Salivary Glands

Question 1

E/O checks for salivation issues

Answer 1

Palpate parotid and submandibular

Question 2

I/O checks for salivation issues (4)

Answer 2

Duct orifices
Minor salivary glands
Fluid expression
Quality of saliva

Question 3

Functions of saliva (4)

Answer 3

Acid buffering (neutralises)

Lubrication for speech + swallowing

Taste

Antibacterial

Question 4

List some causes of a dry mouth (5)

Answer 4

Medications - Ca channel blockers, antihypertensives

Dehydration

Salivary gland disease

Somatisation disorders + anxiety

Radiotherapy/chemotherapy

Question 5

List medical conditions that induce saliva reduction indirectly (5)

Answer 5

Diabetes

Stroke

Addisons disease

VBD

Question 6

List medical conditions that induce saliva reduction directly (problems with gland itself) (5)

Answer 6

Aplasia - ectodermal dysplasia

Sarcoidosis

HIV

Gland infiltration - amyloidosis

CF

Question 7

What part of body affected by ectodermal dysplasia? (5)

Answer 7

Hair
Nails
Teeth
Sweat glands
Salivary glands
Hearing + vision

Question 8

Name a scale used to measure mucosal dryness

Answer 8

Challacombe scale of mucosal dryness

Question 9

Investigations for Salivary disease (5)

Answer 9

• Blood tests
  FBCS
  U+Es
  LFT
  C reactive protein
  Glucose
  Anti-Ro antibody
  Anti-la antibody
• Functional assays - salivary flow
• Tissue assays - labial gland biopsy
• Imaging
• Plain radiographs
• Sialography
• Ultrasound

Question 10

Function of sialography

Answer 10

Contrast to show ducts

Question 11

Disadvantage of sialography

Answer 11

Ionising radiation

Question 12

Risk of labial gland biopsy

Answer 12

Lip numbness

Question 13

How does anxiety reduce saliva flow?

Answer 13

Inhibits salivary production by brain

Question 14

What is a somatoform disease?

Answer 14

Mental health condition
Cause physical body symptoms in response to psychological stress

Question 15

Examples of somatoform disease

Answer 15

IBS
TMD
Oral dysaesthesia

Question 16

Unstimulated saliva flow

Answer 16

<1.5ml in 15 mins = hypo salivation

Question 17

Untx causes of dry mouth

Answer 17

• Sjogrens
• From cancer tx
• From salivary gland disease

Question 18

Dry eye test for dry mouth

Answer 18

Schirmer test tear flow <5mm in 15mins

Question 19

Examples of salivary substitutes

Answer 19

Sprays
Glandosane (acidic)
Orthana (encouraged)

Stimulants
Pilocarpine (sweating/taccychardia)

Question 20

Medical condition causes of hyper-salivation

Answer 20

Dementia
Stroke
Anxiety
Cerebral palsy

Question 21

Medications that can cause hyper-salivation (3)

Answer 21

Clozapine
Ketamine
Bromides

Question 22

Treating hyper salivation

Answer 22

Botox
Anxiety - tx
Antimuscarinic agents

Question 23

List some reasons for changes in gland size

Answer 23

Viral infection - herpes/mumps
Secretion retention - mucoceles/obstruction
Gland hyperplasia
Salivary neoplasms
Sialadenitis - infection

Question 24

Symptoms of mumps (6)

Answer 24

• High temp
• Nausea
• Loss of appetite
• Abdominal pain
• Headache
• Joint pain

Question 25

Common feature of duct obstruction

Answer 25

Swelling increases with meals Usually submandibular as ductal pathway longer

Question 26

Investigations for duct obstruction

Answer 26

Low dose plain radiograph Lower true occlusal - submandibular Ultrasound

Question 27

Cause of duct obstruction

Answer 27

Sialolith Mucous plugging Duct stricture - due to infection/damaged duct

Question 28

Histopathology of non specific sialadentitis

Answer 28

Fibrous scar tissue

Question 29

Management of subacute obstruction

Answer 29

Surgical sialolith removal Sialography for no stone cases - dye to wash mucous plug away

Question 30

Define sialolis

Answer 30

Chronic painless swelling of major salivary gland - usually parotid

Question 31

Define Sjogrens Syndrome

Answer 31

Autoimmune disease that causes loss of salivary/lacrimal tissue through T lymphocytic inflammatory destruction

Question 32

Classifications of Sjogrens

Answer 32

Partial - Sicca syndrome - Dry eyes or mouth Primary - No connective tissue disease Secondary - Connective tissue disease

Question 33

Systemic diseases Sjogrens is linked to

Answer 33

RA Lupus Scleroderma

Question 34

Consequences of Sjogrens

Answer 34

- 5% malignancy risk of lymphoma - Inc caries/oral infection/functional issues - speech+ swallow - Enlargement of salivary glands

Question 35

Immunopathology findings of Sjogrens

Answer 35

Lymphocytic focci within salivary tissue from labial gland biopsy

Question 36

Sialography findings of Sjogrens

Answer 36

Snow storm Leopard spots

Question 37

What is used to help confirm diagnosis of Sjogrens?

Answer 37

AECG

Question 38

Oral symptoms of sjogrens

Answer 38

Dry mouth >3mths Swelling of salivary glands

Question 39

Ocular symptoms of sjogrens

Answer 39

Dry eyes >3mths Sand/gravel in eyes Eye drops >3x a day

Question 40

Criteria of AECG required

Answer 40

1. Dry eyes/mouth 2. Histopathology - focci present 3. AntiRo/La 4. Ultrasound

Question 41

Management of Sjogrens

Answer 41

OHI Spray/stimulant If present early lease with rheumatologist and consider immune modulating drug Hydroxychloroquine