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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 is also known as…

A

mealtime syndrome

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7
Q

obstructive sialadenitis potential causes

A

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

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8
Q

obstructive sialadenitis history -questions to ask patient

A

pain history if needed
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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9
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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10
Q

obstructive sialadenitis investigations in primary care

A

lower occlusal x ray or OPT to identify calcification

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11
Q

obstructive sialadenitis investigations in secondary care

A
  • ultra sound scan
  • sialography
  • MRI or CT may be indicated in some cases
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12
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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13
Q

obstructive sialadenitis surgical/radiological management

A

sialendoscopy
balloon dilation
incisional removal
basket removal
lithotripsy
therapeutic sialography

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14
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 is needed

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15
Q

sialadenitis - define

A

inflammation of the salivary glands

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16
Q

types of acute sialadenitis

A

acute viral sialedenitis
- mumps
acute bacterial sialadenitis

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17
Q

examples of conditions linked to chronic sialadenitis

A

sjorgrens disease
sarcoidosis
IgG4 disease

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18
Q

Acute viral sialodenitis 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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19
Q

acute viral sialadenitis 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
trismus

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20
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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21
Q

Mumps diagnosis

A

clinical
serum antibodies can be considered
viral swab of saliva

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22
Q

mumps management

A

no specific antivirals

supportive management
- hydration
- analgesia
- pyrexia management
- isolation for 6-10 days may be advisable
- contact public health

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23
Q

Mumps prevention

A

2 doses of MMR vaccine before age of 5

24
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

25
acute bacterial sialadenitis risk factors
dehydration radiotherapy duct obstructions sjorgrens disease poor oral hygiene smoking
26
acute bacterial sialedenitis diagnosis
clinical exclude odontogenic infection - consider OPT pus swab - culture and sensitivity exclude sepsis/pyrexia exclude airway obstruction - if there is obstruction - contact OMFS for advice and ambulance if active breathing difficulty
27
Acute bacterial sialedenitis management
antibiotics through GP or OMFS first choice is flucloxacillin - erythromycin if allergic to penicillin airway management if needed manage causative factors when resolved
28
sialosis features
benign and bilateral salivary gland hyperplasia painless soft associated with autonomic neuropathy
29
social and medical factors associated with sialosis
alcohol excess endocrine disorders - diabetes - acromegaly malnutrition anorexia bulimia cystic fibrosis cirrhosis
30
sialosis investigations
Hba1c may be considered ultrasound to exclude other conditions
31
systemic causes of salivary gland swelling
Sjorgrens disease IgG4 disease - rare sarcoidosis - rare amyloidosis - rare
32
salivary gland swelling extra oral features which would indicate referral; to OM or GP
shortness of breath cough chest pain macroglossia peripheral neuropathy bruising peripheral oedema GI symtoms fatigue weight loss
33
Mucocele - define
a cystic lesion of the minor salivary glands
34
mucoceles commonly present in...
lower labial mucosa floor of mouth
35
mucocele appearance
fluctuant blue swelling
36
give the 2 types of mucocele
mucous extravasation (90%) mucous retention (10%)
37
mucous extravasation aetiology cause and features
caused by trauma to minor salivary duct not lined by epithelium - therefore not a true cyst termed ranula if on floor of mouth most commonly present in lower lip/labial mucosa most common under age of 30 - peak incidence 2nd decade
38
mucous retention aetiology and features
saliva being retained in duct/gland - more common over age of 50 - never seen in lower lip - cystic dilation of the duct
39
mucocele - history
swelling rupture partially resolution recurrence history of trauma/lip biting
40
mucocele management options
no tx - unlikely to resolve excision of lesion by oral surgery clinical photos
41
excision of mucocele - risks
high recurrence rate potential damage to neighbouring structures
42
salivary neoplasms features
uncommon most are benign will usually present as unilateral parotid swellings malignancy more common in minor salivary glands
43
neoplasms - risk factors
associated with smoking infection - EBV - Simian virus - some herpes viruses ionising radiation genetics
44
neoplasms - clinical features
- unilateral swelling - any areas where there are major or minor salivary glands
45
neoplasms - red flags
red flags - facial palsy - sensory loss - pain - difficulty swallowing - trismus - rapid growth
46
most common salivary gland neoplasm
Pleomorphic adenoma (PSA)
47
sublingual gland neoplasms are
uncommon and usually malignant
48
parotid gland neoplasms are
usually PSA - pleomorphic adenomas
49
submandibular gland neoplasms are
usually PSA 1/3 are malignant
50
minor salivary gland neoplasms are
50% PSA 50% malignant commonly affect the palate - lips, tongue and buccal mucosa can be affected - adenoid cystic carcinoma are most common
51
neoplasms - management
surgical excision if benign if malignant treatment is decided by MDT on case by case basis: - neck dissection - wide excision - chemotherapy - radiotherapy - immunotherapy
52
risk of surgical excision of a benign neoplasm
facial nerve injury
53
Pleomorphic salivary adenoma features
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
54
Warthin's tumour features
associated with smoking 1 in 10 of salivary neoplasms benign 5% cases are bilateral
55
adenoid cystic carcinoma features
slow growing malignant spreads perineurally metastasises rare
56
mucoepidermoid carcinoma features
slow growing low grade malignancy 10% of salivary neoplasms most common childhood salivary neoplasm

A - BDS4 Oral Medicine (15 decks)

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