Salivary Gland Swellings

Question 1

what type of glands are salivary glands
what is their function

Answer 1

exocrine
produce saliva

Question 2

functions of saliva

Answer 2

buffering
remineralisation
immune defence [innate immunity]
digestion
lubrication
facilitate swallowing/chewing

Question 3

salivary glands are CNS controlled
explain sympathetic vs parasympathetic

Answer 3

sympathetic = “fight-flight”, decreased flow, thoracic

parasympathetic = increased flow, CN, “lemon”

Question 4

parotid

Answer 4

20-25% saliva
stensen duct [upper 7]
parasympathetic via glossopharyngeal

Question 5

submandibular

Answer 5

65-75% saliva
Whartons duct [FOM]
parasympathetic via facial

Question 6

sublingual

Answer 6

7-8% saliva
multiple ducts
parasympathetic via facial

Question 7

minor glands

Answer 7

800-1000
1-2mm

Question 8

which condition is known as “meal-time” syndrome
what does this mean

Answer 8

obstructive sialadenitis

food associated, pain/swelling associated with eating

Question 9

what questions would you ask when expecting obstructive sialadenitis and how would you examine

Answer 9

food associated, coming/going, swallowing, pus, unwell

bimanual palpation FOM, express saliva, calculi/obstruction present

Question 10

symptoms of obstructive sialadenitis

Answer 10

unilateral, intermittent gland swelling @ meal times, pain

can also have bacterial sailadenitis, chronic obstruction leads to gland atrophy

Question 11

what is the most common gland associated with obstructive sialadenitis and why

Answer 11

submandibular
length of duct, flow of saliva, anatomy and mucous content

Question 12

what causes bacterial sialadenitis

how would you further investigate in primary vs secondary care

Answer 12

sialoliths [duct calculi], duct stricture, oedema, trauma, neoplasm, mucous plug

primary - lower occlusal +/- OPT
secondary - US, sialography, MRI/CT

Question 13

management of obstructive sialadenitis

Answer 13

massage duct/gland, heat, citrus, hydrate, OH, analgesia

lithotripsy, sialoendoscopy, balloon dilation, basket removal, incisional removal, therapeutic sialography
risks = damage, stone displacement, full XLA needed

Question 14

pt presents with obstructive sialadenitis with pus FOM, painful swelling, heat and loss of function

what now

Answer 14

urgent referral max fax

amoxicillin + metro
full gland xla rather than drainage

Question 15

acute viral sialadenitis is also known as
what causes it

Answer 15

mumps

RNA paraomyxovirus, 2-3wk incubation, highly infectious

Question 16

acute viral sialadenitis

symptoms
diagnosis
management

Answer 16

painful PAROTID swelling, fever, unwell, trismus, 7 day swelling

clinical, serum antibodies via viral saliva swab

no specific tx, hydration, analgesia, pyrexia ,management, 6-10 day isolation, public health

Question 17

complications of acute viral sialadenitis

how could you prevent?

Answer 17

meningitis, meningism, encephalitis, orchitis, thyroiditis, deafness

2 dose MMR <5y/o

Question 18

acute bacterial sialadenitis
symptoms
risks
diagnosis

Answer 18

unilateral painful swelling, erythema, duct pus, trismus, pyrexia, parotid common

dehydration, radiotherapy, duct obstruction, sjogrens, poor oh, smoking

clinical, exclude odotongoenic, pyrexia/sepsis/airway obstruction
pus swab for culture + sensitivity
manage causative

Question 19

name examples of chronic sialadenitis

Answer 19

sjogrens
sarcoidosis
IgG64 disease

Question 20

what is sialolis

symptoms,
associations
investigations

Answer 20

painless bilateral benign enlargement with autonomic neuropathy
parotid common

excess alcohol, DM, acromegaly, malnutrition, anorexia, bulimia, CF, cirrhosis

HbA1c
US to exclude sarcoidosis, wharthins tumour
rarely sialography/core biopsy

Question 21

mucocele

what
symptoms
history qs
management

Answer 21

minor salivary gland cystic lesion

fluctuant, blue swelling, labial/FOM

swelling, ruptures, partial resolutions, recurrence, lip biting/trauma

no tx - unlikely to resolve
excision by OS - ideally enucleated, high recurrence, damage

photos

Question 22

explain the 2 types of mucocele

Answer 22

mucous extravasation [trauma]
- not true cyst, no epithelial but mucin + granulation
- <30, lower lip, ranula if FOM

mucous retention [retained saliva in duct/gland]
- >50, never lower lip
- cystic dilation of duct

Question 23

pt presents with mucocele on the RHS upper lip

what now

Answer 23

suspect neoplasm, refer

Question 24

pt presents with swelling, ulceration and painless “butterfly” lesion on their palate

what is this and what is the cause

Answer 24

necrotising sialometaplasia

minor salivary gland benign lesion

due to small vessel infarction/ischaemia, smokers, trauma, recent LA to palate

will self-heal in a few weeks

Question 25

RED FLAGS for neoplasms in salivary glands

Answer 25

facial palsy sensory loss pain difficulty swallowing trismus rapid growth

Question 26

associations with salivary neoplasms

Answer 26

smoking infections [EBV, herpes] plumbing manufacturing mineral exposure genetics ionising radiation more common later in life if child = suspect

Question 27

investigation and management of salivary neoplasms

Answer 27

US guided fine needle aspiration [facial nerve risk in parotid] MRI/CT, sialography, sjogrens surgical excision alone if benign malignant = MDT - neck dissection, wide excision, chemo/radio, immunotherapy

Question 28

name 4 neoplasms which are malignant

Answer 28

pleomorphic salivary adenoma wharthins tumour adenoid cystic carcinoma ** mucoepidermoid carcinoma**

Question 29

which neoplasm is most common in parotid, submandibular and 50% of minor glands

Answer 29

pleomorphic salivary adenoma via duct epithelium, slow growing, usually benign 3% recur post-excision