salivary gland enlargement Flashcards
What may cause changes in salivary gland size?
Viral - Mumps, HIV
Secretion retention - mucoceles and duct obstruction
Gland hyperplasia - sialosis when cause unknown, Sjögren’s syndrome
What age group is Mumps associated most with?
Students - 16-25
How is mumps treated?
Symptomatic treatment - analgesics and fluid intake
Describe HIV salivary disease?
A cause of unexplained salivary swelling
Pt may have no other HIV symptoms
Similar appearance to mumps
Generally doesn’t improve with treatment
A lympho-proliferative enlargement of the glands
What is a mucocele?
A swelling in the mucosa filled with saliva
Recurrent and burst within days
Usually related to minor injury eg - lip biting
Describe subacute salivary obstruction
Swelling associated with meals - increases as salivary flow starts and reduces when salivary flow stops
Usually submandibular but occasionally parotid
Causes duct obstruction
What are the causes of subacute salivary obstruction?
Sialolith (stones)
Mucous (plugging)
Ductal damage from chronic infection (scarring)
What investigations are carried out for subacute obstruction?
Low dose plain radiography
Lower true occlusal radiograph or periapical in check for parotid
Sialography
Isotope scan
Ultrasound assessment of duct system
How are salivary stones treated?
Many stones will pass normally into mouth even if large
If no symptoms, no treatment is needed
Removal sometimes requires removal of full gland
What are the consequences of salivary gland duct dilation?
Defect prevents normal emptying
Microorganisms grow and lead to persisting and recurrent sialadenitis
Gland function gradually lost and persisting infection leads to gland removal
What is chronic non-specific sialadenitis?
Damage to the salivary gland gradually over many years
Acinai and ducts are lost and replaced with fibrous scar tissue
What are the consequences of salivary subacute obstruction?
Reformation of the stone/obstruction
Deformity of the duct - stasis and infection
Gland damage leading to low salivary flow and ascending infection
How is salivary subacute obstruction managed?
Surgical sialolith removal if practical
Sialography is no stones present
Consider gland removal if fixed swelling and no obvious cause for obstruction
What is sialosis?
Persisting and unexplained enlargement of one or more salivary gland with no identified glandular cause
Name 4 things associated with sialosis?
Alcohol
Cirrhosis
Diabetes mellitus
Drugs
