Salivary gland Disorders

Question 1

3 main salivary glands

Answer 1

Parotid gland
Submandibular gland
Sublingual gland

Question 2

Structures close to the parotid

Answer 2

Facial Nerve
Terminal branches of external carotid artery
Greater Auricular Nerve

Question 3

Terminal Branches of External Carotid Artery (Seven Angry Ladies Fighting Over PMS)

Answer 3

Superior Thyroid 
Ascending Pharyngeal 
Lingual 
Facial 
Occipital 
Posterior Auricular 
Maxillary 
Superficial Temporal

Question 4

Branches of the Facial nerve (Two Zebras Bit My Coccyx)

Answer 4

Temporal, Zygomatic, Buccal, Mandibular, Cervical

Question 5

What nerve innervates the Parotid Gland

Answer 5

Glossopharyngeal Nerve CN9

Question 6

Stenten’s Duct

Answer 6

Aka Parotid duct, by the 2nd upper molar

Question 7

Nerve supply to the Submandibular gland

Answer 7

Marginal Mandibular branch, Lingual nerve and Hypoglossal nerve

Question 8

Arterial supply to the submandibular gland

Answer 8

Facial artery and lingual artery

Question 9

Wharton’s duct

Answer 9

aka Submandibular gland, found floor of mouth

Question 10

Acute Sialothiasis

Answer 10

When a calcified mass forms within a salivary gland usually the submandibular gland.

Question 11

Signs and symptoms of Acute Sialothiasis

Answer 11

Pain, swelling of the gland, erythema, pus, bad breath, cervical lymphadenitis, palpable hard lump, lack of saliva

Question 12

Risk factors for Sialotiasis

Answer 12

Elderly, defufration, trauma, major surgery, radiotherapy, immunosuppressed, on chemo, Sjorogen syndrome, S. aureus infection

Question 13

Causes of Sialothiasis

Answer 13

abnormalities in calcium metabolism dehydration, reduced salivary flow rate, altered acidity of saliva caused by oropharyngeal infections, and altered solubility of crystalloids

Question 14

Treatment of Sialothiasis

Answer 14

Rehydration- IV and PO fluids
IV Abx
Warm compress/massage
Sialogogues/ citrus juics
Oral irrigations
Shock wave therapy (Extracorporeal shock wave lithotripsy)
Intraoral Sialolithotomy Intraductal sialolithotomy with sialendoscopy

Question 15

Sjoren’s Syndrome

Answer 15

Autoimmune disease, dry eyes (zeropthalmia) and dry mouth (xerostomia), accompanies Rheumatoid arthritis and Lupus, polyarteritis nodosa

Question 16

Risk factors for Sjogren

Answer 16

women, over 40, rheumatic disease

Question 17

Signs for Sjogren

Answer 17

salivary gland hypertrophy

Positive test for anti-Ro and anti-La serologies

Question 18

What can Sjogren progress to

Answer 18

Non-Hodgkin Lymphoma and rarely Waldenstrom’s macroglobulinaemia

Question 19

Complications of Sjogren

Answer 19

Dental Cavities, Yeast infections, vision problems

Question 20

Incidence of Salivary gland tumour

Answer 20

80% in parotid
80% benign
80% pleomorphic adenoma

Question 21

Benign tumours of salivary gland

Answer 21

Pleomorphic adenoma (benign-mixed tumours)
Warthins tumour (adenomlymphoma)

Benign tumours do not usually cause facial palsy. Malignancy should be top differential.

Question 22

Malignant tumours of salivary glands

Answer 22

Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Carcinoma ex-pleomorphic adenoma

Question 23

Investigating Salivary gland tumours

Answer 23

Fine needle aspiration (FNA), Core biopsy, USS or MRI

Question 24

Other causes of enlarged glands

Answer 24

Sialothiasis, mumps, HIV, Granulomatous disease, autoimmune disease

Question 25

Treatment for Salivary gland tumours

Answer 25

Parotidectomy

Question 26

Complications of Salivary gland tumours

Answer 26

Pain, bleeding infection, facial weakness, numbness to ear lobe, Frey's syndrome

Question 27

Frey's Syndrome

Answer 27

Damage to or near the parotid gland causing redness and sweating on cheek near gland in response to gustatory stimuli e.g. just thinking about food

Question 28

TNM Staging

Answer 28

T: Tumour (1-4) N: Nodal spread (1-3) M: Presence of metastasis (0 or 1)

Question 29

Stages of Cancer

Answer 29

``` 0 - Carcinoma in situ 1 - Localised Cancer 2 - Local Invasion 3 - Spread to nodes 4 - Extensive invasion or mets ```

Question 30

Red flags for Head and Neck problems for more than 3 weeks

Answer 30

``` Sore throat Hoarseness Stridor Dysphagia Lump in neck Unilateral otalgia ```

Question 31

Red flags for Head and neck problems

Answer 31

``` Red or white patch in mouth Oral ulceration, swelling or loose tooth Lateral neck mass Rapidly growing thyroid mass New Cranial Nerve palsy Orbital mass Unilateral ear effusion ```