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A - BDS4 Oral Medicine > Salivary Gland lumps lesions and Swellings > Flashcards

Salivary Gland lumps lesions and Swellings Flashcards

1
Q

Effect of sympathetic nervous system on salivary glands

A

fight or fight - decreases salivary flow

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2
Q

parasympathetic nervous system effect on salivary glands

A

increased salivary flow

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3
Q

What are the major salivary glands?

A

parotid
submandibular
sublingual

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4
Q

The major salivary glands make up approximately how much of all saliva produced?

A

90%

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5
Q

obstructive sialadenitis symptoms

A

intermittent swelling of salivary glands
usually unilateral
may or may not have inflammation
usually painful
often associated with mealtimes
can be chronically obstructed
most common in the submandibular gland

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6
Q

obstructive sialadenitis causes

A

sialoiths - duct calculi
stricture in the salivary duct
salivary duct oedema
- trauma
neoplasm
mucous plug

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7
Q

obstructive sialadenitis history -

A

pain history
ask if associated with eating/food
coming and going or persistent
swallowing problems
bad taste or pus
generally unwell
- to exclude acute infection

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8
Q

obstructive sialadenitis clinical examination

A

extra oral exam
bimanual palpation of floor of mouth
express saliva from ducts
- pus?
- obstruction?

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9
Q

obstructive sialadenitis investigations

A

lower occlusal x ray or oPT to identify calcification
- primary care

secondary care
- ultra sound scan
- sialography
- MRI or CT may be indicated in some cases

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10
Q

obstructive sialadenitis conservative measures

A

massage gland and duct
heat application
sucking on citrus fruits or sugarfree sweets
stay hydrated
excellent oral hygiene
simple analgesia

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11
Q

obstructive sialadenitis surgical/radiological management

A

sialendoscopy
balloon dilation
incisional removal
basket removal

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12
Q

obstructive sialadenitis surgical/radiological management - complications

A

damage to duct
displace stone into floor of mouth or closer to gland
- may result in damage to gland
sometimes gland removal necessary

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13
Q

sialadenitis - define

A

inflammation of the salivary glands

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14
Q

types of acute sialadenitis

A

acute viral sialedenitis
- mumps
acute bacterial sialadenitis

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15
Q

examples of conditions linked to chronic sialadenitis

A

sjorgrens disease
sarcoidosis
IgG4 disease

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16
Q

Acute viral salenitis aetiology

A

cause by RNA paramyxovirus - mumps
2-3 week incubation period
patients are infective a few days before and after parotid swelling
highly infectious
- spread by direct contact and saliva droplets

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17
Q

acute viral salenitis clinical features

A

painful parotid swelling
usually bilateral
- can sometimes be a single gland
no hyposalivation
10% have submandibular gland involvement
- very rare to only involve sm gland
malaise, fever and feeling generally unwell
- likely precedes parotid swelling
swelling lasts approximately 7 days

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18
Q

acute viral sialadenitis complications

A

extra salivary manifestations
- orchitis
- thyroiditis
- pancreatitis
deafness
- 1 in 3400-20,000
nervous system
- meningitis
- meningism - headache, photophobia and neck stiffness

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19
Q

Mumps diagnosis

A

clinical
serum antibodies can be considered
viral swab of saliva

20
Q

mumps management

A

no specific antivirals
hydration
analgesia
pyrexia management
isolation for 6-10 days may be advisable
contact public health

21
Q

Mumps prevention

A

2 doses of MMR vaccine before age of 5

22
Q

Acute bacterial sialadenitis features

A

most common in parotid glands
typically unilateral
painful swelling
overlying erythema
pus from duct
trismus
pyrexia
cervical lymphadenopathy
often secondary to salivary gland obstruction

23
Q

acute bacterial sialadenitis risk factors

A

dehydration
radiotherapy
duct obstructions
sjorgrens disease
poor oral hygiene
smoking

24
Q

acute bacterial sialedenitis diagnosis

A

clinical
exclude odontogenic infection
- consider OPT
pus swab
exclude sepsis
exclude airway obstruction
- if there is obstruction - contact OMFS for advice and ambulance if active breathing difficulty

25
Q

Acute bacterial sialedenitis management

A

antibiotics through GP or OMFS
first choice is fluclocacillin
- erythromycin if allergic to penicillin
airway management if needed
manage causative factors when resolved

26
Q

sialosis features

A

benign and bilateral salivary gland hyperplasia
painless
soft
associated with autonomic neuropathy

27
Q

social and medical factors associated with sialosis

A

alcohol excess
endocrine disorders
- diabetes
- acromegaly
malnutrition
anorexia or bulimia
cystic fibrosis
cirrhosis

28
Q

sialosis investigations

A

Hba1c may be considered
ultrasound to exclude other conditions

29
Q

systemic causes of salivary gland swelling

A

Sjorgrens disease
IgG4 disease - rare
sarcoidosis - rare
amyloidosis - rare

30
Q

Mucocele - define

A

a cystic lesion of the minor salivary glands

31
Q

give the 2 types of mucocele and their causes

A

mucous extravasation
- caused by trauma to minor salivary duct
- not true cysts as not lined by epithelium
mucous retention
- saliva being retained in duct/gland

32
Q

salivary neoplasms features

A

uncommon
most are benign
will usually present as unilateral parotid swellings
malignancy more common in minor salivary glands

33
Q

neoplasms - risk factors

A

associated with
smoking
infection
- EBV
- Simian virus
- some herpes viruses
ionising radiation
genetics

34
Q

neoplasms - clinical features and red flags

A

clinical features
- unilateral swelling
- any areas where there are major or minor salivary glands

red flags
- facial palsy
- sensory loss
- pain
- difficulty swallowing
- trismus
- rapid growth

35
Q

most common salivary gland neoplasm

A

Pleomorphic adenoma (PSA)

36
Q

sublingual gland neoplasms are

A

uncommon and usually malignant

37
Q

parotid gland neoplasms are

A

usually PSA - pleomorphic adenomas

38
Q

submandibular gland neoplasms are

A

usually PSA
1/3 are malignant

39
Q

minor salivary gland neoplasms are

A

50% PSA
50% malignant
commonly affect the palate
- lips, tongue and buccal mucosa can be affected
- adenoid cystic carcinoma are most common

40
Q

neoplasms - management

A

surgical excision if benign
if malignant treatment is decided by MDT on case by case basis:
- neck dissection
- wide excision
- chemotherapy
- radiotherapy
- immunotherapy

41
Q

risk of surgical excision of a benign neoplasm

A

facial nerve injury

42
Q

Pleomorphic saliva adenoma features

A

arises from duct epithelium
slow growing
usually benign
3% recur within 5 years of excision
malignant change is uncommon
- suspicious if rapidly growing or painful

43
Q

Warthin’s tumour features

A

associated with smoking
1 in 10 of salivary neoplasms
benign
5% cases are bilateral

44
Q

adenoid cystic carcinoma features

A

slow growing
malignant
spreads perineurally
metastasises
rare

45
Q

mucoepidermoid carcinoma features

A

slow growing
low grade malignancy
10% of salivary neoplasms
most common childhood salivary neoplasm

A - BDS4 Oral Medicine (12 decks)

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