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ENT > salivary gland > Flashcards

salivary gland Flashcards

1
Q

salivary glands

A
  • parotid gland
  • submandibular gland
  • sublingual gland
  • minor salivary gland 600-800
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2
Q

What important structure are in close relationship to the parotid?

A
  • Facial nerve
  • Terminal branches of external carotid artery
  • Greater auricular nerve
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3
Q

parotid gland

A
  • Facial nerve divides within the parotid gland
  • Facial expression:
    temporal , zygomatic, buccal , mandibular and cervical
  • Facial nerve do not supply the parotid gland!!!
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4
Q

lobes of parotid

A

Parotid are anatomically divided into two lobes

Superficial Vs deep

  • Facial nerve intraoperatively
  • Retromandibular vein radiologically

Deep lobe extend around the ramus of mandible
No histologic difference

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5
Q

sensory innervation of submandibular gland

A
  • Marginal mandibular branch
  • Lingual nerve
    anterior and superior to deep portion
  • Hypoglossal nerve
    inferior to deep portion
  • Facial artery and veins
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6
Q

parasympathetic nerve supply: parotid, SMG

A

parotid

  • Glossopharyngeal nerve
  • Lesser petrosal nerve, mandibular nerve
  • Reach the gland via auriculotemporal branch of lingual nerve

SMG

  • Facial nerve -> chorda tympani
  • Chorda tympani joins lingual nerve
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7
Q

Saliva

A
  • 1 litre per day
  • regulated by autonomic nervous system
  • 99% water, rest is protein and electrolytes
  • Parotid watery , serous
  • SMG - thick mucoid
  • gustatory and oflactory stimulation is parotid secretion
  • SMG has higher mucin content and basal flow rate
  • Antimicrobial proteins: IgA, musin lysoenzyme histamine amylase and lactoferrin
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8
Q

acute silolithiasis

A
  • Short history
  • Erthyema, pain, swelling
  • Firm swelling; pus discharged from affected duct
  • Elderly, dehydration, trauma, major surgery, radiotherapy. immunosuppressed , chemo or Sjorogen
  • S. areus
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9
Q

Acute Sialadenitis - treatment

A
  • Short history
    Eliminate salivary stasis

Treat infection

Rehydration - IV and PO fluids
IV Abx 
Warm compress/ massage
Sialogogues / citrus juice (lemon)
Oral irrigations
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10
Q

Sialolithiasis

A
  • ‘Salivary gland stone’
  • 80% of cases -> SMG
  • Recurrent sialolitihitis
  • Pain and swelling of the gland particularly at meal time
  • Ix X-Ray; sialogram; USS
  • 1/3 of calculi are radiolucent
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11
Q

Sialolithiasis treatment

A
  • Intraoral sialolithotomy
  • Intraductal sialolithotomy with sialendocopy
  • If stone is at the hilum of the gland; gland excision is appropriate
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12
Q

Autoimmune - Sjorgen

A

Autoimmune diesase
- dry eyes (xeropthalmia) and dry mouth (xerostomia)
- destruction acinar and ductal cells
- more common in woman
- unilateral or bilateral salivary gland hypertrophy
- Ix : +ve test for anti-Ro and anti-La serologies
histological diagnosis Bx sublabial minor salivary gland > lymphocyte infiltration

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13
Q

Sjogren’s Syndrome

A

May progress to non Hodgkin lymphoma and rarely Waldenstrom’s macroglobulinaemia

Associated with connective tissue disease (RA, SLE, polyarteritis nodosa)

Treatment: symtomatic: oral hygiene, salivary substitutes etc…

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14
Q

Salivary gland tumour: incidence

A

Incidence 3 per 100 000
5% of H&N malignancies

80% in parotid
80% benign
80% pleomorphic adenoma

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15
Q

Salivary gland tumour: benign tumour

A 
Pleomorphic adenoma (benign-mixed tumours)
Warthins tumour (adenolymphoma)
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16
Q

malignant salivary gland tumours

A

Viral / radiation / environmental disorders
No causative relationship with smoking / alcohol
20% parotid , 50% SMG, > 70% minor
Low, intermediate and high

Benign tumour do NOT usually cause facial palsy. Malignancy should be top DD

Mucoepidermoid carcinoma
10 yr survival >90% stage 1/2 but 30% with stage III/IV
Adenoid cystic carcinoma
Carcinoma ex-pleomorphic adenoma
\+ many more
17
Q

salivary gland tumours: investigation

A

Fine Needle aspiration (FNA)
- 85% accuracy in differentiating benign and malignant
Core biopsy
USS or MRI (superior than CT)

18
Q

Other causes of enlarged glands;

A 
Sialolithasis
Mumps
HIV
Granulomatous disease
Autoimmune disease
19
Q

Complications of salivary gland tumours

A

Pain, bleeding infection
Facial weakness
Numbness to ear lobe
Frey’s syndrome

ENT (7 decks)

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