Disorders of Salivary Glands Flashcards
What are the major salivary glands?
- parotid
- submandibular
- sublingual
Describe the parotid gland
- largest
- anterior to the ear
What courses through the parotid gland?
- CN VII (facial n.)
What is the duct associated with the parotid gland and where does it enter the mouth?
- Stensen’s duct
- opposite the upper 1st and 2nd molar (inside the cheek)
Describe the submandibular gland
- second largest
- anterior and inferior to the angle of the mandible
What is the duct associated with the submandibular gland and where does it enter the mouth?
- Wharton’s duct
- bilaterally to the frenulum
Describe the sublingual gland
- smallest (of the major salivary glands)
- inferior to the tongue (floor)
What are some disorders of the salivary glands?
- xerostomia
- muicocele/ranula
- parotitis/sialadenitis
- sialolithiasis
- tumors
What is xerostomia?
- dry mouth
- less than 50% salivary flow
- regardless of hydration/dehydration
What are the signs and symptoms of xerostomia?
- dry mouth, lips, tongue
- difficulty chewing, swallowing, and speaking
- oral pain
- medication list
What question should be asked in the examination for xerostomia and why?
- dryness in other areas of the body
- Sjogrens disease
What will be observed in the physical exam for xerostomia?
- cracked/peeling lips
- pale mucosa
- smooth/red tongue with loss of papilation
- dental caries
- candidiasis
- angular cheilitis
- (+) tongue blade sign
What is the work-up for xerostomia?
- check inflammatory markers if ? sjogrens
- review current rx list
What are the 1st line treatments for xerostomia?
- preventative measures to prevent caries/erosion
- symptomatic (decrease risk factors)
- local salivary stimulant
What are the 2nd line treatments for xerostomia?
- systemic salivary stimulation
- tx underlying dz
What are disorders specific to the parotid gland?
- parotitis (sialadenitis)
- sialolithiasis
- tumors
What do you look for on the physical exam from salivary gland enlargement?
- 5 cardinal signs of infection
- palpate for masses
- check openings of ducts
- dry mucous membranes
- cervical LAD (lymphadenopathy)
What is indicative of a bacterial infection in the salivary glands?
- pus from Wharton’s or Stenson’s ducts
What does decreased facial n. function with palpable salivary gland mass suggest?
- malignancy
What will an XR of the salivary glands r/o?
- stones
What will an US of the salivary glands assess?
- masses v. abscess
- stones
What will sialography assess?
- stones
What imaging should be done when a tumor is suspected?
- CT/MRI
What is mumps parotitis?
- parotitis caused by parmyxovirus (mumps)
When will mumps parotitis present?
- 4-6 y/o
How is mumps parotitis spread?
- respiratory droplets
What is the incubation period of mumps parotitis?
- 2-3w
T/F: mumps parotitis has a long prodrome.
- False: short prodrome
Which is the most commonly affected gland in mumps parotitis?
- parotid
Describe the salivary gland enlargement in mumps parotitis
- sudden and painful
- worsens for 3 days then resolves in 1 w
How is the diagnosis made of mumps parotitis?
- virus antibody screened by immunoassay
What is the treatment for mumps parotitis?
- symptomatic
What is bacterial parotitis/sialadenitis?
- acute and sudden onset of unilateral swollen and painful salivary gland
Who is most commonly affected with bacterial parotitis/sialadenitis?
- elderly
What is the most common pathogen of bacterial parotitis/sialadenitis?
- S. aureus including MRSA
What are the risk factors for bacterial parotitis/sialadenitis?
- retrograde contamination by oral cavity bacteria
- obstruction
What are the risk factors for bacterial parotitis/sialadenitis?
- dehydration
- chronic illness
- advance age
- post op
- immunocompromised
- poor oral hygiene
- Rx meds
- trauma to duct
- oral cavity neoplasm
How does bacterial parotitis/sialadenitis present?
- sudden onset, unilateral or (B) parotid gland enlargement
- painful, tender, indurated, and erythematous overlying tissue
- purulent d/c from Stensen’s duct
What should be done with the d/c from Stensen’s duct in bacterial parotitis/sialadenitis?
- culture
How can mumps and bacterial parotitis be ddx’d?
- prodrome, none in bacterial
How is a diagnosis made for bacterial parotitis/sialadenitis?
- clinical
- culture d/c
- labs (not necessary)
- imaging when ? abscess
What is the treatment for bacterial parotitis/sialadenitis?
- stimulate salivary flow
- abx
- I&D
What is the outpatient abx treatment for bacterial parotitis/sialadenitis?
- augmentin
When does non-bacterial parotitis/sialadenitis occur?
- with underlying disease
What is non-bacterial parotitis/sialadenitis?
- (B) non-tender parotitis
What causes sialolithiasis?
- etiology unknown
Where does sialolithiasis most commonly occur?
- submandibular glands
How does sialolithiasis present?
- hx or acute, painful and intermittent swelling of the gland
When does swelling occur with sialolithiasis?
- with eating but will decrease ~1hr after
How is sialolithiasis diagnosed?
- clinically/palpate
- imaging: XR 1st then US, CT
- sialoendoscopy
What is the treatment of sialolithiasis?
- supportive
- refer to ENT for lithotripsy, sialoendoscopy, or surgery
Where do most salivary gland tumors occur?
- parotid gland
- CHECK FACIAL N. INVOLVMENT
T/F: Most of sublingual gland tumors are malignant
- True
How do benign salivary gland tumors present?
- slowly
- painless
- non-tender
- mobile
- firm
How do malignant salivary gland tumors present?
- enlarge over several weeks
- painless
What is the most common benign salivary gland tumor?
- pleomorphic adenoma
What is the most common malignant salivary gland tumor?
- mucoepidermoid carcinoma
