Salivary Gland Swellings Flashcards

1
Q

What are the 3 major salivary glands and where are they located?

There are several hundreds minor salivary glands

A
  1. Parotid glands on the inside of the cheeks
  2. Submandibular glands on the floor of the mouth
  3. Sublingual glands under the tongue
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2
Q

What is the function of the salivary glands?

A

Salivary glands produce saliva which is important in:

=> lubricating your mouth,

=> help to swallow,

=> protect your teeth against bacteria

=> aid in digestion of food

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3
Q

How and where can salivary glands swellings present?

A
  1. Side of the face, below and in front of the ear => Parotid gland
  2. Upper part of the neck => the submandibular gland and tail of parotid gland
  3. Submucosal swelling in oral cavity => sublingual or minor salivary gland neoplasm
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4
Q

How common is salivary gland disease?

Who does it affect?

A

Malignant tumours of salivary glands are rare.

Salivary gland calculi 50% of all salivary gland disease

Men > Women

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5
Q

What are the causes of salivary gland swellings?

A

Sialolithiasis (salivary stones) and ductal stenosis

Sialadenitis (salivary gland infection usually bacterial)

Viral infections i.e. mumps, flu, EBV, CMV, HIV, Coxackievirus

Cysts

Benign tumours

Malignant cancers

Sjögren’s syndrome

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6
Q

65-70% salivary gland neoplasms are benign. Parotid gland = 80% benign tumours.

What are the common benign tumours of the salivary gland?

A

=> Pleomorphic adenoma

=> Warthin’s tumour

=> Basal cell adenoma

=> Canalicular adenoma

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7
Q

What are the common malignant neoplasms of salivary gland?

A

=> Mucoepidermoid carcinoma

=> Adenoid cystic carcinoma

=> Acinic cell carcinoma

=> Adenocarcinoma

=> Polymorphus, low grade adenocarcinoma

=> Carcinoma ex pleomorphic adenoma

Majority of salivary neoplasms are adenocarcinoma.

Metastases may occur to paraparotid and intraparotid lymph nodes esp from skin cancers

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8
Q

What are the two most common tumours of salivary glands?

Who does it affect?

A
  1. Pleomorphic adenomas -

=> commonly affects parotid glands but can also affect submandibular and minor salivary glands

=> painless and grows slowly

=> benign

=> women > men

  1. Warthin’s tumour

=> benign ; can grow on both sides of face

=> affects parotid gland

=> men > women

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9
Q

What is sialolithiasis?

=> How does it present?

=> Which gland does it affect?

=> What is it’s presentation?

A

Salivary duct stones

=> presents as diffuse glandular swelling

=> classic hx of intermittent swelling and pain of the salivary glands at meal times + gets progressively worse

=> intraoral palpation may identify a calculus along the duct

=> if blockage is not cleared, may result in infection

=> most commonly in submandibular gland - floor of the mouth

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10
Q

Salivary gland infection is more common in older adults with salivary stones and commonly presents in parotid glands

How does an infection of salivary gland (sialadenitis) present?

A

Acute infections:

=> rapid onset of pain and swelling

=> commonly caused by mumps, typically bilateral

=> systemic features : fever, malaise, headache and lymphadenopathy

=> dehydration + malnutrition esp in elderly increases the risk of infection due to lack of salivary flow

=> acute bacterial infection = unilateral with redness overlying the skin + tenderness

Chronic infections:

=> painless, tumour like swelling

=> chronic sclerosing sialadentitis

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11
Q

What is sialadenosis?

A

Generalised gland swelling caused by hypertrophy of acinar component of the gland

=> presents with gradual bilateral enlargement of the glands

=> swelling is poorly defined on palpation

=> parotid gland most affected

It can be a presenting symptom of many systemic diseases such as:

=> Endocrine i.e. diabetes, hypothyroidism, cushing’s

=> Metabolic i.e. alcoholism, anorexia, bulimia, coeliac disease, malnutrition

=> Drugs i.e. anticholinergic drugs, heavy metals, psychotropic drugs

=> Neurogenic i.e. depression

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12
Q

What are the differential diagnosis for salivary lump swelling?

A

=> Neoplasms (benign or malignant)

=> Sialolithiasis and ductal stenosis

=> Infections i.e. mumps or bacterial sialadenitis

=> Pre-cursors for malignancy i.e. Sjögren’s syndrome, HIV

=> Sialadenosis (generalised salivary gland swelling)

=> Lymphadenopathy

=> Non-salivary gland lumps arising from adjacent structures

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13
Q

Red flag symptoms indicate invasion of neighbouring structures and raise suspicion of malignancy.

What are the red flag symptoms suggesting a salivary malignancy?

A

=> facial nerve weakness

=> rapid increase in the size of lump

=> ulceration of unduration of the mucosa or skin

=> overlying skin fixity

=> paraesthesia or anaesthesia of sensory nerves

=> Intermittent pain

=> Hx of previous skin cancer, Sjögren’s syndrome or radiation therapy to the head, neck

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14
Q

When should salivary lumps be referred to secondary care?

A

Due to risk of malignancy, salivary swellings need urgent referral to head & neck surgeon

Patients with obstructed glands do not resolve within a few weeks need removal of stones

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15
Q

What imaging is needed to diagnose salivary gland swelling?

A

=> Ultrasonography: first line of imaging

=> MRI for parotid and submandibular masses with signs of malignancy

=> CT/PET for metastases

=> Salivary duct imaging

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16
Q

How do salivary gland cysts develop?

A

Salivary cysts can develop:

=> injury

=> infection

=> tumours

=> salivary stones blocking flow of saliva

17
Q

How does Sjögren’s syndrome lead to salivary gland swelling?

A

Sjögren’s syndrome is an autoimmune disease => attacks salivary glands and other moisture-producing glands

=> dry mouth and eyes

=> 50% of people with Sjögren’s syndrome have painless enlargement of the salivary glands on both sides

18
Q

Which salivary glands have a higher risk of malignancy?

A

Sublingual / submandibular and minor salivary glands

19
Q

How are salivary gland swellings managed?

A

Salivary neoplasms
=> surgical removals
=> radiation for some benign tumours

Salivary gland stone
=> manual removal, warm compress or sour candies to increase saliva flow
=> if this doesn’t work = surgery

Surgery for some very large cysts

Infection with antibiotics