Salivary Glands

Question 1

What are the major salivary glands?

Answer 1

Submandibular Sublingual Parotid

Question 2

How to examine the salivary glands?

Answer 2

External swellings
Palpate for stones
Test facial nerve unction
Site, size, shape, colour, contour, consistence, temperature, transilluminate, tenderness, fluctuant, fixed

Assess surrounding skin and mucosa

Question 3

What is sialadenitis? Symptoms? Mx?

Answer 3

Acute infection of the submandibular or parotid glands (Staph aureus)
Usually occurs in elderly or debilitated patients who may be dehydrated and have poor oral hygiene

Painful diffuse swelling of gland + fever
Pressure applied over the gland may lead to pus leaking out of the duct
Pain and swelling on eating (Stone)

Antibiotics and good oral hygeine
Surgical drainage may be required

Recurrent attacks may occur due to strictures or salivary gland stones

Question 4

What are sialolithiasis? Where? Clinical features? Investigation? Mx?

Answer 4

Stones affecting usually submandibular gland where secretions are richer in calcium and thicker

Recurrent unilateral pain and tense swelling of gland during/after meals
Stone may be palpable in flow of the mouth

Plain x-ray

Small stones may pass spontaneously - sialogouges (lemon drops which stimulate salivation) may help
Larger stones may need surgical removal

Question 5

What other conditions cause inflammation of the salivary glands?

Answer 5

Sjogrens - may cause diffuse enlargement of parotid, xerostomia

HIV infection/mumps - may cause bilateral multicystical swelling of parotid or submandibular glands

Ganulomatous diseases - TB, sarcoidosis - parotid involvement, bilateral, non-tender, xerostomia

Question 6

What are most salivary gland tumours?

Answer 6

Benign pleomorphic adenomas in the superficial lobe of the parotid gland

Question 7

What are risk factors for malignancy? What symptoms suggest malignancy?

Answer 7

Radiation to neck
Smoking

Hard, fixed mass ± pain
Overlying skin ulceration
Local lymph node enlargement

Associated facial nerve palsy

Question 8

How can you differentiate tumours from salivary stone inflammation?

Answer 8

Tumours do not vary in size when earring

Question 9

Criteria for referral in salivary gland tumour?

Answer 9

Refer all with an unexplained persistent salivary gland swelling or any unexplained lump in the neck

Question 10

What investigation in salivary galen swelling?

Answer 10

US
MRI
Fine needle aspirate cytology
CT guided biopsy

Question 11

What is pleomorphic adenoma?

Answer 11

Slow growing benign tumour occurring in middle age that may turn malignant if present for many years

Painless lump

Most common parotid neoplasm
Diagnosed by FNAC

Appropriate excision to treat - superficial parotidectomy - watch the facial nerve

Question 12

What is Warthin tumour?

Answer 12

Adenolymphoma

Usually occur in elderly men
Most commonly in the parotid gland

Bilateral benign neoplasm

Softer, more mobile and fluctuant

Treated with partial parotidectomy

Question 13

What should you consider in parotid mass in children < 1 year old?

Answer 13

Haemangioma
90% of parotid tumours in children less that 1
Hypervascular on imaging
Spontaneous regression may occur

Question 14

Describe mucoepidermoid carcinoma. Mx?

Answer 14

30% of all parotid malignancy
Usually low potential for local invasiveness and metastasis

Aggressive high-grade tumours require excision and radiotherapy
Low grade tumours just excision

Question 15

Describe adenoid cystic tumour

Answer 15

Painful slow-growing tumours that tend to spread along the nerves (perineural spread) + distal metastases and late recurrence

Nerve growth may display skip lesions resulting in incomplete excision

Question 16

Describe adenocarcinoma

Answer 16

Develops from secretory portion of gland

Risk of regional and distant metastasis

Question 17

Describe lymphoma

Answer 17

Large rubbery lesions may occur in association with Warthins tumour
Diagnosis made based on regional node biopsy rather than parotid resection

Chemotherapy and radiotherapy

Question 18

What is management of benign disease? Malignant disease?

Answer 18

For benign disease this will usually consist of a superficial parotidectomy.

For malignant disease a radical or extended radical parotidectomy is performed.
The facial nerve is included in the resection if involved.
The need for neck dissection is determined by the potential for nodal involvement.

Question 19

What are signs of xerostomia?

Answer 19

Dry, atrophic, fissured oral mucosa
Discomfort, causing difficulty earring, speaking and wearing dentures
No saliva pooling in floor of mouth
Difficulty in expressing saliva from major ducts

Question 20

What are complications of xerostomia?

Answer 20

Dental caries

Candida infection

Question 21

What are causes of xerostomia?

Answer 21

Hypnotics and tricyclics
Antipsychotics
Beta blockers
Diuretics
Mouth breathing
Dehydration
ENT radiotherapy
Sjogren's
SLE
Sarcoidosis
HIV/AIDS
Parotid stones

Question 22

What is management of xerostomia?

Answer 22

Increase oral fluids - frequent sips
Good dental hygiene: no acidic drinks or foods
Saliva substitutes

Question 23

What does seating when earring indicate?

Answer 23

Parotid damage causing damage to trigeminal nerve which sends parasympathetic fibres to parotid and sympathetic fibres to facial sweat glands

During resprouting after injury, fibres switch course to cause gustatory sweating.

Frey’s syndrome
Brith trauma
Parotid surgery complication