Salivary Gland Disease Flashcards
1
Q
what are the major salivary glands
A
- parotid
- submandibular
- sublingual
2
Q
what is the largest salivary gland
A
parotid
3
Q
what type of gland is the parotid gland
A
serous
4
Q
what type of gland is the submandibular gland
A
serous > mucous
5
Q
what type of gland is the sublingual gland
A
mucous
6
Q
what are the functions of the salivary glands
A
- aids in mastication
- deglutition
- immunity
- speech
- tasting
7
Q
what gland produces most stimulated saliva
A
parotid
8
Q
what is the excretory duct of the parotid gland called
A
parotid/stenson’s duct
9
Q
where is the parotid gland location
A
- duct emerges anteriorly from gland is superfcial to masseter muscle, pierces the buccinator muscle
- duct orifices identified by small papilla located close to second maxillary molar
- below/anterior EAC
- posterior to mandibualr ramus and anterior to mastoid process or temporal bone
- ending just inferior to angle of mandible
10
Q
what is the relationship of the parotid gland to the facial nerve
A
facial nerve is embedded within the superficial and deep lobes of the parotid gland
11
Q
what is the relationship of the submandibular gland to the mylohyoid muscle
A
- submandibular gland divided into superficial and deep lobes separated by mylohyoid muscle
- the superficial lobe of the submandibular gland is in the submandibular space and the deep lobe is situated in sublingual space where is can be palpated intraorally
12
Q
what is the excretory duct of the submandibular gland and where is it located
A
- whartons duct - exits on the sides of the lingual frenum
- adjacent to the lingual nerve drains into punctum within the sublingual caruncles on either side of the lingual frenum. punctum prevents retrograde flow or fluid
13
Q
what is the smallest gland
A
sublingual
14
Q
what shape is the sublingual gland and where is it
A
almond shaped and lies beneath the mucous membrane of the floor of the mouth close to the midline
- located on superior surface of mylohyoid muscle and separated from oral cavity by thin layer of mucosa
15
Q
what are the ducts of the sublingual gland called
A
Bartholins ducts
16
Q
describe bartholins ducts
A
consist of 8-20 smaller ducts called ducts of Rivinus empties into floor or mouth near the punctum of Whartons ducts or on a crest of sublingual mucosa called plica sublingualis or directly into wharton’s duct
17
Q
salivary gland disorders and diseases can be caused due to:
A
salivary gland stones, infection, cysts and tumors
18
Q
what are the types of salivary gland disorders/disease
A
- functional
- neoplastic
- obstructive
- infectious
19
Q
sialorrhea is caused by:
A
-pyschosis
- mental retardation
- certain neuro diseases
- rabies
- mercury poisoning
20
Q
xerostomia is caused by:
A
- mumps
- sarcoidosis
- sjoegrens syndrome
- lupus
- post radiation treatment
21
Q
what are the common benign salivary gland tumors
A
- pleomorphic adenoma
- warthins tumor
- canalicular adenoma
22
Q
which benign salivary gland tumor is most common
A
pleomorphic adenoma
23
Q
is pleomorphic adenoma recurrent
A
often
24
Q
is warthins tumor recurrent
A
seldom
25
what are the common malignant salivary gland tumors
- mucoepidermoid tumor
- adenoid cystic carcinoma
- acinic cell tumor
- SCC
26
what is the most common malignant salivary gland tumor
mucoepidermoid
27
what are the types of histological classifications for mucoepidermoid carcinoma
- high grade
- intermediate grade
- low grade- least aggresive
28
adenoid cystic carcinoma has a _____ spread
perineural
29
what are the obstructive disorders of the salivary gland
- sialolithiasis
- mucous retention and extravasation
30
what is the presentation of sialolithiasis
-mechanical usually unilateral diffuse glandular swelling
31
what is the presentation of mucous retention and extravasaton
- mucocele
- ranula
32
what is sialolithiasis
the presence of stones or calculi in the salivary glands or ducts
- common
33
where are sialolithiasis found
submandibular gland > parotid gland
34
_______ sialolithiasis occur in the submandibular gland
92%
35
what percent of sialolithiasis occur in parotid glans
6%
36
most stones are _____
solitary but multiple can be present
37
what is the etiology of sialolithiasis
- etiology is unknown, deposition of calcium salts around a nidus of debris in the duct lumen occurs but the exact cause is unknown
38
what are salivary calculi/stones made of
largely of calcium phosphate and hydroxyapatite
39
what are the risk factors for salivary stones
- dehydration
- diuretics
- anti-cholinergics
- trauma
- smoking
- surgery
40
what can blockage of the duct and inflammation cause
significant damage to the gland
41
who is most affected by salivary stones
young and middle aged adults
42
what is the clinical history of salivary stones
- pts frequently present with episodic pain and swelling particularly around mealtime
- sometimes painless swelling
43
what is the clinical exam of sialolithiasis
- salivary flow evaluation
- stones in the terminal ducts can usually be palpated
- palpation of the stone in the submandibular duct
- palpation of the submandibular gland
- determine expression of pus from the duct- positive or negative
44
what are the imaging options for sialolithiasis
- plain films- radiopaque stones
- CT scan
- ultrasound- stone must be larger than 2mm to be seen
- sialography
- MRI
- occlusal radiograph
45
describe sialography
involves injection of a small amount of contrast medium into the salivary duct of a single gland followed by routine X ray projections
46
what are the non surgical options for sialoliths
small sialoliths can sometimes be removed by gentle massage, sialogogues, most heat or increased fluid intake
47
what are the other treatment options for sialoliths
- transoral sialolithotomy with sialodochoplasty (surgical incision of a salivary duct to remove a calculus)
- sialendoscopy
- surgical removal of salivary gland
48
how is a transoral sialolithotomy with sialodochoplasty performed
with stone is palpable within distal segment or anterior region of whartons duct in submandibular gland
49
what is sialendoscopy
an image guided technique for the evaluation and treatment of patients with obstructive disease of the salivary glands
- the duct of the gland is dilated to allow passage of the sialendoscope. the sialendoscope is a tiny lighted scope about 1.5mm wide that is attached to a camera and has a channel for microinstruments
- uses a camera that is magnified on a monitor in the operatin room
- a wire basket is passed through and tightened around the stones fro removal. the duct can be further examined and flushed if needed
50
when does the salivary gland need to be removed
when a patient has multiple salivary gland stones and chronic recurrent infection of the salivary gland has increase risk for significant damage to the gland
51
where are mucoceles most common
- lower lip - 70%
- buccal mucosa
- rarely occur on upper lip
- more common in children and adolescents
- common
52
what is the clinical presentation of a mucocele
- appear as bluish, dome shaped swellings if superficial or of normal color if deep in the tissues
- they may be slightly painful due to an accompanying acute inflammatory reaction
53
what is the etiology for a mucocele
- traumatic severance of the salivary gland excretory duct
- extravasation of fluid from rupture salivary excretory duct (blue dome shaped lesion)
- encapsulated and consists of mucin
54
what is the treatment and prognosis for mucoceles
- wil rupture spontaneously and heal without treatment
- surgical excision if needed is the treatment of choice. removal of adjacent minor salivary gland helps prevent recurrence
- the prognosis is excellent although occasional mucoceles with recur, necessitating re-excision, especially if the feeding glands are not removed
55
what is a ranula
- a translucent, blue, dome shaped, fluctuant swelling in the tissues of the floor of the mouth
- obstruction disorder usually involves the sublingual gland
- consists of mucin from rupture of salivary gland
- common in children
- usually asymptomatic with exception to elevation in floor of mouth
56
what is the etiology of a ranula
usually trauma to sublingual gland duct although severence of the submandibular duct may also be the cause
- blockage of the duct with a salivary gland stone may produce a ranula which is a true mucous cyst
57
what are the clinical features of a ranula
- ranula is a term used for mucoceles that occur in the floor of the mouth
- derived from latin word frog
- they appear as dome-shaped , fluctuant swellings unless they are deep in the tissue
- typically occur lateral to the midline
- plunging or cervical ranulas dissect through the mylohyoid muscle to produce swelling in the neck
58
what is the treatment for ranula
- removal of the sublingual gland
- marsupialization may sometimes be used, where the intra oral lesion is opened to the oral cavity with the aim of allowing the sublingual gland to re-establish connection with the oral cavity
59
describe a plunging ranula
- soft painless fluctuant mass
- extend through facial planes usually posterior to the mylohyoid muscle into the neck and present as cervical masses
60
what are the treatments for a plunging ranula
- surgical removal of sublingual gland, submandibular gland or both
61
what is sialadenitis
an inflammation of gland or duct. inflammation of the salivary gland can arise from various infectious and non infectious causes
62
what are the causes of sialadnitis
- obstruction
- bacterial infection
- viral (HIV, mumps)
- sarcoidosis
- sjogrens syndrome
- tumor
- irradiation
- malnutrition
63
most bacterial infections arise as a result of:
ductal obstruction or decreased salivary flow
64
one of the more common causes of sialadenitis is:
recent surgery
65
describe acute/suppurative bacterial sialadenitis
- parotid> SMG (sialadenitis)
- adults> children
- pain, swelling, with or without fevers
- staph aureus or MRSA (parotid gland)
- strep, pneumonia
- strep viridans (submandibular gland)
66
describe chronic/non- suppurative bacterial sialadenitis
- parotid> SMG
- adults > children
- pain, swelling, with or without fevers
- staph aureus, strep. pneumonia, strep viridans
67
describe acute/suppurative sialadenitis clinical presentation
- indurated/swelling
- erythema
- pain
- +/- fever
- +/- infection
- +/- obstruction
- acute bacterial sialadenitis is most common in the parotid where it produces a painful swelling
- the overlying skin may be erythematous and the patient may have low grade fever, trismus, and purulent discharge from parotid duct
- chronic sialadenitis is associated with periodic swelling and pain
68
what is the treatment for sialadenitis
antibiotic therapy and rehydration, heat, salivary stimulants to help salivary flow
- surgical drainage may be required if abscesses occur, culture pus
- management of chronic sialadenitis depends on the severity and duration of the condition
- significant inflammatory destruction of the salivary gland (chronic sialadenitis) can occur requiring surgical removal
69
