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Module 7 > ORAL SURG salivary gland disease > Flashcards

ORAL SURG salivary gland disease Flashcards

1
Q

where do you find minor salivary glands and roughly how many are there?

A

500-100 all over mouth except gingivae and anterior hard palate

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2
Q

what type of glands are the minor salivary glands?

A

mostly mucous

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3
Q

what pathology is found of the minor salivary glands?

A

most common=mucus extravasation cyst
benign/ malignant tumours

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4
Q

treatment for mucous extravasation cyst?

A

excision with overlying mucosa and underlying glandular tissue

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5
Q

general treatment for benign/ malignant minor salivary gland tumours?

A

excision with a margin of normal tissue

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6
Q

name the 3 major salivary glands

A

parotid glands
submandibular glands
sublingual glands

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7
Q

how are all 3 major salivary glands palpated?

A

parotid + subman = EO
sublingual = IO

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8
Q

when do the major salivary glands produce saliva?

A

when thinking about eating
when eating
when smelling food

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9
Q

what predisposes major salivary glands to infection?

A

their period of status when no saliva passing down the duct - bacteria from mouth can enter the duct and will therefore not be flushed out

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10
Q

what is the largest paired major salivary gland?

A

parotid

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11
Q

what are the parotid glands enclosed by and where are they located?

A

fascia located anterior to the ear behind the ramus of the mandible

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12
Q

what is the name of the main excretory duct of the parotid gland and where is it located?

A

Stenson’s duct
opens opposite the second maxillary molar

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13
Q

what type of saliva do the parotid glands excrete?

A

mixed seromucous
predominantly serous

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14
Q

what should you palpate for the parotid glands?

A

palpate masseter and parotid duct when pt clenches teeth

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15
Q

what muscle do the parotid glands overlap?

A

masseter muscle

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16
Q

where does the tail of the parotid extend?

A

down the angle of the mandible

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17
Q

what are the 2 parts of the parotid gland and where do they sit?

A

superficial (4/5) - sits above the facial nerve
deep lobe (1/5) - sits below the facial nerve

ala of the parotid - sits behind angle of mandible
accessory lobe - sits above the duct

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18
Q

what vasculature runs through the parotid? include nerves

A

facial nerve
terminal branch of external carotid artery
superficial temporal artery
maxillary artery
greater auricular nerve

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19
Q

where are the submandibular glands located?

A

in the submandibular triangles

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20
Q

what are the submandibular glands encapsulated by?

A

cervical fascia and stylohyoid ligament

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21
Q

where do the submandibular glands drain via?

A

Whartons duct in FOM

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22
Q

what type of saliva do the submandibular glands excrete?

A

mixed seromucous

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23
Q

what do you palpate for the submandibular glands?

A

deep lobe - palpate IO (posterior FOM at posterior margin of mylohyoid)
superficial lobe - under the chin EO

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24
Q

what anatomy surrounds the submandibular glands?

A

anterior and posterior head of digastric muscle
stylohyoid muscle and ligament (posteriorly)
facial artery and vein
marginal branch of facial nerve
lingual nerve

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25
Q

where are the sublingual glands located and what covers them?

A

FOM
covered by mucosa

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26
Q

where do the sublingual glands drain via?

A

Ravinis ducts on the plica sublingularis
or
Bartholin’s duct

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27
Q

what type of saliva do the sublingual glands secrete?

A

mucous

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28
Q

list common pathology of the major salivary glands/

A

inflammatory disorders:
- viral (mumps, coxsackie, CMV, HIV)
- bacterial (TB, sarcoid)
- radiation induced

obstruction/ trauma

neoplasms

autoimmune/ degenerative (Sjorgens syndrome)

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29
Q

what is the clinical name for mumps and describe it?

A

paramyxovirus
causes sialadenitis
- most common viral pathology
- bilateral enlargement of parotid glands
- disease of childhood but can affect adults (severe symptoms)
- self limiting

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30
Q

what is CMV?

A

Cytomegalovirus
causes sialadenitis
- affects babies or very old/ immunocompromised pts (severe symptoms)
- most primary infections are asymptomatic

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31
Q

what is sialadenitis?

A

inflammation of the salivary glands

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32
Q

differential diagnosis of a unilateral facial swelling?

A

mumps
odontogenic infection

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33
Q

what is the treatment for viral sialadenitis?

A

self limiting - no meds

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34
Q

what is the treatment for bacterial sialadenitis?

A

abx if systemically unwell - first line

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35
Q

what is the treatment for facial swelling caused by odontogenic infection?

A

eliminate focus of infection by creating a path of least resistance
extirpate pulp or XLA

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36
Q

why cant you incise and drain an inflamed salivary gland?

A

major glands are encapsulated - only way to drain is through the duct

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37
Q

what are the 2 presentations of sialadenitis?

A

acute or chronic
*often presents as acute but can become chronic

38
Q

what is the local cause of sialadenitis?

A

secondary to stasis
- gland not functioning
- pt starving/ fasting
- obstruction of duct (mucus plug, stone)

39
Q

what are systemic causes of sialadenitis?

A

immunosuppression
immune based
medication
dehydration
irradiation

40
Q

what is the acute management sialadenitis/

A

antibiotics
fluids
sialogogues
analgesics

41
Q

what can be used as a sialagogue?

A

lemon juice
chewing gum

42
Q

when would you incise and drain a case of sialadenitis?

A

if there is abscess formation

43
Q

when would you surgically treat a case of sialadentitis?

A

if chronic symptoms present

44
Q

what gland is more commonly affected by sialadenitis?

A

submandibular

45
Q

what do sialagogues do?

A

encourage drainage of the glands by saliva stimulation

46
Q

what is a symptom which well differentiates sialadenitis and odontogenic infection?

A

prandial symptoms - symptoms associated with meal times

if the gland is partially obstructed

47
Q

if a pt presents with extreme facial swelling what do you do and why?

A

refer quickly for intravenous abx
risk of retrograde spread and cavernous sinus thrombosis

48
Q

what may be damaged when draining an area of inflammation in the pre auricular area?

A

the facial nerve

49
Q

when there is a submandibular swelling, what may be inflammed?

A

the gland or any of the 3 nodes

50
Q

with a gland swelling, what is a sign of chronic infection?

A

the overlying skin is not inflamed

51
Q

what disease should be considered when asymmetry involving the subman triangle?

A

lymphoma

52
Q

what would you do if a pt presents with asymmetry involving the subman triangle?

A

refer for ultrasound or MRI (this determines whether submandibular gland infection or lymph node involvement)

first line investigation - FNA under ultrasound

53
Q

what may cause obstruction/ trauma to salivary glands?

A

sialolithiasis (salivary gland stones)
stasis of saliva
mucus plug or duct stricture (caused by trauma)

54
Q

how does sialolithiasis occur?

A

organic nidus (mucous) containing calcium and phosphate ions out of solution from saliva causes it to enlarge

55
Q

what type of pts and glands does sialolithiasis affect?

A

pts older than 20
submandibular 80%
parotid 19%

56
Q

describe the presentation of obstructive sialadenitis?

A
  • recurrent episodes of transient prandial salivary gland swelling
  • no symptoms between attacks as saliva escapes from gland
  • the bigger the stone becomes the more severe the symptoms
  • complete obstruction causes stasis of saliva and allows commensals from the oral cavity to enter the gland, causing persistent pain
57
Q

describe the presentation of acute sialadenitis secondary to obstruction (sialolithiasis)?

A

increasing painful swelling of 24-72 hour duration
oral discharge of pus when massaged
systemic manifestations

58
Q

there is a small sialith in the left submandibular gland orifice. what is the treatment?

A

encourage the use of sialagogues to flush the stone forward
if cannot, remove stone by cutting the opening large enough

59
Q

what are the 2 presentations of a submandibular sialolith?

A

intraductal
intraglandular

60
Q

what radiographs would you take to view a submandibular sialolith?

A

intraductal - occlusal view of FOM
intraglandular - DPT

61
Q

why is the submandibular gland more commonly affected by sialalothiasis?

A

its duct is long
gland is more alkaline so the calcium and phosphate ions come out of solution quicker

62
Q

does removal of a gland lead to dry mouth?

A

no
there is such a large physiological reserve of saliva

63
Q

how are submandibular gland stones removed?

A

intraductal - under LA
intraglandular - surgery along with the gland

*always advise there may be future episodes

64
Q

when removing an intraductal sialolith in FOM where must sutures be placed and why?

A

pass suture behind the stone to prevent it moving back into the gland when trying to retrieve it

65
Q

at what size does a sialolith have to be surgically removed?

A

if the stone is 1/3 larger than diameter of the duct (it wont spontaneously shed)

66
Q

what is basket retrieval of stones?

A

less invasive technique using endoscope
only works for small stones

*not available in Scotland

67
Q

describe the process of removing a submandibular duct sialolith?

A
  1. identify the outline of the stone under mucosa (yellow colour)
  2. pass a suture behind and infront of the stone to immobilise
  3. incise through firm swelling, cut through mucosa and roof of the duct
  4. take out the stone
  5. flush with saline
  6. remove traction sutures
  7. leave open or stich open with non resorbable sutures
68
Q

what is lithotrypsy?

A

a machine which produces ultrasonic waves that break down saliva stones into smaller components which can be shed

*used in Kings college in London

69
Q

what are the 2 types of mucocoeles and where do you find them?

A

mucus retention cyst - sublingual gland
mucus extravasation cyst - lip

70
Q

what is a ranula?

A

a large mucus retention cyst in the FOM

71
Q

what is the treatment for a ranula?

A

marsupialisation - create an opening for the gland to discharge

72
Q

what gland would ascending infections not present in?

A

sublingual gland

73
Q

what is sialometaplasia?

A

traumatic inflammatory condition which affects minor salivary glands of the palate

74
Q

how may sialometaplasia present?

A

between junction of H+S palate
keratotic
red dots (inflamed minor salivary duct orifices)

often presents with pain

75
Q

treatment for sialometaplasia?

A

review - if doesnt resolve within 2-3 weeks, biopsy

76
Q

describe a salivary gland tumour?

A

localised salivary enlargement
tend to be solid and more discrete

77
Q

what type of glands are more common for tumours?

A

major glands
90% parotid (80% benign)
50% subman
25% sublingual

78
Q

where do you tend to find salivary gland tumours?

A

55% palate
20% upper lip

79
Q

investigations for a pleomorphic adenoma?

A

incisional biopsy and CBCT to determine whether bony erosion/ invasion

80
Q

what SG pathology has intermittent swelling?

A

transient obstructive sialadenitis

81
Q

what SG pathology has persistent swelling?

A

complete obstructive sialadenitis

82
Q

what SG pathology presents with unilateral but diffuse swelling?

A

obstructive or viral sialadenitis

83
Q

what SG pathology presents with unilateral but localised swelling?

A

tumour

84
Q

what SG pathology presents with bilateral localised swelling?

A

Warthons tumour

85
Q

what SG pathology presents with bilateral diffuse swelling?

A

Sjogrens or sialadenosis

86
Q

what SG pathology presents with prandial pain?

A

obstructive sialiadenitis

87
Q

what SG pathology may present with persistent pain?

A

Sjorgens

88
Q

what SG pathology presents with pain involving a particular branch of nerve/ facial palsy?

A

neoplasm

89
Q

what is sialorrhea?

A

excess salivation
symptom of an inability to clear saliva due to a neuromuscular reason

90
Q

what SG pathology presents with pain in the tongue?

A

lingual nerve tumour

91
Q

what does viscous saliva imply?

A

autoimmne problems

92
Q
A

Module 7 (58 decks)

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