Salivary gland disorders

Question 1

How do salivary gland diseases present?

Answer 1

lumps, dry mouth, hypersalivation

Question 2

how do you examine the salivary glands

Answer 2

inspection: from the front, side and behind of the pt (compare left and right)
palpation (bimanual palpation for submandibular gland)

Question 3

what system increases saliva flow?

Answer 3

parasympathetic

Question 4

where are the minor salivary glands distributed?

Answer 4

lips, cheeks, palates, floor of mouth and retromolar pad

Question 5

how much do the minor salivary glands contribute to saliva production?

Answer 5

10%

Question 6

what is saliva mostly made up of?

Answer 6

water!!!!

Question 7

what are the normal non-stimulated and stimulated flow rates of saliva?

Answer 7

non-stimulated 0.3-0.4ml
stimulated 4-5ml

Question 8

what are the inorganic, organic and macromolecule components of saliva?

Answer 8

inorganic: sodium, potassium chloride, hydrogen, iodine, fluoride,
organic: urea, uric acid, glucose, fatty acids, lactate
macromolecules: serum proteins, glycoproteins, lysozyme, lipase, lipids, hormones, carbs

Question 9

What are some investigations of salivary gland disease?

Answer 9

sialometry (measure saliva flow)
plain film radiography
ultrasounds
bloods
MRIS
biopsies

Question 10

what does sjogrens screen involve?

Answer 10

FBC
U&E’s (urea/electrolytes) and LFTS (liver function tests)
Hb1AC
Serum ACE levels

Question 11

What is ultrasonography?

Answer 11

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

Question 12

how are radiographs used in salivary glands?

Answer 12

identify radio-paque caliculi - ideally need 2 radiographs at 90deg to help localise the calculus

Question 13

what is retrograde sialography?

Answer 13

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

Question 14

what does MRI better demonstrate detail of?

Answer 14

soft tissue detail and the extend and relationships of tumours to normal anatomy

Question 15

How is MRI different to radiography

Answer 15

it does not involve ionising radiation

Question 16

what is considered a low unstimulated salivary flow?

Answer 16

<0.1ml/min

Question 17

what is used to measure saliva volumes in the parotid gland?

Answer 17

lashley cup

Question 18

how do you identify bacteriology and virology in glands?

Answer 18

bacterial swabs
venous blood for virology

Question 19

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?

Answer 19

excisional for minor salivary glands and incisional for major salivary glands

Question 20

what specific biopsy is done in some sjogrens cases?

Answer 20

minor labial salivary gland biopsy

Question 21

what are the symptoms of salivary gland?

Answer 21

• 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)

Question 22

what are the salivary gland diseases?

Answer 22

1. Obstructive SG dx
2. Xerostomia
3. Sialorrhoea
4. Sarcoidosis/HIV/GvHD related salivary gland disease
5. Cancers
6. Benign neoplasia’s e.g. pleomorphic adenoma and Warthin’s tumour
7. Benign cysts/pseudocysts
8. Acute/chronic sialadenitis
9. Frey’s syndrome
10. Developmental abnormalities e.g. atresia or hypoplasia
11. Primary and Secondary Sjogren’s syndrome
12. Sialosis

Question 23

what is obstructive salivary gland disease?

Answer 23

obstruction of the major salivary glands due to mechanical blockage (which does not always have an associated infection)

Question 24

what can cause obstructive salivary gland disease?

Answer 24

calculi, strictures or infections

Question 25

sialadenitis (inflammation of the salivary gland) needs to be further categorised into what?

Answer 25

infective sialadenitis or obstructive sialadentitis

Question 26

what are the commonest cause of obstructive sialadenitis involving major glands? what is the term?

Answer 26

calculi - called sialoliths