salivary gland lumps lesions and swellings Flashcards
1
Q
what type of glands are salivary glands
A
exocrine
2
Q
function of salivary glands
A
- make saliva - important for lubrication, innate immunite and facilitating chewing and swallowing
-1.5L of saliva a day
3
Q
what are salivary glands controlled by
A
- autonomic nervous system
- sympathetic - fight or flight - decreases salivary flow - dry mouth when anxious
- thoracic innovation
- parasympathetic - increases - salivary flow - passing bakery
- cranial nerve innervation
4
Q
what are major salivary glands
A
- make around 90% of all saliva produced
- parotid glands
- submandibular glands
- sublingual glands
5
Q
submandibular gland opening and innervation
A
- 60-75% saliva
- submandibular duct (whartons duct)
- duct orfice is in anterior floor of mouth
- parasympathetic innervation from facial nerve
6
Q
parotid gland opening and innervation
A
- parotid duct (stensons duct)
-20-25% saliva - duct orfice is in buccal mucosa in the region of the upper first molars
- parasympathetic innervation from glossopharyngeal nerve
- has intra-gland lymph node
7
Q
sublingual gland opening and innervation
A
- multiple small ducts - some connect to submandibular duct
- parasympathetic innervation from facial nerve
8
Q
what are minor salivary glands
A
- 800-1000 in number
- labial, buccal , lingual mucosa
- hard and soft palate
- 1-2mm in diameter
- may have its own duct or shared with other surrounding glands
- they lie beneath the mucosa or between muscle fibres
9
Q
what are some causes of lumps and swellings in salivary glands
A
- obstruction
-sialadenitis
-sialosis
-neoplasm
-trauma and fluid
-solid deposits
-intra-gland lymph node swelling
10
Q
what is obstructive sialadenitis
A
mealtime syndrome
blockage
most commonly submandibular gland
11
Q
symptoms of obstructive sialadenitis
A
- intermittent swelling of salivary glands
- usually unilateral
- may or may not have inflammation
- usually painful but can be painless
- often associated with mealtimes
- may have accompanying bacterial sialadentis
- can be chronically obstructed - may lead to gland atrophy
12
Q
causes of obstructive sialadenitis
A
- sialoths - duct calculi, common in submandibular due to anatomy
- stricture in salivary duct
- salivary duct oedema - trauma
- neoplasm
- mucous plug
13
Q
how to clinically exam salivary gland blockages
A
- extra oral exam
- bumanual palpation of FOM
- express saliva from ducts ?
- can i express saliva
- is there pus
- is there an obstruction i can see
14
Q
investigations for obstructive sialadenitis
A
- lower occlusal x-ray +/- OPT to identify calcification - primary care
- ultrasound scan - secondary care
- sialography - secondary care
- MRI or CT may be indicated in some instances - secondary care
15
Q
conservative measures for obstructive sialadenitis
A
- massage gland and duct
- heat application
- sucking on citrus fruits/sweets
- stay hydrated
- excellent OH
- simple analgesia
16
Q
surgical/radiological management of obstructive sialadenitis
A
- lithotripsy
- sialoedenoscopy
- balloon dilation
- basket removal
- incisional removal
- theraputic sialography
17
Q
what is sialadenitis
A
inflammation of salivary gland
18
Q
types of sialadenitis
A
- acute viral - mumps
-acute bacterial
-chronic sialadenitis - sjogrens, sarcoidosis
19
Q
aetiology of acute viral sialadenitis
A
- cause by the RNA paramyoxovirus (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
20
Q
complications of acute viral sialadenitis
A
extra salivary manifestations
- thyroiditis
-pancreaitis
-meningocephelitis
-deafness
-meningitis and encephalitis
20
Q
clinical features of acute viral sialadenitis
A
- painful parotid swelling
- usually bilateral
- sometimes can be a single gland
- no hyposalivation
- 10% have submandibular gland involement
- very rare to involve only the submandibular gland
- malaise, fever and feeling generally unwell, which likely precedes the parotid swelling
- trismus
- swelling will last approx 7 days
21
Q
diagnosis for acute viral sialadenitis
A
- clinical
-serum antibodies
-viral swab in saliva
22
Q
management of acute viral sialadenitis
A
supportive therapy
- hydration
-analgesia
-pyrexia management
-isolation
22
Q
prevention of mumps
A
- two dosease MMR vacine before age 5
- confers a 60-90% proection after 2 doses for mumps and 99% against measles and rubella
23
what does acute bacterial sialadenitis present as
- Most common in parotid glands (parotitis)
- Typically unilateral
- Painful swelling
- Overlying erythema
- Pus from duct – rarely may have extr-oral pointing
- Trismus
- Pyrexia
- Cervical Lymphadenopathy
- Often secondary to salivary gland obstruction
24
risk factors for acute bacterial sialadenitis
- dehydration
- radiotherapy
- duct obstructions
- sjogrens disease
- poor OH
- smoking
25
diagnosis for acute bacterial sialadenitis
- clinical grounds
-exclude odontogenic infection
-pus swab for culture and sensitivity
-exclude pyrexia/sepsis
-exclude airway obstruction
26
management for acute bacterial sialadenitis
- antibiotics through Gp or OMFS
- first choice is flucoloxacillin, erythromycin in penicillin-alergic patients
- airway management if needed
- manage causative factors when acutre sialadenitis resolved
27
what is sialosis
- benign and bilateral salivary gland hyperplasia
- painless, soft
-associated with autonomic neuropathy
28
what is sialosis associated with
- Alcohol excess
- Endocrine disorders
- Diabetes
- Acromegaly
- Malnutrition
- Anorexia
- Bulimia
- Cystic fibrosis
- Cirrhosis
29
investigations for sialosis
- Hba1c/LFT may be considered
- Ultrasound scan to exclude other conditions e.g. sarcoidosis or Warthin’s tumour
- Rarely sialography or core biopsy
30
systemic causes of salivary gland swelling
- sjogrens
- IgG4 diease
-sarcoidosis
-amyloidosis
31
what is sarcoidosis
- Rare multi-system non-caseating granulomatous reaction
- Lung involvement in 90% of patients
32
what is amyloidosis
Rare disease where amyloid builds up in organs impacting function
33
what is IgG4 disease
IgG4-RD is a recently recognised, rare autoimmune condition that can affect most organs
34
referral to GP if following signs present with salivary gland swelling
- Shortness of breath
- Cough
- Chest pain
- Uveitis
- Macroglossia
- Peripheral neuropathy
- Bruising/purpura
- Peripheral oedema
- GI symptoms
- Fatigue
- Weight loss
35
what is a mucocele
cystic lesions of minor salivary gland
36
where is mucocele commonly present
- lower labial mucosa
- Floor of mouth
- Less common in upper lip – upper lip lesions have a higher risk of malignancy
37
how do mucoceles appear
- Fluctuant
- Blue swelling
- Swelling
38
two types of mucocele
mucous extravasation
mucous retention
39
what is mucous extravasation
- trauma to minor salivary duct
- Not lined by epithelium, therefore not a true cyst
- May have mucin and inflamed granulation tissue histologically
- Most commonly present in the lower lip/labial mucosa (70%)
- Floor-of-mouth occurrence is termed a ranula
- Most common under the age of 30, peak incidence in 2nd decade
40
what is a mucous retention
- saliva retained in duct/gland
- More common over the age of 50
- Never seen in the lower lip
- Cystic dilatation of the duct
41
treatment for mucocele
- No treatment - but unlikely to resolve
- Can be a good option when waiting for children to be able to tolerate intervention
- Excision of lesion by Oral Surgery
- The cysts are enucleated ideally
- High recurrence rate
- Damage to neighbouring structures
- Clinical photos
42
what is necrotising sialometaplasia
- swelling then ulceration
-painless, self healing
-benign lesion on hard palate
43
clinical differential diagnosis for necrotising sialometaplasia
- squamous cell carcinoma
- salivary gland carcinoma
44
aetiology for necrotising sialometaplasia
- small vessel infarction/ishaemia
-smokers, trauma and LA
45
what is a neoplasm
malignant and non malignant tumours
usually unilateral parotid swelling
46
what is most common neoplasm
pleomorphic adenoma
47
which type of gland is malignancy more common in
minor
48
benign salivary gland neoplasms
49
malignant salivary gland neoplasm
50
incidence of neoplasm
- Present in later life
- In adults 10-25% are malignant
- In children 50% are malignant
- Female predisposition
- Some association with salivary gland and breast cancer
51
associations with neoplasm
- smoking
- infections: EBV, simian virus 40, some herpes virus
- plumbing, manufacturing , minteral exposure
- ionizing radiation
- genetics - altered expression of PLAG1, P53, Mcm-2, C-kit
52
clinical features of neoplasm
- unilateral swelling
- any areas where there are minor or major salivary glands
53
red flags of neoplasm
- Facial palsy
- Sensory loss
- Pain
- Difficulty swallowing
- Trismus
- Rapid growth
54
which type of neoplasm usually seen in parotid and submandibular
PSA
55
which gland is most uncommon for tumour
sublingual
usually malignant
56
what type of neoplasms common in minor salivary glands
- 50% PSA
- 50% malignant
- commonly affect palate, but lips , tongue and buccal mucosa can be affected
- adenoid cystic carcinoma most common
57
how to investigate for neoplasm
- Ultrasound useful
- Ultrasound guided Fine Needle Aspiration – give histological specimen - risk of facial nerve injury if taking sample form parotid
- MRI or CR can be considered
- Sialography
- Sjogren’s disease investigations
58
management of neoplasm if benign
excision
risk of facial nerve injury
59
management of neoplasm if malignant
- Neck dissection
- Wide excision
- Chemotherapy
- Radiotherapy
- Immunotherapy
60
what is PSA
- Arises from duct epithelium
- Slow growing
- Usually benign
- 3% recur within 5 years of excision
- Malignant change is uncommon – if this was rapidly growing or had pain suspicion is raised
61
what is warthins tumour
- Associated with smoking
- Accounts for 1 in 10 salivary neoplasms
- Benign
- 5% of cases are bilateral
62
what is adenoid cystic carcinoma
- Slow growing
- Malignant
- Spreads perineurall
- Metastasizes
- Rare
63
what is mucoepidermoid carcinoma
- Slow growing
- Low-grade malignancy
- Accounts for 10% of salivary neoplasms
- Most common childhood salivary neoplasm
