salivary glands Flashcards
what are the 3 main salivary glands
parotid, submandibular, sublingual
what nerve supplies the major salivary glands
facial nerve
during the parasympathetic response, does salivary flow increase or decrease
during the sympathetic response (fight) does salivary flow increase or decrease
increases
decreases
name the different ways you can test for salivary gland diseases
MRI
sialometry - measures saliva flow
plain film radiography
ultrasound
biopsy
endoscopy
how do salivary gland disease present
lumps
dry mouth
hypersalivation
what are sialogoues and give examples
substances which increase saliva flow such as lemon drops and pineapple
what causes dry mouth
sjogens
anxiety
medications
HIV
salivary gland disease
what are some causes of siallhorea (hypersalivation)
cerebral palsy
parkinsons
Name the different types of salivary gland disorders
Obstructive SG dx
Xerostomia
Sialorrhoea
Sarcoidosis/HIV/GvHD related salivary gland disease
Cancers
Benign neoplasias e.g. pleomorphic adenoma and Warthin’s tumour
Benign cysts/pseudocysts
Acute/chronic sialadenitis
Frey’s syndrome
Developmental abnormalities e.g. atresia or hypoplasia
Primary and Secondary Sjögren’s syndrome
Sialosis
what are the different types of Sjogren’s disease and how do you differentiate the 2
primary and secondary
primary isnt associated with a connective tissue
secondary is associated with connective tissue e.g. rheumatoid arthiriris
what is sjogrens
an autoimmune disease which self damages the exocrine system (salivary glands) therefore causing dry eyes and dry mouth
how to test for sjogrens
blood test called ANA which specifically look for RO and LA antibodies
how many minor saliva glands are there, where in the mouth are they and what % saliva do they present
450 minor salivary glands,
distributed through mucosa, lips, cheeks, tongue, roof of mouth and retromolar pad
what is the normal saliva flow rate for a non-stimulated and stimulated mouth
0.3-0.4ml/ minute
4-5 ml/ minute
What is the composition of saliva
inorganic molecules - sodium, potassiom, fluoride, chloride, iodine, calcium phosphate
organic molecules- urea, uric acid, amino acids , glucose, lactate, fatty acids
macromolecules- glycoprotein, amylase, IgA, IgM etc, lipids, hormones, carbs
what is the difference between endocrine and exocrine glands
endo secrete hormones into blood stream such as pituitary, ovaries, testes
exo secretes substaces into ducts which secrete to target tissue e.g. saliva, sweat and mucous
when would you do a venous blood sample and what does it consist of
mostly for dry mouth (sjogens)
- FBC
- hb1ac
- serum ace levels
- U & E and LFT (urea and electrolytes)
-ANA screen ( looks for antibodies that attack your own cells)
- serum immunoglobulins (IGA,IGM etc)
what is ultrasonography
high frequency sound waves
quick cheap, non invasive
identifies solid lesions e.g. tumours and calculi
identifies cysts
not good for assessing SG fuction
textural changes in sjogens
plain radiographs
to identify radiopaque calculi
80% SMG calculi is radiopaque 60% parotid calculi is radiopaque
you need 2 radiographs at 90 degrees to help localise the calculus
what is retrograde sialography
radiographic eexamination of the ductal system using the medium radioiodide
this can highlight
strictures - restrictions in the ducts
sialectasia- dilations in the ducts
not good to identify tumours
Punctate sialectasis – typical of Sjögren’s Syndrome (“tree in winter” appearance)
what is MRI
does not involve ionising radiation
demonstrates the extent and relationships of tumours to normal anatomy
collection of parotid saliva
lashley cup held in place over one parotid papilla by suction
measure non stimulated and stimulated saliva volumes
symptoms of salivary gland disorders
Pain
o E.g. stretching of parotid capsule due to swelling
o Invasion of nerves by malignant neoplasms (rare compared to other causes of
pain)
Discharge from duct – may C/O foul taste
Decreased saliva – xerostomia (extremely common)
Increased saliva – sialorrhoea (very rare)
salivary gland diseases we need to know about are:
- Obstructive SG dx
- Xerostomia
- Sialorrhoea
- Sarcoidosis/HIV/GvHD related salivary gland disease
- Cancers
- Benign neoplasias e.g. pleomorphic adenoma and Warthin’s tumour
- Benign cysts/pseudocysts
- Acute/chronic sialadenitis
- Frey ’s syndrome
- Developmental abnormalities e.g. atresia or hypoplasia
- Primary and Secondary Sjogren’s syndrome
what is sialadenitis and what are the 2 types
inflammation of the salivary gland
there is obstructive sialadenitis or infective
what causes obstructive salivary gland disease
calculi, strictures (narrowing sg), or infections, or local swellings from cancers or other structures like like lymph nodes or mumps
what is another name for salivary gland calculi
sialoliths
what is the most common cause for obstructive salivary gland disease
salivary gland calculi- a hard sludge
may be asymptomatic
can occur in major and minor salivary glands
what are strictures
trauma to the salivary duct followed by fibrosis- thickening of the tissue
causing narrowing of SG
usually occur in conjunction with calculi
how do you treat strictures
balloon dilation
but future re stenosis may occur
how do you treat strictures
balloon dilation however they may re-stenose over time
what is acute salivary gland obstruction and how is it caused
usually caused by calculus or a mucous plug,
occurs before a meal
resolves around 30 mins
how do you manage salivary calculi
if asymptomatic leave alone
if small symptomatic - incise duct and remove stone
large stones- remove the whole gland or remove stone using endoscopy and then lithotripsy- ultrasonic shock waves to stone
what are the risks associated with removing the submandibular gland
damage to mandibular nerve - diminishes motor innervation of muscles
damage to lingual nerve- diminished sensory sensation to lingual tissues
damage to hypoglossal nerve- diminished motor function to tongue
what are the risks associated with (complications) removal of parotid gland
damage to facial nerve may lead to unilateral facial weakness of all branches
freys syndrome
what causes xerostomia
medications
diabetes mellitus
anxiety
dehydration
mouth breathing
acute infection
recreational drugs
radiation to salivary glands
endogenous salivary gland disease such as sjogrens
how do drugs effect saliva production
drugs act in 3 different mechanisms :
central effects in the brain
anti- muscarinic effects -
sympathomimetic- stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system (activates receptors)
what type of drugs cause xerostomia give examples
tricyclic depressants e.g. amitriptyline
antihistamines, diuretics, antipsychotic, antiparkinsonian
which recreational drugs can cause xerostomia
amphetamines, ecstatsy
what advice would you give to pts to manage dry mouth
- smoking cessation
minimise alcohol - increase water intake in small sips
- avoid caffeine drinks
- sugar free chewing gum
- avoid cariogenic good - caries increasing foods such as cakes, biscuits
- use high fluoride toothpaste
- increase dental check ups
- discourage mouth breathing
- identify and treat oral candidosis
- OHI perio
what is sialorrhoea and what causes it
- too much saliva
this can be due to: parkinsons, cerebral palsy - rabies
- pregnancy
- acute viral infection
- teething
- new dentures
- pancreatitis
- some drugs such as clozapine
how do you manage sialorrhea
anti muscarinics- glycopyronium bromide
botulinum toxin A (botox) can be injected into salivary glands to reduce acetylcholine and :. inhibit salivation
surgical management- incision of gland
what is HIV salivary gland disease
this type of salivary gland disease is common in children with HIV
HIV can cause cystic changes in salivary glands
involves the swelling of one or both parotid glands
Xerostomia common in hIV
what causes salivary gland cancers
benign and malignant neoplasms
in malignanies of the salivary gland, you may find cervical lymphodenapthy representing local metastasis
what are the 2 types of benign neoplasia
pleomorphic adenoma
warthins tumour
where are pleomorphic adenoma most commonly found
what % of benign neoplasia do they make up
parotid gland
80%
what is the main difference between pleomorphic adenoma and warthins syndorme
pleomorphic is very common 80% but poorly encapsulated :. incision is harder
warthins less common but better encapsulated :. easier incision
what is the technical name for benign cycts
mucocles
what are mucocles
a cyst of a minor salivary gland usually on floor of mouth
how can you identify mucocles
they present as persistent fluctuant swellings which transilluminate in the lower lip or buccal mucosa at a ‘biting distance’
what is a ranula
a sialocyst arising from the floor of mouth from a sublingual gland
some are unilateral and may raise the tongue
can sometimes extend to pharynx
how would you treat a ranula
marsipulation- drainage of the cysts
excision- cutting the cyst out- this is rarely done
which gland does acute sialadenitis usually affect
parotid
which gland does chronic sialadenitis mostly affect
submandibular
