Salivary Gland Disease Flashcards
What are the reasons for salivary gland lumps or swellings?
Obstruction
Sialadenitis
Sialosis
Neoplasm
Trauma and fluid
Solid deposits
Intra-gland LN swelling
Describe salivary gland obstruction
Something is stopping the saliva from leaving the gland
eg - salivary duct calculi, duct stricture
Describe sialadenitis
Inflammation of the salivary gland
eg - Sjögren’s, infection
Describe sialosis
Bilateral painless swelling - unknown cause
Describe salivary neoplasms
Malignant and non-malignant tumours
eg - pleomorphic salivary adenoma, warthin’s tumour, mucoepidermoid carcinoma
Describe salivary gland trauma and fluid
Oedema and blood cause by trauma or allergy
Describe solid salivary gland deposits
Protein build up
eg - amyloidosis
Describe intra-gland LN swelling
eg - lymphoma or acute infection
What should be asked in a history for obstructive sialadenitis (mealtime symptoms)
Pain history if needed
Ask if associated with eating/food
Are symptoms coming and going or persistent
Any swallowing problems
Bad taste or pus
Generally unwell - exclude acute infection
Describe a clinical assessment of obstructive sialadenitis
E/O exam
Bimanual palpation of FoM
Express saliva from ducts - can you do it, is there pus, is there any obstruction
What investigations should be carried out for obstructive sialadenitis?
Lower occlusal X-ray +/- OPT to identify calcification - primary care
Ultrasound - secondary care
Sialograhy - secondary care
MRI or CT in some instances - secondary care
What are the clinical features of acute viral sialadenitis?
Painful parotid swelling
Usually bilateral
Sometimes can be a single gland
No hyposalivation
10% have submandibular gland involvement
Very rare to have only submandibular gland
Malaise, fever and general unwell feeling
Trismus
Swelling will last approx 7 days
How is acute viral sialadenitis diagnosed?
Clinically
Serum antibiotics can be considered
Viral swab of saliva
How is acute viral sialadenitis managed?
No specific antivirals
Supportive therapy:
- hydration
- analgesia
- pyrexia management
- isolation for 6-10 days may be advisable
- contact public health
What are the clinical findings of acute bacterial sialadenitis?
Most common in parotid gland
Typically unilateral
Painful swelling
Overlying erythema
Pus from duct
Trismus
Pyrexia
Cervical lymphadenopathy
Often secondary to salivary gland obstruction
How is acute bacterial sialadenitis diagnosed?
Clinically
Excluded odontogenic infection - OPT
Pus swab for culture
Exclude pyrexia/sepsis
Exclude airway obstruction - if yes then emergency, contact OMFS for advice and possibly ambulance if active difficulty breathing
How is acute bacterial sialadenitis managed?
Antibiotics through GP or OMFS
First choice is flucloxacillin, erythromycin in penicillin allergic pts
Airway management if needed
Manage causative factors when sialadenitis resolved
How are mucoceles managed?
No tx but unlikely to resolve
Excision of lesion by OS - cysts are enucleated ideally, high recurrence rate, damage to neighbouring structures
Clinical photos
What are the red flags in salivary neoplasms?
Facial palsy
Sensory loss
Pain
Difficulty swallowing
Trismus
Rapid growth
What investigations should be carried out for salivary neoplasms?
Ultrasound
Ultrasound guided fine needle aspiration - gives histological specimen
MRI or CT considered
Sialography
Sjögren’s disease investigations
How are salivary neoplasms managed?
Surgical excision alone if benign - facial nerve energy is major risk
If malignant may require:
- neck dissection
- wide excision
- chemotherapy
- radiotherapy
- immunotherapy
