Salivary Glands

Question 1

What is a mucocele?

Answer 1

Secretion retention
Obstruction of a minor salivary gland
Swelling in the mucosa filled with saliva
The swelling will often burst itself, the pressure within the ductile system causes rupturing and the gland will shrink back in size

Question 2

What is the treatment for a mucocele?

Answer 2

No treatment and usually only cause minimal discomfort

Question 3

What is the treatment for a mucocele that becomes fixed in size?

Answer 3

Needs to be removed by removing the extravasated mucous or the mucous within the duct together with the underlying gland
However if left alone they do not cause anything other than a cosmetic defect

Question 4

Where are the common sites for a mucocele?

Answer 4

Junction of the hard and soft palate
Lower lip

Question 5

What is a subacute obstruction?

Answer 5

A swelling associated with meals
Can be slowly progressive- over weeks
Eventually becomes fixed and painful
-as the gland fully obstructs and saliva cannot escape

Question 6

What is the cause of a subacute obstruction?

Answer 6

Duct obstruction
Usually duct blockage in submandibular
Usually duct stricture in parotid
Sialolith (stones)
Mucous plugging
Ductal damage from chronic infection (scarring)

Question 7

What will the patient complain of if they have a subacute obstruction?

Answer 7

Swelling of the gland when eating meals
Swelling will increase as the salivary stimulation for flow increases and when the meal has passed and the stimulation drops, the swelling will gradually reduce as the saliva is released past the obstruction into the mouth

Question 8

What are the investigations for subacute obstructions?

Answer 8

Low dose plain radiography
Lower true occlusal
–reduced exposure as the calcium content of these stones are low and might not show at normal exposure
Isotope scan if gland function uncertain
–determines if glands are still able to secrete
Ultrasound assessment of duct system
Sialography- when infection free

Question 9

When does a duct stricture occur?

Answer 9

When there has been damage or infection in the duct
Happens over several years of low grade infection

Question 10

What is duct dilatation?

Answer 10

Flabby ductal tree
Defect prevents the gland from emptying
Micro-organisms grow and lead to persisting and recurrent sialadenitis
Gland function gradually lost and persisting infection leads to gland removal

Question 11

What is chronic non-specific sialadenitis?

Answer 11

Where damage to the gland happens gradually over many years it often produces a picture of sialadenitis
Can be in minor or major glands

Question 12

How do you investigate sialosis?

Answer 12

Blood tests (FBC, U&E’s, LFTs, bilirubin)
Glucose
BBV screen- HIV, Hep B, Hep C
Autoantibody screen
–anti-Ro, anti-La
Sialosis is largely a diagnosis of exclusion so these tests are all within normal limits

Question 13

What are some causes of a dry mouth?

Answer 13

Salivary gland disease
Drugs (anti-muscarinic cholinergic action which will reduce the stimulation to the glands to produce saliva)
Medical conditions and dehydration
Radiotherapy & cancer treatments
Anxiety & somatisation disorders

Question 14

What kind of drugs can cause a dry mouth?

Answer 14

Anti-muscarinic cholinergic drugs
-Tricyclic antidepressants
-Antipsychotics
-Antihistamine
-Atropine
-Diuretics
-Cytotoxins

Question 15

What chronic medical problems can cause dehydration?

Answer 15

Diabetes- Mellitus & Insipidus
Renal disease
Stroke
Addison’s Disease
Persisting Vomiting

Question 16

What is sarcoidosis?

Answer 16

Granulomatous condition which will cause an infiltrate within the gland and prevent it from functioning properly
Multi system disease

Question 17

How can HIV cause a dry mouth?

Answer 17

Lymphoproliferative changes in the gland so that there is increase in bulk of the gland but perhaps reduction in function as the active acinar tissue is gradually lost

Question 18

How can Haemachromoatosis cause a dry mouth?

Answer 18

Excess storage of iron within the tissues which eventually will stop the salivary tissue from being able to function

Question 19

How can Amyloidosis cause a dry mouth?

Answer 19

Deposition of protein within the gland which prevents the gland from functioning properly

Question 20

How can radiation treatment cause a dry mouth?

Answer 20

Damage to the vascular supply to the salivary glands causing the blood supply to be gradually lost and salivary function will be lost as well
When radiotherapy stops there may be some recovery but often there is a permanent deficit

Question 21

How can Graft vs Host disease cause a dry mouth?

Answer 21

Following bone marrow transplant
Causes immune damage to the salivary gland and may over time result in inadequate salivary gland tissue for adequate production of saliva

Question 22

How do Antineoplastic drugs or radioiodine cause a dry mouth?

Answer 22

Accumulate in the salivary glands and over time will gradually kill off the acinar cells and prevent gland function

Question 23

What are some treatable causes of dry mouth?

Answer 23

Dehydration
Medicines with anti-muscarinic side effects
Medicines causing dehydration
Poor diabetes control- Type 1 or Type 2
Somatoform disorders

Question 24

What should a GDP’s management of the dry mouth be?

Answer 24

To prevent oral disease
-caries risk assessment
-candida/staphylococci awareness and reduction- low sugar diet and OHI
Maximal preventative strategy
-Diet
-Fluoride
-Treatment planning for a caries risk mouth

Question 25

What are some saliva substitute sprays?

Answer 25

Glandosane (often discourages as they have an acidic pH)
Saliva Orthana- mucin based spray

Question 26

What are some lozenge saliva substitutes?

Answer 26

Saliva orthana
SST-saliva stimulating tablets

Question 27

What are some salivary stimulants?

Answer 27

Pilocarpine (salagen)
Increased residual gland function

Question 28

How can you deal with excess saliva?

Answer 28

Drugs to reduce salivation
–Anti-muscarinic agents
–Botox to prevent gland stimulation
Biofeedback training (in stroke patients)
Surgery to salivary system
–Gland removal
–Duct repositioning