S2 - Salivary Gland Disorders Flashcards
What are the salivary glands? (4)
- parotid
- submandibular
- sublingual
- minor salivary glands
Where are the major salivary glands located
parotid - between posterior border of md and ear, facial nerve seperates superficial and deep lobes
submd- in submd triangle, HUGS mylohyoid muscle
sublingual - in fom
Some diff diagnoses for swelling around angle of md? What might be a clinical clue differentiation?
- ameloblastoma arising from body of md
- parotid tumour
parotid swellings tend to raise the lobe of the ear
2 differential diagnoses for swelling in angle of mandible. What may be an important clinical clue?
- ameloblastoma arising from body of md
- parotid gland tumour
parotid swellings tend to lift the lobe of the ear
Position of parotid (stensen’s) duct and accessory lobe of the parotid gland?
accessory lobe sits along the parotid duct which runs through buccinator and opens opposite upper 2nd m
Where would tumours of the accessory parotid duct present?
more on the cheek
in MRI scan - accessory lobe mass within what would normally be buccinator
Describe submandibular gland anatomy
lie in posterior part of the submd triangle, wraps/hugs around mylohyoid muscle which seperates the superficial and deep (in back of mouth) part
whartons duct runs over the submd AND sublingual gland and opens in the anterior fom (sublingual papilla)
Histology of salivary gland types
parotid - mainly serous
submd - mixed, mainly serous
sublingual - mixed, mainly mucous
Where are minor salivary glands located?
there are 100s
- particularly in palatal vault (in areas not tightly bound down to gingival mucoperiosteum and median palatal raphe
- mixed mucous serous in tongue and inner lips
How much saliva produced per day. Resting vs stimulated SFR
1-1.5L /day
resting SFR 0.25ml/min, stimulated SFR 1ml/min (eating, preparing food, thinking abt food etc - might be important for pain hx)
Which of the 3 major salivary glands produce most to least saliva
- submd (75%)
- parotid (25%)
- sublingual (5%)
What is xerostomia. What are some clinical features.
a chronic debilitating conditio
= subjective sensation of dry mouth
- difficulty chewing and swallowing
- erythematous, atrophic, cracked, dry oral mucosa (mirror sticks)
- lobulation & depapillation of tongue
- females/elderly
- risk of oral candidiasis/angular cheilitis
- increased risk of dental caries (smooth surface) & perio
- risk of secondary infections
Name some causes of xerostomia (2 categories)
primary (salivary gland pathology):
- aplasia (missing)
- excision/irradiation
- infection/obstruction
- Sjogren’s syndrome
- Sarcoid (growth of granulomas)
- HIV
- cystic fibrosis
- primary biliary cirrhosis (destroyed)
secondary (to systemic disease):
- fluid/electrolyte imbalance
- neurological
- anxiety
- drug therapy
Categories of drugs that may induce xerostomia
- antihistamines
- antidepressants
- antipsychotics
- anti-cholinergic drugs
- diuretics (some antihypertensives)
- narcotics (opioids)
2 main categories of salivary gland disease
neoplastic
non-neoplastic
Types of neoplastic and non-neoplastic salivary gland disease.
What is recurrent punctate sialectasis in child
ballooning damage of the acini structure of glands
may be unusual iatrogenic condition or children who develop recurrent mumps infection (since not necessarily from paramyxoviridae, can also be from Coxsackie etc)
Causes of persistent diffuse enlargement (aka swelling) (3) Describe character.
- Sjogren’s syndrome
- Sialosis (non-inflam, non-neoplastic - eating disorders, HIV or diabetes)
- Sarcoidosis (infiltration of proteins and granulomas into tissues)
affects whole gland (diffuse), doesnt go down and up, stays up (persistent)
Symptoms of Sjogren’s Syndrome (4)
- persistent xerostomia (dry mouth, frequent intake of water, dry red atrophic wrinkled mucosa, depapillated, lobulated tongue, cervical caries)
- persistent xerophthalmia (dry, gritty eyes, keratoconjuctivitis sicca, freq use of tear substitues)
- salivary and lacrimal gland enlargement
- parotitis (parotid infection)
(main symptoms: dry mouth, dry eyes, RA)
pictures show lacrimal gland enlargement (uncommon), bilateral parotid gland swelling (more common)
Investigations for Sjogren’s Syndrome
- unstimulated total SFR <1.5ml in 15min
- imaging: sialography will show punctate sialectasis snow storm appearance
- labial gland biopsy (of swellings?)
- blood tests - increased ESR, Anti-Ro and Anti- La Antinuclear antibodies, Rheumatoid Factor
- Schimer test - blotting paper test for tear production <5mm/5min
What would be seen histologically in labial gland biopsy. Why is it important to detect early?
focal lymphocytic infiltrate (blue cells) destroying and replacing salivary acini
as a result of this infilitration of lymphocytes there is a risk over-time of lymphoma (check that there is no nodular, rubbery hard lump within the swelling)
Describe typical character of benign vs malignant salivary gland tumours
benign - slow growing, symptomless lump
malignant - rapid enlargement, pain, bone destruction, trismus, facial paralysis (invade nerves), ulceration
What is pleomorphic salivary adenoma
‘mixed tumour’ arising from duct epithelium and myoepithelial cells (epithelial cells that line the duct and muscle epithelial cells that squeeze saliva out)
incomplete capsule with ductal, fibrous, myxoid, elastic, cartilage tissue
squamous metaplasia & keratin foci
smooth, rubbery, nodular, lobulated swellings, slowly grow to great size
occasionally undergo malignant change
What is adenoid cystic carcinoma?
common salivary gland cancer
slow growing malignant tumour with late metastases in the lungs
histology: characteristic cribriform ‘swiss cheese’ appearance
has particular predilection to bony invasion and infiltration along nerve sheath
