Head and Neck - Salivary Glands Flashcards
What are the 3 major salivary glands?
parotid
submandibular
sublingual
How many minor salivary glands are there?
600-1000 located beneath the mucosa of the upper aerodigestive tract
Which nerve runs through the parotid gland?
Facial nerve
What are the branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular Cervical
What other structures run through the parotid gland?
Reteromandibular vein
External carotid artery which divides
Secretemotor fibres
Sympathetic fibres
What structures lie within the submandibular gland?
mandibular branch of facial nerve
secretemotor fibres
sympathetic fibres
Look at anatomy pics of glands
:(
What stimulates saliva?
smell taste - esp acid, sugar, salt, sweet psychic stimuli - sight of food chewing and mastication parasympathomimetic drugs
What are the common causes of a dry mouth?
Depression Anxiety Drugs - ant muscarinic activity and with sympathetic activity Sjogrwen syndrome Radiotherapy to head and neck
What are some causes of non salivary swellings?
Hypertrophy of the masseter
Ageing - absorption of adipose tissue
Neuromas, aneurysms and cysts
Lymphadenopathy secondary to otitis externa
Dental infections, lymph nodes
Mandibular tumours
Mastoiditis causing a subperitoneal abscess
What are the viral causes of parotitis?
Presentation?
Treatment?
Viral - mumps, acho, coxsachie (treat with hydration and analgesics)
HIV- diffuse enlargement and multiple cysts
What are the bacterial causes of parotitis?
Presentation?
Treatment?
staphylococcal infection - debilitated, may be on anticholinergics, dehydrated, treat with sialogogues, massage or drain pus if present
TB - drug treatment
What are the fungal causes of parotitis?
rare
candidiasis
immunosuppressed
What is sialectasis?
dilation, stenosis, and necrosis of acini forming cysts cause unknown initial event in sialolithiasis
Investigate with xray and sialogram
Remove callus
Gland may need to be excised
What are the symptoms of Sjogrens syndrome?
dry eyes, dry mouth, keratoconjuctivitis, glossitis, secondary candiasis, stomatitis
40% will have enlarged parotid
20% will show enlargement
Where do most salivary tumours occur?
Parotid
What percentage of salivary tumours are benign?
80%
What is the most common type of benign salivary tumour?
Pleomorphic adenomas
How are salivary swelling investigated?
fine needle aspiration cytology
ultrasound or CT
How are benign salivary swellings treated?
superficial parotidectomy/ tumour excision with complete cuff of normal tissue / total parotidectomy
What are the examples of malignant tumours of the salivary glands?
adenoid cystic carcinoma adenocarcinoma lymphoma metastases carcinoma ex pleomorphic adenoma
What are the important questions to ask in a history of a salivary swelling?
age, sex unilateral or bilateral swelling is the swelling constant or intermittent pain? constant or intermittent? foul taste in mouth? sudden change? facial weakness? dry eyes, mouth, arthritis?
How should you examine a salivary swelling?
welling whole neck in structured method think mets oral cavity and bimanual palpation cranial nerves
What investigations should be carried when looking at a salivary swelling?
routine bloods virology, ACE SSA and SSB x ray plain, sialogram, CT sialogram, CXR USS high definition and Doppler MRI Schmer's, carlsson-crittenden
FNAC
Bipsy gland
sublabial biopsy for non neoplastic disease
