Salivary Gland Enlargement Flashcards

1
Q

What are the causes of salivary gland enlargement?

A

Viral- HIV, mumps

Secretion retention- duct obstruction, mucocele (obstruction in minor gland)

Gland hyperplasia- Sjogren’s, Sialosis

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2
Q

What are the features of the mumps virus?

A

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

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3
Q

What are the signs and symptoms of mumps?

A

Headache

Joint pain

Nausea

Dry mouth

Mild abdominal pain- pancreas and testicles

Feeling tired

loss of appetite

Pyrexia of 38C, or above

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4
Q

How is mumps treated?

A

MMR vaccine

Fluids

Analgesia

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5
Q

How do HIV swellings differ from Mumps?

A

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

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6
Q

What is a mucocele?

A

Swelling in mucosa filled with saliva from minor glands

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7
Q

What are the types of mucocele?

A

Mucous retention cyst- within ductal system

Mucous extravasation cyst- saliva spills out into tissue from ruptured duct

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8
Q

What are the common sites for mucoceles?

A

Lips

Junction between hard and soft palate

-> Areas of trauma

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9
Q

What are the symptoms of mucoceles?

A

Recurrent swelling that bursts

Salty taste

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10
Q

When may a mucocele be removed?

A

If it is fixed in size
-> OS may remove extravasated mucous or mucous in duct as well as gland

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11
Q

What would happen if a mucocele was left alone?

A

Would not cause harm but may cause cosmetic defect

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12
Q

What are the causes of subacute obstruction?

A

Blockage in submandibular (long duct pathway)
-> Mucous plugs
-> Sialoliths (stones)
-> damage from infection causing scarring

Strictures in parotid

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13
Q

What are the signs and symptoms of subacute obstruction?

A

Swelling around meal times
-> Increases when salivary flow starts and reduces after

Can become fixed after a while
-> causing pain and swelling

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14
Q

What investigations can be done for salivary gland obstruction?

A

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

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15
Q

Why is lower exposure used in plain radiographs of sialoliths?

A

Due to low calcium content risking not been seen on normal exposure

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16
Q

What are mucous plugs?

A

Hardened/sticky adherent mucous
-> Same symptoms but won’t be seen on radiographs

17
Q

How are sialoliths treated?

A

If symptom free (can be an incidental finding)- no treatment

If symptoms- surgery will involve removal of gland (must be beneficial to patient)

18
Q

What can happen if stone or plug is not removed?

A

Back pressure from blocked secretion will cause damage and scarring

19
Q

What causes duct strictures to occur?

A

When damage and infection has occurred in duct over a long period of time

20
Q

What can be used to investigated duct strictures?

A

Plain radiographs

3D CT

21
Q

How are strictures treated?

A

Using balloon catheters

22
Q

What is ductal dilatation?

A

Flabby ductal tree (sausage like defects) which prevent normal emptying of duct
-> Increased infection due to salivary stasis in dilated areas

23
Q

What condition is ductal dilatation associated with?

A

Recurrent parotitis which occurred in childhood leading to low grade damage over many years

24
Q

What occurs is chronic sialadenitis, how does it appear histologically?

A

Atrophy of normal glandular tissue around stone

Histologically- ducts and acini seen in health are replaced with fibrous scar tissue

25
Q

What are the management options for salivary gland obstruction?

A
  • 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)
26
Q

What is sialosis?

A

Persisting enlargement with no obvious glandular cause
- Diagnosis of exclusion- do tests for other diseases
- Tests will usually be within normal limits if Sialosis

27
Q

What are the conditions associated with sialosis?

A

Alcohol abuse
Cirrhosis
Diabetes Mellitus
Drugs

28
Q

How does sialosis appear on MRI and biopsy?

A

MRI- Diffuse enlargement (appears like hyperplasia)

Biopsy- normal

29
Q

What can cause pain in sialosis?

A

Stretching of the capsule around gland (esp in parotid)

30
Q

How is sialosis differentiated from Sjogren’s?

A

Patient rarely has dry mouth in sialosis