Salivary Gland lumps lesions and Swellings Flashcards
Effect of sympathetic nervous system on salivary glands
fight or fight - decreases salivary flow
parasympathetic nervous system effect on salivary glands
increased salivary flow
What are the major salivary glands?
parotid
submandibular
sublingual
The major salivary glands make up approximately how much of all saliva produced?
90%
obstructive sialadenitis symptoms
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
obstructive sialadenitis is also known as…
mealtime syndrome
obstructive sialadenitis causes
sialoiths - duct calculi
stricture in the salivary duct
salivary duct oedema
- trauma
neoplasm
mucous plug
obstructive sialadenitis history -questions to ask
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
obstructive sialadenitis clinical examination
extra oral exam
bimanual palpation of floor of mouth
express saliva from ducts
- pus?
- obstruction?
obstructive sialadenitis investigations in primary care
lower occlusal x ray or OPT to identify calcification
obstructive sialadenitis investigations in secondary care
- ultra sound scan
- sialography
- MRI or CT may be indicated in some cases
obstructive sialadenitis conservative measures
massage gland and duct
heat application
sucking on citrus fruits or sugarfree sweets
stay hydrated
excellent oral hygiene
simple analgesia
obstructive sialadenitis surgical/radiological management
sialendoscopy
balloon dilation
incisional removal
basket removal
lithotripsy
therapeutic sialography
obstructive sialadenitis surgical/radiological management - complications
damage to duct
displace stone into floor of mouth or closer to gland
- may result in damage to gland
sometimes gland removal is needed
sialadenitis - define
inflammation of the salivary glands
types of acute sialadenitis
acute viral sialedenitis
- mumps
acute bacterial sialadenitis
examples of conditions linked to chronic sialadenitis
sjorgrens disease
sarcoidosis
IgG4 disease
Acute viral sialodenitis aetiology
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
acute viral sialadenitis clinical features
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
acute viral sialadenitis complications
extra salivary manifestations
- orchitis
- thyroiditis
- pancreatitis
deafness
- 1 in 3400-20,000
nervous system
- meningitis
- meningism - headache, photophobia and neck stiffness
Mumps diagnosis
clinical
serum antibodies can be considered
viral swab of saliva
mumps management
no specific antivirals
supportive management
- hydration
- analgesia
- pyrexia management
- isolation for 6-10 days may be advisable
- contact public health
Mumps prevention
2 doses of MMR vaccine before age of 5
Acute bacterial sialadenitis features
most common in parotid glands
typically unilateral
painful swelling
overlying erythema
pus from duct
trismus
pyrexia
cervical lymphadenopathy
often secondary to salivary gland obstruction
acute bacterial sialadenitis risk factors
dehydration
radiotherapy
duct obstructions
sjorgrens disease
poor oral hygiene
smoking
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
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
sialosis features
benign and bilateral salivary gland hyperplasia
painless
soft
associated with autonomic neuropathy
social and medical factors associated with sialosis
alcohol excess
endocrine disorders
- diabetes
- acromegaly
malnutrition
anorexia
bulimia
cystic fibrosis
cirrhosis
sialosis investigations
Hba1c may be considered
ultrasound to exclude other conditions
systemic causes of salivary gland swelling
Sjorgrens disease
IgG4 disease - rare
sarcoidosis - rare
amyloidosis - rare
salivary gland swelling - other 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
Mucocele - define
a cystic lesion of the minor salivary glands
mucoceles commonly present in…
lower labial mucosa
floor of mouth
mucocele appearance
fluctuant
blue swelling
give the 2 types of mucocele
mucous extravasation (90%)
mucous retention (10%)
mucous extravasation 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
mucous retention cause and features
saliva being retained in duct/gland
- more common over age of 50
- never seen in lower lip
- cystic dilation of the duct
mucocele - history
swelling
rupture
partially resolution
recurrence
history of trauma/lip biting
mucocele management option
no tx
- unlikely to resolve
excision of lesion by oral surgery
clinical photos
excision of mucocele - risks
high recurrence rate
potential damage to neighbouring structures
salivary neoplasms features
uncommon
most are benign
will usually present as unilateral parotid swellings
malignancy more common in minor salivary glands
neoplasms - risk factors
associated with
smoking
infection
- EBV
- Simian virus
- some herpes viruses
ionising radiation
genetics
neoplasms - clinical features
- unilateral swelling
- any areas where there are major or minor salivary glands
neoplasms - red flags
red flags
- facial palsy
- sensory loss
- pain
- difficulty swallowing
- trismus
- rapid growth
most common salivary gland neoplasm
Pleomorphic adenoma (PSA)
sublingual gland neoplasms are
uncommon and usually malignant
parotid gland neoplasms are
usually PSA - pleomorphic adenomas
submandibular gland neoplasms are
usually PSA
1/3 are malignant
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
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
risk of surgical excision of a benign neoplasm
facial nerve injury
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
Warthin’s tumour features
associated with smoking
1 in 10 of salivary neoplasms
benign
5% cases are bilateral
adenoid cystic carcinoma features
slow growing
malignant
spreads perineurally
metastasises
rare
mucoepidermoid carcinoma features
slow growing
low grade malignancy
10% of salivary neoplasms
most common childhood salivary neoplasm
