Salivary Gland Swellings Flashcards
What are the 3 major salivary glands and where are they located?
There are several hundreds minor salivary glands
- Parotid glands on the inside of the cheeks
- Submandibular glands on the floor of the mouth
- Sublingual glands under the tongue
What is the function of the salivary glands?
Salivary glands produce saliva which is important in:
=> lubricating your mouth,
=> help to swallow,
=> protect your teeth against bacteria
=> aid in digestion of food
How and where can salivary glands swellings present?
- Side of the face, below and in front of the ear => Parotid gland
- Upper part of the neck => the submandibular gland and tail of parotid gland
- Submucosal swelling in oral cavity => sublingual or minor salivary gland neoplasm
How common is salivary gland disease?
Who does it affect?
Malignant tumours of salivary glands are rare.
Salivary gland calculi 50% of all salivary gland disease
Men > Women
What are the causes of salivary gland swellings?
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
65-70% salivary gland neoplasms are benign. Parotid gland = 80% benign tumours.
What are the common benign tumours of the salivary gland?
=> Pleomorphic adenoma
=> Warthin’s tumour
=> Basal cell adenoma
=> Canalicular adenoma
What are the common malignant neoplasms of salivary gland?
=> 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
What are the two most common tumours of salivary glands?
Who does it affect?
- Pleomorphic adenomas -
=> commonly affects parotid glands but can also affect submandibular and minor salivary glands
=> painless and grows slowly
=> benign
=> women > men
- Warthin’s tumour
=> benign ; can grow on both sides of face
=> affects parotid gland
=> men > women
What is sialolithiasis?
=> How does it present?
=> Which gland does it affect?
=> What is it’s presentation?
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
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?
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
What is sialadenosis?
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
What are the differential diagnosis for salivary lump swelling?
=> 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
Red flag symptoms indicate invasion of neighbouring structures and raise suspicion of malignancy.
What are the red flag symptoms suggesting a salivary malignancy?
=> 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
When should salivary lumps be referred to secondary care?
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
What imaging is needed to diagnose salivary gland swelling?
=> Ultrasonography: first line of imaging
=> MRI for parotid and submandibular masses with signs of malignancy
=> CT/PET for metastases
=> Salivary duct imaging
