Salivary Gland Surgery

Question 1

What are the main functions of the salivary gland?

Answer 1

• Lubricant
• Ion reservoir
• pH buffer
• antimicrobial
• digestion (contains amylase)
• aids taste
• pellicle formation

Question 2

Name the main salivary gland diseases

Answer 2

• Swellings (viral, bacterial, sialosis)
• Ranula (cyst)
• Salivary gland tumors (benign / malignant)
• Obstructive salivary disease
• Xerostomia
• Sjogrens syndrome

Question 3

What are the 3 main obstructive salivary gland diseases?
What are the main symptoms for diagnosis of obstructions?

Answer 3

• Mucoceles and salivary cysts
• Sialolithiasis
• Strictures

Meal time syndrome, swelling of the gland, asymmetry of gland,

Question 4

What is the main treatment for a salivary gland stricture?

Answer 4

Balloon dilatation

Question 5

If we find a mucocele on the upper lip, what must we rule out?

Answer 5

• Malignancy

Question 6

What is a ranula and how must we treat it?

Answer 6

• Mucocele of the sublingual gland and draining ducts
• Becomes plaunging when the swelling goes through the neck and into the mylohyoid muscle
• Surgical treatment: decompression, excision of the whole gland by an intra-oral or extra-oral approach

Question 7

What is the criteria for doing basket retrieval surgery?

Answer 7

• Mobile stone
• No stricture distal to stone
• Stone no more than 50% larger then duct width
• Basket can pass the stone

Question 8

What are the main complications of submandibular gland removal?

Answer 8

• Submandibular scar
• Haematoma (bleeding on the FOM)
• Marginal mandibular nerve weakness – immobility of the angle of the mouth
• Damage to the duct / salivary flow
• Damage to the lingual and hypoglossal nerve – rare

Question 9

Compare the clinical features of a benign and malignant salivary gland tumour

Answer 9

Benign: slow-growing, soft or rubbery consistency, 85% of parotid tumors, do not ulcerate, no associated nerve signs

Malignant: fast growing, hard consistency, 45% of minor gland tumours, may ulcerate and invade bone, may cause cranial nerve palsies

Question 10

What is the name of the main benign parotid tumour?

Answer 10

• Pleomorphic salivary adenomas

Question 11

What are the complications of parotid gland surgery?

Answer 11

o Freys syndrome – uncharacteristic sweating near glands
o Damage to the greater auricular nerve causing ear lobe paraesthesia
o Temporal nerve weakness (10%)
o Permanent facial nerve weakness (1%)
o Haematoma
o Necrosis near incision
o Facial asymmetry
o Salivary fistula or sialocolele – salivation from wound
o Recurrence