Lecture 6-Surgery of salivary glands Flashcards
What is Sialolithiasis?
Theses are tiny calcium rich stones which form inside the salivary glands
What causes Sialolithiasis?
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
What are the signs and symptoms of Sialolithiasis?
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
What is Sialadenitis
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.
What are the signs and symptoms of Sialadenitis?
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.
What is mumps?
When a systemic viral infection settles into the salivary glands.
How does mumps present?
Fever, malaise, joint pain and muscle pain.
Then bilaterally facial swelling in the parotid region
What are cysts, who gets them and where and why do they occur?
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.
Where does the most common salivary gland tumour occur?
In the parotid and the majority are benign.
How do parotid salivary gland tumours present?
Slow growing painless lump at the back of the jaw. Just below the earlobe.
What are the risk factors for salivary gland tumours?
Radiation or smoking.
What is a classic sign of a malignant tumour?
Facial nerve interference.
What is Sialadenosis?
When salivary glands become enlarged without evidence of infection, inflammation or tumour. Cause is unknown but often occurs in the parotid.
How does sialadeuosis present?
Painless bilateral lump, often in the parotid area.
What questions would the dentist ask when a lump presents?
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.
What would a a blood test show when testing for salivary gland lumps?
High white blood cell count would indicate bacterial infection.
What surgical disorders are there of the major salivary glands?
Trauma Bacterial Rare auto immune Stones Benign and malignant tumours infections disorders Stones 
What are the surgical disorders of the minor salivary glands?
Benign and malignant tumours
Retention cysts

What parotid gland trauma can occur?
Fistula due to scaring tissue
injuries to the duct
Injuries to the tissue itself
What are the long standing injuries of the parotid gland
Sialocoele
Parotid effusion
External fistula
What is Acute suppurative sialadenitis?
Inflammatory disorder
often of the parotid gland
There is a blockage and ascending bacterial infection
Most commonly caused by staph areas
What is Acute parotid sialendentitis
Mumps in children
Coxsachie or Echo virus in adults
Clinical features- Hot, tender in the region of the parotid
obstruction and pain on eating
How to treat acute parotid sialendenitis
Often give IV antibiotics
-anti staphylococcal antibiotics.
If symptoms don’t improve then do ultrasound guided drainage.
what is Acute submandibular sialadenitis
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
what is Chronic recurrent parotid sialadenitis

Persistant infection
treat the stones or stricture
Can be visualised by a sialogram
A Parotidectomy is difficult to perform.
Where are salivary calculi commonely found
80% in the submandibular
Mostly they are single stones
associated with diabetes, hypertension and liver disease.
What are the clinic features of salivary calculi?
pain, swelling, redness, Palpable, suppuration
how to investigate salivary calculi?
Sialography, Plain x rays or MRI
How to treat salivary calculi?
Removal of the gland.
incise over stone if Distal duct of submandibular gland
what are the exclusion criteria for minimally invasive techniques of Extracorporeal shock-wave lithotripsy?
Calculi not readily identifiable by ultrasonography
Patients with blood dyscrasias or haemostatic abnormalities Pregnancy
Patients who have undergone stapedectomy or ossicular repair
what are the exclusion criteria for minimally invasive techniques of basket retrieval?
Known fixed salivary calculi
Calculi located within diverticulas
Large calculi >50% wider than the distal duct, especially in the parotid duct
what are the exclusion criteria for minimally invasive techniques of intra oral surgery?
Cannot palpate the stone
Of salivary gland tumours where do they most commonly occur and are they benign or malignant?
Parotid and often benign.
Which glands do most malignant tumours occur in?
Minor salivary glands
What is a pleomorphic ademoma?
Slow growing, painless lump
Don’t often compromise the facial nerve.
What are the other differential diagnosis of the pleomophic adenoma?
Lymph nodes
Other salivary gland tumours
Lipomata, sebaceous glands cysts.
What are the investigation for a salivary gland tumour?
FNA MRI Excision of affected gland. Recurrence due to inadequate excision: MRI Multiple small nodules Radiotherapy May undergo malignant change 
what are the complications of a parotidectomy?
Nerve injury Haematoma Temporary facial weakness s syndrome Numbness of the ear Salivary fistula Wound dimple
What are the red flags for neck lumps?
Rapid change in size
Facial nerve weakness
Ulceration
Skin changes
what are the Malignant Tumours of Salivary Glands

Mucoepidermoid adenoid cystic acinic cell carcinoma squamous cell carcinoma Malignant pleomorphic adenoma Lymphoma
Where can you get retention cysts?
In the minor salivary glands.
