Lecture 6-Surgery of salivary glands

Question 1

What is Sialolithiasis?

Answer 1

Theses are tiny calcium rich stones which form inside the salivary glands

Question 2

What causes Sialolithiasis?

Answer 2

Cause is unknown but believed that dehydration can lead to thickening of the saliva.
Decreased food intake- reduced the need for saliva
Drugs- Drugs causing xerostomia

Question 3

What are the signs and symptoms of Sialolithiasis?

Answer 3

Often a painful lump at the floor of the mouth.
Often pain is increased during eating.
Can partially or totally block the duct leading to decreased salivation. This can then be followed by a infection called sialadentis

Question 4

What is Sialadenitis

Answer 4

It is a painful infection of the salivary gland by bacteria.
It is more common in those with salivary stones and the elderly although can be common in the very young.
Needs to be treated as can develop into a severe infection which can be problematic in the elderly or debilitated.

Question 5

What are the signs and symptoms of Sialadenitis?

Answer 5

Often a tender painful lump under the chin or the buccal mucosa.
Usually unilateral
The skin over lying is often erythematous.
A foul tasting pus discharge may be seen
In some cases, fever and chills may be present.

Question 6

What is mumps?

Answer 6

When a systemic viral infection settles into the salivary glands.

Question 7

How does mumps present?

Answer 7

Fever, malaise, joint pain and muscle pain.

Then bilaterally facial swelling in the parotid region

Question 8

What are cysts, who gets them and where and why do they occur?

Answer 8

Tiny fluid filled sacs
Often babies will get salivary cysts in the parotid gland often associated with problems with the ear development before birth .
In adulthood can occur due to trauma, infection ( including HIV) salivary gland stones or tumours.

Question 9

Where does the most common salivary gland tumour occur?

Answer 9

In the parotid and the majority are benign.

Question 10

How do parotid salivary gland tumours present?

Answer 10

Slow growing painless lump at the back of the jaw. Just below the earlobe.

Question 11

What are the risk factors for salivary gland tumours?

Answer 11

Radiation or smoking.

Question 12

What is a classic sign of a malignant tumour?

Answer 12

Facial nerve interference.

Question 13

What is Sialadenosis?

Answer 13

When salivary glands become enlarged without evidence of infection, inflammation or tumour. Cause is unknown but often occurs in the parotid.

Question 14

How does sialadeuosis present?

Answer 14

Painless bilateral lump, often in the parotid area.

Question 15

What questions would the dentist ask when a lump presents?

Answer 15

Have you decreased any of you food or drink recently? (Possibly post surgery?)
have they received any radiation in the head or neck region?
have they ever had any rheumatoid symptoms.
Were they diagnosed with mumps or being vaccinated for mumps in the past?
Have they felt any flu like symptoms.

Question 16

What would a a blood test show when testing for salivary gland lumps?

Answer 16

High white blood cell count would indicate bacterial infection.

Question 17

What surgical disorders are there of the major salivary glands?

Answer 17

Trauma
Bacterial
Rare auto immune
Stones
Benign and malignant tumours
infections disorders
Stones


Question 18

What are the surgical disorders of the minor salivary glands?

Answer 18

Benign and malignant tumours
Retention cysts


Question 19

What parotid gland trauma can occur?

Answer 19

Fistula due to scaring tissue
injuries to the duct
Injuries to the tissue itself

Question 20

What are the long standing injuries of the parotid gland

Answer 20

Sialocoele
Parotid effusion
External fistula

Question 21

What is Acute suppurative sialadenitis?

Answer 21

Inflammatory disorder
often of the parotid gland
There is a blockage and ascending bacterial infection
Most commonly caused by staph areas

Question 22

What is Acute parotid sialendentitis

Answer 22

Mumps in children
Coxsachie or Echo virus in adults
Clinical features- Hot, tender in the region of the parotid
obstruction and pain on eating

Question 23

How to treat acute parotid sialendenitis

Answer 23

Often give IV antibiotics
-anti staphylococcal antibiotics.
If symptoms don’t improve then do ultrasound guided drainage.

Question 24

what is Acute submandibular sialadenitis

Answer 24

Often causes by a build up of calculus.
Detected by a plain intra oral x ray
Sialography when the infection has died down.
Removal of proximal stones is by removal of the sub mandibular gland
Distil stones- incision at the floor of the mouth

Question 25

what is Chronic recurrent parotid sialadenitis



Answer 25

Persistant infection
treat the stones or stricture
Can be visualised by a sialogram
A Parotidectomy is difficult to perform.

Question 26

Where are salivary calculi commonely found

Answer 26

80% in the submandibular
Mostly they are single stones
associated with diabetes, hypertension and liver disease.

Question 27

What are the clinic features of salivary calculi?

Answer 27

pain, swelling, redness, Palpable, suppuration

Question 28

how to investigate salivary calculi?

Answer 28

Sialography, Plain x rays or MRI

Question 29

How to treat salivary calculi?

Answer 29

Removal of the gland.
incise over stone if Distal duct of submandibular gland

Question 30

what are the exclusion criteria for minimally invasive techniques of Extracorporeal shock-wave lithotripsy?

Answer 30

Calculi not readily identifiable by ultrasonography
Patients with blood dyscrasias or haemostatic abnormalities Pregnancy
Patients who have undergone stapedectomy or ossicular repair

Question 31

what are the exclusion criteria for minimally invasive techniques of basket retrieval?

Answer 31

Known fixed salivary calculi
Calculi located within diverticulas
Large calculi >50% wider than the distal duct, especially in the parotid duct

Question 32

what are the exclusion criteria for minimally invasive techniques of intra oral surgery?

Answer 32

Cannot palpate the stone

Question 33

Of salivary gland tumours where do they most commonly occur and are they benign or malignant?

Answer 33

Parotid and often benign.

Question 34

Which glands do most malignant tumours occur in?

Answer 34

Minor salivary glands

Question 35

What is a pleomorphic ademoma?

Answer 35

Slow growing, painless lump

Don’t often compromise the facial nerve.

Question 36

What are the other differential diagnosis of the pleomophic adenoma?

Answer 36

Lymph nodes
Other salivary gland tumours
Lipomata, sebaceous glands cysts.

Question 37

What are the investigation for a salivary gland tumour?

Answer 37

FNA
MRI
Excision of affected gland.
Recurrence due to inadequate excision:
MRI
Multiple small nodules
 Radiotherapy
May undergo malignant change


Question 38

what are the complications of a parotidectomy?

Answer 38

Nerve injury
Haematoma
Temporary facial weakness
s syndrome
 Numbness of the ear
Salivary fistula 
Wound dimple

Question 39

What are the red flags for neck lumps?

Answer 39

Rapid change in size
Facial nerve weakness
Ulceration
Skin changes

Question 40

what are the Malignant Tumours of Salivary Glands



Answer 40

Mucoepidermoid
adenoid cystic
acinic cell carcinoma
squamous cell carcinoma
Malignant pleomorphic adenoma
Lymphoma

Question 41

Where can you get retention cysts?

Answer 41

In the minor salivary glands.