Salivary Gland Enlargement Flashcards
What are the causes of salivary gland enlargement?
Viral- HIV, mumps
Secretion retention- duct obstruction, mucocele (obstruction in minor gland)
Gland hyperplasia- Sjogren’s, Sialosis
What are the features of the mumps virus?
Paramyxovirus
Droplet spread
Incubation 2-3 weeks
1/3 have no symptoms
Occurs between 3-5 years in unprotected population
-> more severe in older patients
What are the signs and symptoms of mumps?
Headache
Joint pain
Nausea
Dry mouth
Mild abdominal pain- pancreas and testicles
Feeling tired
loss of appetite
Pyrexia of 38C, or above
How is mumps treated?
MMR vaccine
Fluids
Analgesia
How do HIV swellings differ from Mumps?
Major salivary glands enlarge significantly giving mumps like appearance (lympho-proliferitive enlargement)
-> Discomfort from distended tissue but no other mump like symptoms
Does not reduce with time- surgical reduction for cosmetic reasons is possible but not common
What is a mucocele?
Swelling in mucosa filled with saliva from minor glands
What are the types of mucocele?
Mucous retention cyst- within ductal system
Mucous extravasation cyst- saliva spills out into tissue from ruptured duct
What are the common sites for mucoceles?
Lips
Junction between hard and soft palate
-> Areas of trauma
What are the symptoms of mucoceles?
Recurrent swelling that bursts
Salty taste
When may a mucocele be removed?
If it is fixed in size
-> OS may remove extravasated mucous or mucous in duct as well as gland
What would happen if a mucocele was left alone?
Would not cause harm but may cause cosmetic defect
What are the causes of subacute obstruction?
Blockage in submandibular (long duct pathway)
-> Mucous plugs
-> Sialoliths (stones)
-> damage from infection causing scarring
Strictures in parotid
What are the signs and symptoms of subacute obstruction?
Swelling around meal times
-> Increases when salivary flow starts and reduces after
Can become fixed after a while
-> causing pain and swelling
What investigations can be done for salivary gland obstruction?
Low dose plain radiography
Lower true occlusal (PA if parotid)
SIALOGRAPHY – when infection free (don’t want to wash more infection into gland)
-> can also help remove blockage
Isotope scan- to check secretion ability
Ultrasound assessment of duct system
Clinical visual assessment
Why is lower exposure used in plain radiographs of sialoliths?
Due to low calcium content risking not been seen on normal exposure
What are mucous plugs?
Hardened/sticky adherent mucous
-> Same symptoms but won’t be seen on radiographs
How are sialoliths treated?
If symptom free (can be an incidental finding)- no treatment
If symptoms- surgery will involve removal of gland (must be beneficial to patient)
What can happen if stone or plug is not removed?
Back pressure from blocked secretion will cause damage and scarring
What causes duct strictures to occur?
When damage and infection has occurred in duct over a long period of time
What can be used to investigated duct strictures?
Plain radiographs
3D CT
How are strictures treated?
Using balloon catheters
What is ductal dilatation?
Flabby ductal tree (sausage like defects) which prevent normal emptying of duct
-> Increased infection due to salivary stasis in dilated areas
What condition is ductal dilatation associated with?
Recurrent parotitis which occurred in childhood leading to low grade damage over many years
What occurs is chronic sialadenitis, how does it appear histologically?
Atrophy of normal glandular tissue around stone
Histologically- ducts and acini seen in health are replaced with fibrous scar tissue
What are the management options for salivary gland obstruction?
- Rapid removal of stone should be arranged without delay
- If no stone visible- sialography
- Removal- if fixed swelling and no obvious cause found (if persistent and recurring infection consider removal)
What is sialosis?
Persisting enlargement with no obvious glandular cause
- Diagnosis of exclusion- do tests for other diseases
- Tests will usually be within normal limits if Sialosis
What are the conditions associated with sialosis?
Alcohol abuse
Cirrhosis
Diabetes Mellitus
Drugs
How does sialosis appear on MRI and biopsy?
MRI- Diffuse enlargement (appears like hyperplasia)
Biopsy- normal
What can cause pain in sialosis?
Stretching of the capsule around gland (esp in parotid)
How is sialosis differentiated from Sjogren’s?
Patient rarely has dry mouth in sialosis
