Salivary Glands and Non-neoplastic Neck Swellings

Question 1

Which are the major salivary glands?

Answer 1

Parotid

Submandibular

Sublingual

Question 2

Describe the anatomy of the parotid gland?

Answer 2

Wedge shape organ invested by fascia

Divided artificially by plane of VII nerve into superficial lobe (80%) and deep lobes (20%)

Situated just in front of the ear.

Structures within the gland: facial nerve and its 5 branches (temporal, zygomatic, buccal, mandibular and cervical). Retromandibular vein, External carotid aa dividing into terminal superficial temporal and maxillary aa.

Question 3

What are the causes of non neoplastic causes of swellings around the oral cavity?

(Glands, muscles, dental, bones, nodes)

Answer 3

Lympathendopathy

Parotitis

Hypertrophy of the masseter

Sebaceous cysts

Dental infections

Mastoiditis causing a abscess

Question 4

What are the different forms of Parotitis and treatments?

Answer 4

Viral: Mumps, treat with analgesia and hydration. HIV, causes a diffuse enlargement.

Bacterial: Staphylococcal infection. TB

Fungal: Candidiasis in immunocompromised (rare)

Other: Iatrogenic (drugs) Sarcoidosis

Question 5

What is sialectasis?

Answer 5

Sialectasis is a cystic dilatation of a salivary gland. It is usually caused by the formation of a stricture. Necrosis & stenosis also occurs

Presents with diffuse swelling of salivary gland

Question 6

What is sjögren’s syndrome, what are the common symptoms?

Answer 6

Sjogren’s syndrome is thought to be an autoimmune disease in which there is a lymphocytic inflitration of exocrine glands specifically, salivary and lacriminal glands.

Therefore the common symptoms are dry eyes and dry mouth. (xeropthalmia and xerostomia).

Other symptoms include keratoconjunctivitis, glossitis, stomatitis (inflammation of the mucous membrane of the mouth) and dry vagina. Parotid gland enlargement.

Question 7

What is the difference between primary and secondary sjögrens?

Answer 7

Primary is when Sjögrens is in the absence of another autoimmune disease.

Secondary is when the patient is also suffering from another AI disease such as SLE, RA,or scleroderma.

Question 8

What are the major risks associated with Sjogrens?

Answer 8

1 in 6 will develop Non hodgkins lymphoma.

Risk is further increased if patient has parotid gland enlargement. Also associated with lymphoblastic sarcoma.

Question 9

What is the treatment for Sjorgrens?

Answer 9

Artificial tears, saliva and lubricants for symptoms.

Steroids for parotid swelling.

Parotidectomy if rapid growth.

Question 10

What is a branchial cyst and where is it likely to arise?

Age?

Answer 10

A branchial cyst is a congenital epithelial cyst which arises in the lateral part of the neck due to failure of the obliteration of the second branchial cleft in embryonic development.

Child/young adult

Question 11

What is a thyroglossal cyst?

Answer 11

A thyroglossal cyst is a cyst which is formed from the thyroglossal duct which usually atrophises during development. They usually occur in the midline of the neck they will move up with swallowing and when the tounge is protruded.

Question 12

What are the different causes of thyroid masses?

Answer 12

• Non-toxic (simple) goitre - non-functioning nodules. TFTs are normal.
• Toxic multinodular goitre - functioning nodules. Abnormal TFTs.
• Graves’ disease - diffusely enlarged overactive thyroid gland.
• Hashimoto’s thyroiditis - autoimmune destruction of the gland may cause diffuse enlargement.
• Retrosternal goitre (usually multinodular).
• Hyperplastic nodule (single nodule or part of multinodular goitre).
• Colloid nodule goitre. (adenomatous non toxic goitre)
• Thyroid cyst.
• Thyroid adenoma.
• Thyroid carcinoma.