Pedi Salivary gland Flashcards
Discuss the causes of acute suppurative sialadenitis
in premature neonates.
● Reduction in salivary flow
● Immunologic immaturity
● Presence of bacteria in the oral cavity of neonates
● Dehydration
● Prolonged orogastric feeding
● Congenital anomalies of the floor of the mouth
What is the treatment for acute suppurative
sialadenitis in premature neonates?
Hydration and antimicrobial therapy should lead to a
response within 48 to 72 hours. Gland manipulation should
be avoided in a preterm child to reduce the risk of systemic
septicemia. If no satisfactory improvement is seen, incision
and drainage are recommended.
What are the causes of pediatric viral sialadenitis?
Epstein-Barr virus, parainfluenza viruses, adenovirus, human
herpes virus–6, human immunodeficiency virus (HIV),
Coxsackievirus, mumps virus, and influenza virus
What organ systems are involved in patients with
mumps?
Parotid and submandibular glands (diffuse tender enlarge-
ment), gonads, pancreas, and meninges
What is the classic triad of symptoms seen with
infectious mononucleosis?
About 80% of patients have the triad of fever, sore throat,
and posterior cervical adenopathy that can involve the
periparotid or perifacial (submandibular) lymph nodes with
subsequent involvement of adjacent glands.
Discuss the clinical findings of human
immunodeficiency virus (HIV)-associated benign
lymphoepithelial cysts.
They occur in up to 10% of HIV-positive children, often early
in the course of HIV infection with slowly progressive,
asymptomatic parotid gland enlargement and often asso-
ciated with cervical lymphadenopathy. Cysts are usually
bilateral (up to 80%), multiple (up to 90%), and involve the
superficial lobe.
What are the most common pathologies causing
granulomatous inflammation of the major salivary
glands?
Actinomycosis, tuberculosis, atypical mycobacterial infec-
tions, and sarcoidosis
What bacteria are associated with nontuberculous
mycobacterial infections of the salivary glands?
Mycobacterium avium-intracellulare (70 to 90% of cases), M.
bovis, M. kansasii, and M. scrofulaceum
What pathology is thought to be a form of
sarcoidosis characterized by uveitis, parotid
enlargement, and facial paralysis?
Heerfordt syndrome (or uveoparotid fever). Its symptoms
include fever, malaise, weakness, nausea, and night sweats.
Evaluation includes chest radiography looking for hilar
adenopathy and an acetylcholinesterase level. A biopsy
from the lip or tail of the parotid may confirm the diagnosis.
What pathology is characterized by recurrent
episodes of nonobstructive, nonsuppurative
unilateral (60%) or bilateral (40%) parotid
inflammation in a 5-year-old boy?
Juvenile recurrent parotitis (JRP). The peak incidence is
between the ages of 3 and 6 years, with predominance in
boys. Diagnosis is made on a clinical basis and is confirmed
by ultrasonography or sialography, which shows patho- gnomonic sialectasias (intraductal cystlike dilations).
What are the medical treatment options for
sialorrhea?
● Oral motor training: Exercises are done to encourage
swallowing, improve muscle tone and oral sensation,
stabilize body and head position, promote jaw stability
and lip closure, and decrease tongue thrust.
● Behavioral therapy: Verbal and auditory cues can increase
the frequency and efficiency of swallowing.
● Anticholinergic pharmacotherapy, oral glycopyrrolate,
botulinum toxin injections into major salivary glands may
decrease the volume of saliva.
What are the surgical treatment options for
sialorrhea?
● Submandibular gland excision* ● Submandibular duct rerouting * ● Parotid duct rerouting* ● Sublingual gland excision ● Ligation of parotid ducts ● Transtympanic bilateral tympanic plexus neurectomy and bilateral chorda tympani nerve section ● Any combination of these procedures *Highest rates of success
What are the most common benign pediatric
tumors of the parotid gland?
Parotid gland hemangiomas constitute 50% of pediatric
parotid gland tumors.
Discuss the development and natural history of
pediatric parotid gland hemangiomas.
These hemangiomas may be part of a segmental V3
hemangioma, or they may be isolated focal hemangiomas.
They occur at birth or shortly thereafter and act like other
hemangiomas, undergoing a rapid proliferative growth
phase followed by involution.
What is the first-line treatment for parotid
hemangiomas?
Oral propranolol therapy
