Salivary Gland Disease Flashcards
Name the 3 pairs of salivary glands
3 major pairs: submandibular (mixed production and most stones), parotid (serous production and most tumours) and sublingual (mucous production). When examining the salivary glands feel for swelling and stones and test facial nerve.
What is sialadenitis?
Infection of the submandibular or parotid glands, usually from staphylococcus aureus. Be wary of the formation of an abscess as it may spread through deep tissues and occlude the airway.
Which organisms causes sialadenitis?
Staph aureus Paramyxovirus – mumps Coxsackie virus Echovirus HIV
What are the risk factors for sialadenitis?
Elderly
Dehydrated
Debilitated
Poor oral hygiene
How is sialadenitis managed?
Antibiotics
Good oral hygiene
Salivation inducers such as lemon drops are good
Surgical drainage
What is sialolithiasis?
Salivary stones, most commonly affect the sub-mandibular gland because the secretions are richer in calcium. Usually stones are calcium phosphate or calcium carbonate.
What are the clinical features of sialolithiasis?
Colicky pain especially during/after eating or seeing food
Palpable stone in the floor of the mouth
What is the investigation of choice for sialolithiasis?
Plain x-ray or sialogram if doubtful
How should salivary stones be managed?
Small stones pass by themselves
Stone impacted in the distal aspect of Wharton’s duct may be removed orally
Surgical removal if larger
What is Sjorgren’s Syndrome
Autoimmune disorder characterised by parotid gland enlargement, xerostomia and keratoconjunctivitis sicca. 90% of cases occur in females. Can be primary or secondary to rheumatoid arthritis so should investigate for Rheumatoid factors. Increased risk of lymphoid malignancy.
What are the clinical features of Sjorgren’s syndrome?
Bilateral non tender enlargement of the parotid glands Lymphocytic infiltrate histologically Xerostomia Keratoconjunctivitis sicca (dry eye) Vaginal dryness Arthralgia Raynaud’s Recurrent parotitis
How is Sjogren’ syndrome investigated and managed?
Investigation
Antibody test for Rheumatoid factor, ANA, anti-ro, anti-la
Schirmer’s test – filter paper near conjunctival sac to measure tear formation
Management
Supportive – artificial saliva and tears, pilocarpine to stimulate saliva production
Discuss Salivary gland tumours and the presentation of malignant salivary gland tumours?
80% of all tumours are in the parotid gland and 80% of these are benign pleomorphic adenomas. 50% of submandibular gland tumours are malignant. Symptoms include, short history, painful, hot skin, CNVII involvement, hard mass, lymphadenopathy, facial palsy.
What is xerostomia?
Dry mouth, which is atrophic, fissures and painful especially when eating, talking and putting dentures in.
What causes xerstomia
Causes include drugs, mouth breathing, dehydration, radiotherapy, parotid stones.
