parotid, saliva and stuff

Question 1

Two main types of benign salivary gland tumour

Answer 1

Warhin's tumour (2-6%)
Pleiomorphic adenoma (80%)

Question 2

What is a Warthin’s Tumour?

Answer 2

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

Question 3

What is a pleiomorphic adenoma?

Answer 3

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!

Question 4

Give twos examples of mixed benign and malignant tumour?

Answer 4

MUCO-EPIDERMOID CARCINOMA

ACINIC CELL

Question 5

What red flag questions should you ask to decipher whether it might be malignant?

Answer 5

Facial nn palsy
Fast growing
Pain

Question 6

Where do ACINI cells originate from?

Answer 6

Reserve epithelial cells of terminal or intercalated ducts, almost all from parotid gland

Question 7

The most common salivary gland cancer in children is…??

Answer 7

MUCOEPIDERMOID CARCINOMA

Question 8

What are the different types of malignant salivary gland tumour?

Answer 8

Adenoid cystic carcinoma
Adenocarcinoma
Lymphoma
Carcinoma ex pleiomorphic adenoma

Question 9

Describe the presentation of adenoid cystic carcinoma, including treatment

Answer 9

Slow growing tumour, originates from reserve epithelial cells in the intercalated ducts
Painful
CNVII palsy

Surgery: wide-local excision, ideally sparing CNVII

Question 10

Which cancer is the most aggressive?

Answer 10

Adenocarcinoma

Question 11

Metastatic sites for these cancers?

Answer 11

Local: melanoma and SCC
Distant: kidney, lungs, upper GI, breasts

Question 12

What are main causes of salivary gland swelling and pain, that aren’t cancers?

Answer 12

Systemic infection of salivary glands
Sjorgen's syndrome
Granulomatous disease
Sialolithiasis
Sialodenitis

Question 13

Aetiology of parotitis?

Answer 13

Viral: mumps (RNA paromyxovirus), echovirus, coxsackie virus, HIV
Bacterial: staphlococcal infection, can be TB
Fungal: rare, usually IC, would be candidiasis

Question 14

Presentation of mumps?

Answer 14

Prodromal illness, mild fever
Bilateral parotid swelling
Pain due to stretching of the parotid capsule
Orchitis, oophoritis 
Aseptic meningitis

Question 15

Management for mumps

Answer 15

Ex: ENT, external genitalia
Ix: IgM for salivary mumps
Rx: isolation and supportive care

Question 16

Who is more likely to get bacterial mumps\? How does it compare to viral?

Answer 16

It’s more severe, tends to affect older people

Question 17

What is sialolithiasis?

Answer 17

It’s a condition, usually affecting the submandibular gland where a sialolith/ a stone causes duct blockage (Warthion’s duct)

Question 18

Presentation of sialolithiasis?

Answer 18

Colicky facial pain
Post-prandial swelling
Halitosis

Question 19

Ix and Rx for sialolithiasis?

Answer 19

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

Question 20

Which duct is associated with the parotid gland?

Answer 20

Stenon’s duct

Question 21

What is sialidenitis? focus on aetiology

Answer 21

An acute bacterial infection

Question 22

Which condition is associated with the initial stage of sialolithiasis?

Answer 22

sialectasis: stenosis, necrosis, dilation of cystic ducts. Normally caused by sialolithiasis
85% affecting submandibular gland

Question 23

What are the risks you should be wary of with sialidenitis?

Answer 23

Deep space neck infection
Erosion of affected gland (3+ cases in one year?)
Airway obsturction— IV ABX stat!

Question 24

Risk factors for sialidenitis?

Answer 24

Vulnerable, older patients with poor oral hygiene
Have had recent surgery
Xerostomic medication use
Sjorgen’s, s.lithiasis

Question 25

Ix for sialectasis?

Answer 25

x-ray, sialogram

Question 26

What is granulomatous disease?

Answer 26

Cold abscess in the LN adjacent to salivary gland.

Can be TB

Question 27

Treatment of sialadenitis

Answer 27

Remember to culture from ductal orifiice
Rehydrate
Oral hygeine
Sialologues
Broad spec ABX
Analgesia, NSAIDs

Question 28

What are the xerostomic medications?

Answer 28

anti-cholinergics
anti-histamines
anti-depressants

Question 29

Two principle features of primary sjorgen’s syndrome
What about secondary?

Other symptoms

Answer 29

Xerostomia (mouth)
Xeropthalmia
Association with RA, SLE, polymyositis, HLA-II marker, younger age of onset,

Glossitis
Stomatitis 
Dental caries
Secondary candidiasis
Dry vagina

Question 30

A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment. diagnosis?

Answer 30

Sarcoidosis

Sarcoid occurs bilaterally in 70% of cases and facial nerve involvement is recognised. Treatment is conservative in most cases although individuals with facial nerve palsy will usually receive steroids with good effect.

Question 31

What conditions is mumps associated with?

Answer 31

orchitis, pancreatitis, reduced hearing, meningoencephalitis

Question 32

Important question to ask someone with suspected tonsilitis?

Answer 32

Do you have a cough? No, then this suggest a diagnosis

Question 33

1st line agent for tonsilitis?

Answer 33

phenoxymethylpeniclllin for 10 days

Question 34

which duct is involved in sialolithiasis?

Answer 34

Warthon’s duct: drains the submandibular gland