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5th Oral Disease - Other > Salivary Gland Imaging > Flashcards

Salivary Gland Imaging Flashcards

1
Q

What are common problems related to salivary gland?

A
  1. Dry mouth
  2. Painful and swollen gland
  3. Lump in gland
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2
Q

What are causes of dry mouth

A

Diabetes
Medication
Radiotherapy
Immune- conditions

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3
Q

Examples of medications cause dry mouth?

A

Anti-cholinergics
Cytotoxic
Diuretics
Antidepressants

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4
Q

What can cause painful and swollen gland?

A

Sialadenitis
Can be chronic or acute
Bacterial or viral

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5
Q

What is likely cause of lump in saliva gland?

A

Tumour - benign or malignant

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6
Q

What imaging can be taken if dry mouth?

A

Ultrasound first line

If suspect Sjogren - sialography

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7
Q

What imaging can be taken is painful/swollen gland?

A

Plain radiography followed sialography

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8
Q

What imaging can be used if lump in gland?

A

Ultrasound

Need core biopsy for tissue diagnosis (if malignant MRI)

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9
Q

What is the only cause of dry mouth that can be identified on imaging?

A

Sjogrens syndrome

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10
Q

How does Sjogren’s present on imaging?

A

Normal gland replaced by inflammation = black spaces

Disease process destroy gland parenchyma

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11
Q

How does obstructive sialadentitis present?

A

Swollen and painful gland occurs at mealtime/ thinking/ smelling food

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12
Q

What causes obstructive sialadentitis?

A

Salivary calculi/ strictures or debris in ductal system

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13
Q

Where is it most common for obstructive sialadenitis to occur?

A

Submandibular gland

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14
Q

What gland is more prone to strictures?

A

Parotid

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15
Q

Why is obstruction of sublingual gland rare?

A

Doesn’t have single duct - multiple opening in floor of mouth

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16
Q

What radiographs are needed to identify submandibular obstruction?

A

Lower true occlusal

Posterior oblique occlusal film

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17
Q

How is sialography performed?

A

Inject iodine contract along duct - contrast makes duct densely radiopaque, stones are less dense than contrast so appear radiolucent

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18
Q

What gland should sialograpy not be performed in?

A

Sublingual

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19
Q

What expect to see on sialography if have calculi/ obstruction?

A

Radiolucent obstruction within duct

Dilation of duct

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20
Q

How does treatment of submandibular calculi vary?

A

Depends on size, location and mobility of stone

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21
Q

When can intra-oral surgical approach be used?

A

Stone in anterior 1/3rd of duct

22
Q

When may basket removal be indicated?

A

Small and mobile stone

Anterior to mylohyoid bend

23
Q

When is extra-oral approach taken?

A

Calculi large

Beyond mylohyoid bend

24
Q

What is basket removal?

A

Intra-ductal technique under LA

25
Q

How is basket removal carried out?

A

Closed helical wire inserted into duct opening
Advance wire past calculi
Open wire
Calculus snared in basket and drawn duct opening
Calculi released w/ small papillotomy incisor

26
Q

Complication basket remova;?

A

Pain and swelling spot proceudre
Failure remove stone - esp if >1cm
Basket stuck in duct
Persistent symptoms

27
Q

Why can symptoms carry on after calculus removed by basket

A

Possible ductal stenosis post incision

28
Q

What common see sialography of parotid?

A

Strictures and narrowing of duct

29
Q

How to treat parotid strictures?

A

Balloon-dilation

30
Q

How to treat parotid strictures?

A

Balloon-dilation if extra-glandular

Superficial parotidectomy intra-glandular

31
Q

How treat parotid stones?

A

Surgical excision - if at duct opening
Basket retrieval - if in extra-glandular duct
Superficial parotidectomy/ lithotripsy - if in gland parenchyma

32
Q

What is lithotripsy?

A

Way to shatter stones using sound waves

33
Q

How is balloon-dialtion carried out

A

Intra-ductal procedure under LA

Articaine mixed iodinated contract - allows identification stricture site

34
Q

Technique of balloon dilation?

A

Parotid papilla dilated using lacrimal probe
Insert angioplasty balloon along duct
Balloon positioned across stricture using x-ray gudiance
Inflated 90 sec - can do 2/3 inflation

35
Q

What are associated complication of balloon dilation?

A

Stricture can be too tight to pass balloon
Uncomfortable even with LA
Some strictures all not dilate
Re-stenosis

36
Q

How do salivary gland tumours present?

A

Slow-growing solid masses

37
Q

What features of salivary gland tumour would be indicative of malignancy?

A

Rapid growth
Fixation to skin/ underlying tissue
Pain
If in parotid - facial nerve weakness

38
Q

Rule of thumb regarding salivary gland malignancy?

A

Smaller gland higher risk of malignancy

e.g
Sublingual 85% malignant
Minor salivary gland 50% malignant

39
Q

Which gland is most likely to have malignant tumour?

A

Sublingual

40
Q

What are two common benign salivary gland tumour?

A

Pleomorphic adenoma

Warthins tumour

41
Q

What salivary gland tumour only occurs in parotid?

A

Warthin’s tumour

42
Q

Most common benign salivary gland tumour?

A

Pleomorphic adenoma

Most common parotid

43
Q

Can pleomorphic adenoma be malignant?

A

Small malignant transformation rate

44
Q

When is it more likely to see Warthin tumour?

A

Tail of parotid
Elderly - over 60
Smokers
Males (2:1)

45
Q

How can Warthins tumours present clinically?

A

10-15% bilateral

46
Q

How do benign salivary gland lesions present imaging?

A

Well defined solid mass

Smooth/lobulated margin

47
Q

How do malignant salivary gland lesion present on imaging?

A

Infiltrative

Speculated margin - ill-defined

48
Q

Which salivary gland are lymph nodes found in?

A

Parotid - not submandibular or lingual

49
Q

Why are nodes found in parotid?

A

Parotid is encapsulation after the development of lymphatic system - submand/lingual encapsulated before

50
Q

What differential can be given to a parotid gland mass that isn’t given to submandbiualr/lingual mass?

A

Pathological intra-parotid lymph nodes

5th Oral Disease - Other (13 decks)

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