Salivary gland disorders Flashcards
How do salivary gland diseases present?
lumps, dry mouth, hypersalivation
how do you examine the salivary glands
inspection: from the front, side and behind of the pt (compare left and right)
palpation (bimanual palpation for submandibular gland)
what system increases saliva flow?
parasympathetic
where are the minor salivary glands distributed?
lips, cheeks, palates, floor of mouth and retromolar pad
how much do the minor salivary glands contribute to saliva production?
10%
what is saliva mostly made up of?
water!!!!
what are the normal non-stimulated and stimulated flow rates of saliva?
non-stimulated 0.3-0.4ml
stimulated 4-5ml
what are the inorganic, organic and macromolecule components of saliva?
inorganic: sodium, potassium chloride, hydrogen, iodine, fluoride,
organic: urea, uric acid, glucose, fatty acids, lactate
macromolecules: serum proteins, glycoproteins, lysozyme, lipase, lipids, hormones, carbs
What are some investigations of salivary gland disease?
sialometry (measure saliva flow)
plain film radiography
ultrasounds
bloods
MRIS
biopsies
what does sjogrens screen involve?
FBC
U&E’s (urea/electrolytes) and LFTS (liver function tests)
Hb1AC
Serum ACE levels
What is ultrasonography?
high frequency sound waves that are good for identifying solid lesions (tumours and calculi) and cysts and textural changes in Sjogrens
- not good for assessing SG function or identifying strictures or mucus plugs
how are radiographs used in salivary glands?
identify radio-paque caliculi - ideally need 2 radiographs at 90deg to help localise the calculus
what is retrograde sialography?
radiographic examination of the ductal system using radioiodide as contrast medium - used to identify any blockages of the ductal system of the submandibular or parotid gland
what does MRI better demonstrate detail of?
soft tissue detail and the extend and relationships of tumours to normal anatomy
How is MRI different to radiography
it does not involve ionising radiation
what is considered a low unstimulated salivary flow?
<0.1ml/min
what is used to measure saliva volumes in the parotid gland?
lashley cup
how do you identify bacteriology and virology in glands?
bacterial swabs
venous blood for virology
majority of salivary gland pathologies can be diagnosed from the clinical history, examination and imaging but biopsies may be used - how would these be done for major and minor salivary glands?
excisional for minor salivary glands and incisional for major salivary glands
what specific biopsy is done in some sjogrens cases?
minor labial salivary gland biopsy
what are the symptoms of salivary gland?
- swelling (localised or generalised, unilateral or bilateral, persistent or transient)
- pain (stretching of parotid capsule due to swelling)
- discharge (from duct - pt may complain of foul taste)
- decreased saliva (xerostomia)
- increased saliva (sialorrhoea)
what are the salivary gland diseases?
- Obstructive SG dx
- Xerostomia
- Sialorrhoea
- Sarcoidosis/HIV/GvHD related salivary gland disease
- Cancers
- Benign neoplasia’s e.g. pleomorphic adenoma and Warthin’s tumour
- Benign cysts/pseudocysts
- Acute/chronic sialadenitis
- Frey’s syndrome
- Developmental abnormalities e.g. atresia or hypoplasia
- Primary and Secondary Sjogren’s syndrome
- Sialosis
what is obstructive salivary gland disease?
obstruction of the major salivary glands due to mechanical blockage (which does not always have an associated infection)
what can cause obstructive salivary gland disease?
calculi, strictures or infections
sialadenitis (inflammation of the salivary gland) needs to be further categorised into what?
infective sialadenitis or obstructive sialadentitis
what are the commonest cause of obstructive sialadenitis involving major glands? what is the term?
calculi - called sialoliths
