q

What is the outpatient abx treatment for bacterial parotitis/sialadenitis?

A
  • augmentin
44
Q

When does non-bacterial parotitis/sialadenitis occur?

A
  • with underlying disease
45
Q

What is non-bacterial parotitis/sialadenitis?

A
  • (B) non-tender parotitis
46
Q

What causes sialolithiasis?

A
  • etiology unknown
47
Q

Where does sialolithiasis most commonly occur?

A
  • submandibular glands
48
Q

How does sialolithiasis present?

A
  • hx or acute, painful and intermittent swelling of the gland
49
Q

When does swelling occur with sialolithiasis?

A
  • with eating but will decrease ~1hr after
50
Q

How is sialolithiasis diagnosed?

A
  • clinically/palpate
  • imaging: XR 1st then US, CT
  • sialoendoscopy
51
Q

What is the treatment of sialolithiasis?

A
  • supportive

- refer to ENT for lithotripsy, sialoendoscopy, or surgery

52
Q

Where do most salivary gland tumors occur?

A
  • parotid gland

- CHECK FACIAL N. INVOLVMENT

53
Q

T/F: Most of sublingual gland tumors are malignant

A
  • True
54
Q

How do benign salivary gland tumors present?

A
  • slowly
  • painless
  • non-tender
  • mobile
  • firm
55
Q

How do malignant salivary gland tumors present?

A
  • enlarge over several weeks

- painless

56
Q

What is the most common benign salivary gland tumor?

A
  • pleomorphic adenoma
57
Q

What is the most common malignant salivary gland tumor?

A
  • mucoepidermoid carcinoma

Clin Med I - ENT (13 decks)

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