Head and neck Flashcards
- three main salivary glands(3)
- function of salivary glands(3)
- parotid, submandibular, sunlingual
- lubrication for oral mucosa, begin digestion of food, secretions have antibacterial function
- stimulated reflexively to produce saliva*
salivary glands-structure and function
-parotid gland. quality of secretions (1) location (2) secretions drain into mouth through (1) opening where (1) what nn passes through gland (1) what aa lies in gland
-parotid gland. serous gland - watery secretions. situated in cheek - space between mastoid process and mandible. secretions drain into mouth through parotid duct. opening opposite second molar. facial nn passes through gland. divides into five branches that supply the mms of the face. most at risk structure during surgery. last part of external carotid aa
submandibular gland. type of secretion. (1) opening of duct (1)
sublingual gland. type of secretion. (1). location. (1) drains where (1)
nb parotid submandibular and sublingual glands are all paired
submandibular gland. mixed serous and mucous. duct opens into mouth as many papillar next to frenulum of tongue.
sublingual gland. mucus secretion. lies along course of submandibular duct. drains either directly inot mouth of into submandibular duct.
diseases of salivary gland overview
- may be single gland. may be multiple glands eg with systemic cause*
- congenital (2)
- acquired (7)
congenital - cysts, vascular malformations eg hemangiomas
acquired - systemic viral infections, sialolithiasis, sialadentitis, granulomatous tb or non-tb mycobacterial infections can affect intrapatorid lymph nodes or gland itself, sjogrens syndrome this syndrome affects many organ systems and is prob autoimmune pt presents with xerostomia and dry eyes, multiple glands affected diffusely, diagnosis biopsy of oral mucosa, mx symptomatic benigh neoplastic, malignant neoplastic
saliv gland dis
-systemic viral infection. what is the most common cause of bilateral parotid gland enlargement. (submandibular occasionally involved). (1). usual age onset (1). hpc (2) assx(1). what is a difference systemic virus that causes cystic enlargement.
-systemic viral infection. mumps, caused by paramyxovirus. usually children. swelling and pain caused by stretching of parotid capsule. hiv
saliv gland dis - sialadenitis
- what is sialadenitis. acute sialadenitis - hpc(1). who most likely to get (4) asx (2) o/e (3). mx (3) comp (1)
- chronic sialadenitis. - cause (2). hpc (2). comps (4) mx (2)
sialadenitis = inflammation of salivary glands. usually refers to parotid gland.
acute sialadenitis. pain and swelling. old pts, debilitated, dehydrated, poor oral hygene eg after major surgery. assx pyrexia, systemic upset. o/e parotid swollen, tender, may be pus coming from opening. mx antibiotics, rehydration, oral hygene. comp is abscess
-chronic sialadenitis. - following acute inf, or insidious. hpc pain and swelling commonly worst following meal. comps involvement of submandibular gland, scarring of gland, acute ep, sialolithiasis. mx antibiotics, surgery.
saliv gland dis- sialolithiasis
what is sialolithiasis. most common gland involved and why. hpc (2) assx (1) o/e (3) inx (2) mx (3)
sialolithiasis = stones/calculi in salivary glands. most common gland involvedis submandibular due to more calcium rich secretions. postprandial pain and swelling of gland. assx chronic sialodentitis. o/e pain, tender, stones may be palpabe in floor or mouth if moved to submandibular duct. inx ct, xray can do following injection of radio-opaque die = saliogram. will show stones and changes/scarring of chronic sialodentitis. mx oral fluids, sialogogues eg lemon juice. stone may pass. sugery of stone or whole gland
neoplastic dis - benign
- benign neoplastic tumours. hpc (2). o/e (3). most common tumour (1) mx (1)
- nb neoplastic dis of sal glands v uncommon. tumours of parotid more likely to be benign. tumours of submandib and subling more likely to be malignant.*
-benign neoplastic tumours. hpc slow growing painless mass. o/e smooth subcutanous mass, not atteched to skin. most common tumour is pleomorphic adenoma malignant change may occur after many years. mx surgery
qneoplastic dis - malignant neoplastic dis r**elatively uncommon
-hpc (2). assx (2) malignancies more common in what glands (2) types of tumour (2) mx(2)
- hpc rapidly growing painful swelling. parotid malignancy assx metastasis to lymph nodes, facial nn palsy nb benign is very uncommonly assx with facial nn palsy therefore this is almost diagnostic of malignancy. most common in submandib, sublingual minor glands.
- types - mucoepidermoid tumours range of grades or adenoid cystic carcinomas.
- mx depends on grade. radiotherapy or radical surgical excision or combination
- saliv gland dis- neoplastic dis - inx
- inx of neoplasm (4)
-CT, MRI, FNA (fine needle aspiration), excision biopsy may be needed if diagnosis still in doubt following fna, nb incisional biopsies should not be done as there is a risk of seeding tumour
-differential diagnosis of suspected salivary gland swellings / pseudosalivary gland sweelings.(5) a number of conditions may mimic.
- disease of intraglandular lymph node most common
- -*hypertrophy of masseter
- dental abcesses and lesions
- mandibular tumours
- parapharyngeal space lesions
- what is leukoplakia (1). what does it often mean (1) what is hyperkeratosis usually assx with. (1). why is it important to recognise (1). what action must be taken (2). what is a form that can develop with AIDs (1)
- what is erythroplakia. (1). why is this important to recognise. action (2)
- leukoplakia = white patch in mouth. often means hyperkeratosis of oral mucosa. usually assx with local irritation eg ill fitting dentures, eating strong spices, smoking, alc. important to recognise as 3% of such lesions undergo malignant change within 5 years. must be biopsied and reviewed regularly. a form that can develop with AIDs is hairy leukoplakia, on lateral border of tongue.
- erythroplakia = red patch in mouth. important to recognise as has an even higher potential for malignanct change. action is biopsy and regular review. even if intial bopsy is benign.
branchial cyst
- age onet (1). typical location (1). comp (1) inx (1) mx (1) main dd (1)
- pathophysiology (1)
- age onet before 30. typical location is lump in neck situated in middle third of scm. comp if cyst becomes infected, will be painful. inx fine needle apsiration cytology will result in pus like aspirate that is rich in cholesterol crystals. mx surgical excision
- main dd enlarged lymph node of deep cervial chain
- pathophysiology originally thought to be fusion of embrylogical branchial clefts, more recently suggested that they may result from epithelial inclusions within lymph node that later undergoes process of cystic degeneration.
thyroglossal duct cyst
- these lesions are congenital but often do not present at birth. age presentation (1). location of cyst. (1). important feature o/e (1). hpc cyst(1) hpc fistula(1). mx (1)
- pathophysiology
- age presentation childhood or early adulthood. cyst in midline. o/e cyst will move upwards when pt protrudes tongue due to attachment of tract to hyoid bone and tongue base. hpc cyst - swelling. hpc fistula - discharging area from front of neck. nb formation of spontaous fistula rare, usually restuls from misguided attempts to drain or surgery
- -*mx is surgical excision of whole tract, inc body of hyoid. nb problem will reoccur unless whole tract is removed from nexk skin to tongue base if necessary.attemps at local excision misguided
-pathophysiology
>embryonically thryoid develops at base of tongue
>descends downwards around hyoid bone, through tissues of neck
>eventually to overlie trachea and thyroid cartilage
- as a result of this descent a tract is left from foramen caecum of tonue to thyroid gland
- tract usually resorbs, if it remains cyst or fistula of tract may result
thyroid masses
-what diseases can cause thyroid masses (7)
simple goitre, multinodular goitre, solitary nodule, benign tumour, malignant tumour, thyroiditis
