Salivary Glands Flashcards
What are the major salivary glands?
Submandibular Sublingual Parotid
How to examine the salivary glands?
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
What is sialadenitis? Symptoms? Mx?
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
What are sialolithiasis? Where? Clinical features? Investigation? Mx?
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
What other conditions cause inflammation of the salivary glands?
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
What are most salivary gland tumours?
Benign pleomorphic adenomas in the superficial lobe of the parotid gland
What are risk factors for malignancy? What symptoms suggest malignancy?
Radiation to neck
Smoking
Hard, fixed mass ± pain
Overlying skin ulceration
Local lymph node enlargement
Associated facial nerve palsy
How can you differentiate tumours from salivary stone inflammation?
Tumours do not vary in size when earring
Criteria for referral in salivary gland tumour?
Refer all with an unexplained persistent salivary gland swelling or any unexplained lump in the neck
What investigation in salivary galen swelling?
US
MRI
Fine needle aspirate cytology
CT guided biopsy
What is pleomorphic adenoma?
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
What is Warthin tumour?
Adenolymphoma
Usually occur in elderly men
Most commonly in the parotid gland
Bilateral benign neoplasm
Softer, more mobile and fluctuant
Treated with partial parotidectomy
What should you consider in parotid mass in children < 1 year old?
Haemangioma
90% of parotid tumours in children less that 1
Hypervascular on imaging
Spontaneous regression may occur
Describe mucoepidermoid carcinoma. Mx?
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
Describe adenoid cystic tumour
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
Describe adenocarcinoma
Develops from secretory portion of gland
Risk of regional and distant metastasis
Describe lymphoma
Large rubbery lesions may occur in association with Warthins tumour
Diagnosis made based on regional node biopsy rather than parotid resection
Chemotherapy and radiotherapy
What is management of benign disease? Malignant disease?
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.
What are signs of xerostomia?
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
What are complications of xerostomia?
Dental caries
Candida infection
What are causes of xerostomia?
Hypnotics and tricyclics Antipsychotics Beta blockers Diuretics Mouth breathing Dehydration ENT radiotherapy Sjogren's SLE Sarcoidosis HIV/AIDS Parotid stones
What is management of xerostomia?
Increase oral fluids - frequent sips
Good dental hygiene: no acidic drinks or foods
Saliva substitutes
What does seating when earring indicate?
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
