Salivary gland disorder Flashcards
size of parotid gland - general
up to TMJ
to mandible and behind
von frey syndrome
gustatory sweating
- Result after trauma occured to the parotid region of the face
instead of going to parotid gland – goes to sweat gland
three major etiology of infections
viral - like mumps
from stones - like mucus plug (like secondary)
retrorade infection
high temp dysphagia trismus swelling and malaise - may be from?
pus draining from wharton’s duct - submandibular gland infection
features of chronic infection / blockage
diminshed salivary flow
turbind, viscous discharge
pain and swelling seen at meal time
moderate enlargment of the affected gland
scarring pattern seen on sialolith
typically swells at meal time
chronic paraotid infection
with turbid viscous discharge milked from duct
tx for glandular
hydration – water
plus acidic like lemons and pickles
stimulation
ductile dilation – probing - only chronic though - not acute infections
antibiotics
sialolothectomy
sialolithectomy
sialogram
‘easy’ sialothith to remove
can almost see it
- traction suture – suture ligation of duct
2.
clinically important parotid gland anantomy
- superficial / deep lobe
- facial nerve courses through
- retromandibualr relationship
- course of stenson’s duct
- over masseteric muscle - accessory gland
its large!
- also because wraps around behind - trismus could be associated
clinically important submandibular gland anatomy
- muscualr triangle
- allow these muscsles to swallow
- symptoms = difficulty swallowing - facial nerve, artery and vein
- hypoglossal nerve
- whartons duct
- lingual nerve
- crossing UNDER WHARTON’S DUCT
whartons duct?
from submandibular gland to oral cavity
stensons duct
from parotid gland
clinically important sublingual gland anatomy
- deceptively large size
- directly drains by 8-20 ductiles
- can be injured
- like mucocele formed - bartholin’s duct into whartons
trauma examples
- mucocele
- ranula
- laceration of salivary duct
- salivary fistula
- von frey syndrome
ranula is
when the sublingual gland has been injured
mucous pulling underneath
typical mucocele
dome shaped
fluid filled
non ulcerated
moveable
can occur wherever minor salivary glands are
very large fluctuant swelling in the area of the sublingual gland
ranula
chance of reoccurence when marsupilization ? next what?
yes can happen – try again
ranula can be cause by - example he gave
trauma from sunction tip / high speed suction in dental procedure
pt. with x-ray of face with discontinuity defect
possible FRACTURE
STENSONS duct is injured – from parotid
typical acute submandibular gland infection
discrete swelling
som hurt to swallow
PUS milked from wharton’s duct
acute parotiditis presentation
sudden onset
mild trismus
fever
pre and infra auricular swelling
tx for the acute
antibiotics – not going to go into an acutely infected duct area
pt says has acute parotid glan infection but presents with multiple swellings
infection may be secondary to CANCER
- had lymphoma
not tender swollen parotid gland
lymphoma
pain that is suggestive of chronic infectin / blockade
pain and swelling at MEAL time
turbid viscous discharge milked from out of duct more likely to be
CHRONIC
- typically swelling at meal times
treatment of infections
- HYDRATION
- stimulation
- acidic / lemon/ pickles
- right behind incisors – get them to salivate - ductile dilation
- antibiotics
- sialolithectomy
- sialogram - inject die into it
- sialoendoscopy
when can yuo put something INTO the duct
during CHRONIC LOW GRADE infection
NOT acute
dilate the duct
important in treatment in chronic low grade infection
what should see from sialogram
continual taper of the duct but with the die we can see the obstruction
dialates BEHIND OBTRUCTION
main locations we see salivary stones in the mandible
- orifice of duct
- middle of it
- point of exit -
always put what behind the gland when retrieving stone
TRACTION SUTURE
- if dont stone will be pushed back further
incision made where on lower?
making sure to keep away from?
in anterior portion of the mouth make incision TO THE MEDIAL ASPECT OF THE DUCT
if cut into where sublingual will be – too lateral can get ranula
ake incision too lateral?
can get secondary ranula
traction suture so
AKA
stone cannot go further back
made BEFORE making any incision
AKA LIGATION suture
indication to remove an acute salivary stone
based upon LOCATION – lie if you can get it - get it
example with a long history of episodic pain and submandibular swelling which is getting worse
dx by?
small round radio-opaque somewher ein the subMANDIBULAR area
inject the DIE@@
- trying to push it in - and it is not working past the stone
- so identitifed that the stone is in the duct
neoplasia aka
benign tumors
occurence of benign tumors from most to least
- parotid (90% will be benign)
- minor salivary glands ( 40- 60 % will be malignant)
- submandibular
- sublingual
- has the most occurence of a MALIGNANT one
90% of the benign tumors are ___
pleomorphic adenomas
wharton’s tumor?
8% of the parotid tumors
commonly a BILATERAL tumor
ELDERLY MEN
bilateral tumor in elderly men close to tail of parotid
WHARTON’S TUMOR
TUMORS CAN BECOME MALIGNANT
YES- TRUE
malignant salivary tumors
mucoepidermoid carcinoma
adenoid cystic carcinoma
adenocarcinoma
malignant pleomorphic adenoma
lymphoma
squamous cell carcinoma
acinic cell carcinoma
highlighted malignant
lymphoma (second most malignant in head and neck region and squamouos cell carcinoma
pleomorphic adenoma
can become malignant in a long standing
firm mass - cannot rule out
tumor -malignancy
like a lymphoma
facial paralyiss can be a presentation associated with
cancer
loss of lines in forehead
close not closing
pt presented with TMJ pain and swelling in the pre-auricular area
metastic colon cancer to the parotid gland
statistically sublingual gland tumors should be
malignant
- but still can present as a pleomorphic adenoma
chance of malignacy from most to least
- sublingual
- submandibular
- parotid
90% of the benign tumors are
pleomorphic adenomas
nicotinic stomatitis
inflammation of the minor salivary glands
each one of them can become a tumor of one
6 months draining a lesion?
most likely not an infection
tumor of salivary gland on the palate
if locate NO SOURCE OF INFECTION – doing a biopsy
doing incision and drainage on non odontogenic?
NO
mucocele should NOT present where
in the posterior retromolar pad area
muco-epidermoid carcinoma or salivary gland tumor until we prove otherwise
front or floor of mouth probably a mucocele
upper lip mass vs lower lip mass
lower - mucocele
upper - tumor
indurated / hard mass on buccal mucosa associated with V2 parasthesia
think TUMOR
adenomatoid cystic carcinoma
NON inflammatory enlargment of parotid glands
sialosis
benign salivary hypertrophy
causes of sialosis
- malnutrition
- chronic alcoholism
- diabetes
- HIV disease
necrotizing sialometaplasia
hallmark sign?
INTENE ACUTE PAIN
necrotic slough of tissue frequently seen
Patient will say something dropping / coming out of the roof of my mouth
THIS WILL HEAL
___ puts at risk for developing lymphoma
sjorgen’s syndrome – 40% increased risk to develop lymphoma
presenting chatacteristics of sjorgen’s syndrom
xerophthalmia - dryness in eye
xerostomia
rheumaotid arthritis
40X more likely to develop lymphomas
common presentation of sialosis
NON INFLAMMATORY ENLARGMENT
-BILATERAL
PAROTID ENLARGEMENT
SEEN IN - DIABETICS - ALCOHOLIC - MANLUTRITION HIV DISEASE
