ENT: Salivary gland disorders

Question 1

name the salivary glands of the head?

Answer 1

Parotid gland

Submandibular gland

Sublingual gland

Question 2

What important structure are in close relationship to the parotid salivary glands?

Answer 2

Facial nerve

Terminal branches of external carotid artery

Greater auricular nerve

retromandibular vein

Question 3

what is the Parotid duct and where is it?

Answer 3

The parotid duct or Stensen duct is a duct and the route that saliva takes from the parotid gland, into the mouth.

• exit opposite the 2nd upper molar

Question 4

Both the submandibular gland and duct share an intimate anatomical relationship with which three principal nerves?

Answer 4

lingual nerve

hypoglossal nerve

facial nerve (marginal mandibular branch)

Question 5

what is the Wharton’s duct and where is it?

Answer 5

The submandibular duct the route the route that saliva takes from the submandibular gland, into the mouth.

• base of the tongue/floor of mouth

Question 6

What is the nerve supply of the parotid salivary glands?

Answer 6

glossopharyngeal nerve

• > synapses with the otic ganglion
• > The auriculotemporal nerve then carries parasympathetic fibres to the gland

Question 7

What is the nerve supply of the sublingual salivary glands?

Answer 7

Facial nerve -> chorda tympani

Chorda tympani joins lingual nerve

Question 8

how much saliva to we produce a day?

Answer 8

1 litre

n.b:
- 99% water, rest is protein and electrolytes
- Parotid watery , serous
SMG - thick mucoid

Question 9

what is Sialadenitis?

Answer 9

The inflammation and enlargement of one or several major salivary glands. It most commonly affects parotid and submandibular glands.

Bacterial infection can supervene if salivary flow is diminished by illness or medication, or is obstructed by a sialolith (salivary stone). Most commonly caused by Staphylococcus aureus.

(salivary stasis)

Question 10

how does Acute Sialadenitis present?

Answer 10

Erthyema, pain, swelling

Firm swelling; pus discharged from affected duct

Question 11

what commonly causes Acute Sialadenitis?

Answer 11

most commonly due to bacterial infections caused by Staphylococcus aureus

Question 12

how do you manage Acute bacterial Sialadenitis? (non-obstructive)

Answer 12

1st line: broad-spectrum IV or Oral antibiotic

plus:

• hydration
• analgesics
• oral corticosteroid

Surgical drainage may be an option.

effectively: treat infection / stop saliva stasis

Question 13

what is a complication of Sialadenitis?

Answer 13

Airway compromise is an important potential consequence of acute glandular swelling.

Question 14

what is Sialolithiasis?

Answer 14

salivary gland stones

Question 15

what causes Sialolithiasis?

Answer 15

stagnation of saliva

nb: typically composed of calcium phosphate and hydroxyapatite, as the saliva is rich in calcium

Question 16

how does Sialolithiasis present?

Answer 16

Whilst most cases are asymptomatic, some can present with facial swelling and / or facial pain.

Question 17

Sialolithiasis most commonly occurs in which salivary gland?

Answer 17

submandibular gland

due to the anatomy of this duct being long and its flow of saliva against gravity and the secretions from the SMG are more mucoid in nature than other glands.

Question 18

what investigations would you do to diagnose Sialolithiasis?

Answer 18

ultrasound scan

most salivary gland stones are radio-opaque

Question 19

how do you treat Sialolithiasis?

Answer 19

Intraoral sialolithotomy

Intraductal sialolithotomy with sialendocopy

If stone is at the hilum of the gland; gland excision is appropriate

Question 20

what is Sjogren’s Syndrome?

Answer 20

This is an autoimmune condition that affects the exocrine glands. It leads to the symptoms of dry mucous membranes, such as dry mouth, dry eyes and dry vagina.

Question 21

Sjogren’s Syndrome is associated with which autoimmune antibodies?

Answer 21

anti-Ro

anti-La

Question 22

what is xerostomia?

Answer 22

dry mouth resulting from reduced or absent saliva flow

Question 23

what is primary/secondary Sjogren’s Syndrome?

Answer 23

Primary Sjogren’s is where the condition occurs in isolation.

Secondary Sjogren’s is where it occurs related to SLE or rheumatoid arthritis.

Question 24

what is the management for Sjogren’s Syndrome?

Answer 24

Artificial tears

Artificial saliva

Vaginal lubricants

Hydroxychloroquine is used to halt the progression of the disease.

Question 25

what are some complications of Sjogren’s Syndrome?

Answer 25

• eye infections
• dental cavities
• candida infections
• sexual dysfunction

Question 26

Sjogren’s Syndrome may progress to what disease?

Answer 26

Non-Hodgkins lymphoma