parotid, saliva and stuff Flashcards
Two main types of benign salivary gland tumour
Warhin's tumour (2-6%) Pleiomorphic adenoma (80%)
What is a Warthin’s Tumour?
A benign tumour of the parotid tail. Slow growing, affects mainly older people, particularly men.
Multiple cysts and soft components
Bilateral not uncommon
Treatment is with excision
What is a pleiomorphic adenoma?
Benign tumour, the most common. Mostly affecting younger people. Small risk of turning malignant
Affects intercalated ducts where reserve cells reside
Ix with FNAC
Total or partial parotidectomy : but leave some!
Give twos examples of mixed benign and malignant tumour?
MUCO-EPIDERMOID CARCINOMA
ACINIC CELL
What red flag questions should you ask to decipher whether it might be malignant?
Facial nn palsy
Fast growing
Pain
Where do ACINI cells originate from?
Reserve epithelial cells of terminal or intercalated ducts, almost all from parotid gland
The most common salivary gland cancer in children is…??
MUCOEPIDERMOID CARCINOMA
What are the different types of malignant salivary gland tumour?
Adenoid cystic carcinoma
Adenocarcinoma
Lymphoma
Carcinoma ex pleiomorphic adenoma
Describe the presentation of adenoid cystic carcinoma, including treatment
Slow growing tumour, originates from reserve epithelial cells in the intercalated ducts
Painful
CNVII palsy
Surgery: wide-local excision, ideally sparing CNVII
Which cancer is the most aggressive?
Adenocarcinoma
Metastatic sites for these cancers?
Local: melanoma and SCC
Distant: kidney, lungs, upper GI, breasts
What are main causes of salivary gland swelling and pain, that aren’t cancers?
Systemic infection of salivary glands Sjorgen's syndrome Granulomatous disease Sialolithiasis Sialodenitis
Aetiology of parotitis?
Viral: mumps (RNA paromyxovirus), echovirus, coxsackie virus, HIV
Bacterial: staphlococcal infection, can be TB
Fungal: rare, usually IC, would be candidiasis
Presentation of mumps?
Prodromal illness, mild fever Bilateral parotid swelling Pain due to stretching of the parotid capsule Orchitis, oophoritis Aseptic meningitis
Management for mumps
Ex: ENT, external genitalia
Ix: IgM for salivary mumps
Rx: isolation and supportive care
Who is more likely to get bacterial mumps\? How does it compare to viral?
It’s more severe, tends to affect older people
What is sialolithiasis?
It’s a condition, usually affecting the submandibular gland where a sialolith/ a stone causes duct blockage (Warthion’s duct)
Presentation of sialolithiasis?
Colicky facial pain
Post-prandial swelling
Halitosis
Ix and Rx for sialolithiasis?
Ix: sialography
Rx: Sialogogues and fluids to stimulate natural removal
Massage the gland
Oral removal if distal (i.e wharton’s duct)
Surgical removal if within intraglandular duct and less accessible
Which duct is associated with the parotid gland?
Stenon’s duct
What is sialidenitis? focus on aetiology
An acute bacterial infection
Which condition is associated with the initial stage of sialolithiasis?
sialectasis: stenosis, necrosis, dilation of cystic ducts. Normally caused by sialolithiasis
85% affecting submandibular gland
What are the risks you should be wary of with sialidenitis?
Deep space neck infection
Erosion of affected gland (3+ cases in one year?)
Airway obsturction— IV ABX stat!
Risk factors for sialidenitis?
Vulnerable, older patients with poor oral hygiene
Have had recent surgery
Xerostomic medication use
Sjorgen’s, s.lithiasis
