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Surgery M4 part 1 > Salivary glands & diseases > Flashcards

Salivary glands & diseases Flashcards

1
Q

Where the the largest salivary gland situated?

A

The parotid gland is situated below the acoustic meatus

between the ramus of mandible & sternomastoid muscle

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2
Q

The deep cervical fascia is deficient at which part of the parotid gland?

A

deep cervical fascia forms parotid capsule that is deficient at the upper part

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3
Q

What part of the parotid gland lies over the posterior part of the ramus of the mandible?

A

superficial part

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4
Q

What part of the parotid gland lies behind the mandible & medial pterygoid muscle?

A

deep part (in relation to mastoid & styloid process)

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5
Q

what is the accessory parotid gland?

A

prolongation of the gland along the parotid duct

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6
Q

What are the structures that pass within the parotid gland?

A
  • external carotid artery (with terminations maxillary & superficial temporal arteries)
  • retromandibular vein (with terminations maxillary & superficial temporal veins)
  • facial nerve & its branches (temporal, zygomatic, buccal, mandibular, cervical)
  • intra-parotid lymph nodes
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7
Q

What are the branches of the facial nerve & what do they supply?

A

MOTOR NERVES

  • temporal -> auricularis anterior -> superficial part of frontalis
  • zygomatic -> frontalis -> orbicularis oculi
  • buccal -> buccinator -> elevators of lip
  • mandibular -> lower lip muscles
  • cervical -> platysma
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8
Q

What is the duct of the parotid gland called?

A

STENSEN’S DUCT

  • begins at angle of mandible
  • runs over masseter
  • passes through buccinator
  • opens into oral mucosa OPPOSITE TO THE CROWN OF UPPER SECOND MOLAR TOOTH
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9
Q

What is the blood supply & drainage of the parotid gland?

A

external carotid artery

- internal jugular vein

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10
Q

What is the nerve supply of the parotid gland?

A

PARASYMPATHETIC: secretomotor from AURICULOTEMPMORAL NERVE

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11
Q

What is the nerve supply of the parotid gland?

A

PARASYMPATHETIC: secretomotor from AURICULOTEMPORAL NERVE (from mandibular division of trigeminal)

SYMPATHETIC: vasomotor from PLEXUS AROUND EXTERNAL CAROTID ARTERY

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12
Q

Where is the submandibular gland located?

A

in the anterior part of the digastric TRIANGLE

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13
Q

Which part of submandibular gland lies in the submandibular triangle?

A

Superficial part: between the two bellies of the digastric muscle (superficial to mylohyoid & hyoglossus)

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14
Q

which part of the submandibular gland lies in the floor of the mouth deep to the mylohyoid?

A

deep part

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15
Q

What is the blood supply & venous drainage of the submandibular gland?

A
  • FACIAL ARTERY

- anterior facial vein

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16
Q

What is the name of the submandibular duct?

A

WHARTON’S DUCT

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17
Q

What are the important structures related to the submandibular glands?

A
  • LINGUAL NERVE (triple relation) -> related to Wharton’s duct
  • submandibular gangilion (upper pole of gland)
  • HYPOGLOSSAL NERVE -> deep to gland
  • FACIAL ARTERY (double relation) -> enters gland from posterior & deep surface crosses lower border of mandible to enter face
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18
Q

Where do the sublingual glands drain?

A

directly into mucosa or through a duct which drains into submandibular duct called BARTHOLIN DUCT

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19
Q

What is Sialorrhoea & what is its cause?

A 
increased salivary flow 
due to: 
- drugs 
- cerebral palsy 
- physically handicapped person
- children 
- psychiatry patients
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20
Q

What is Xerostomia & what are its causes?

A 
decreased salivary flow 
due to:
- post-menopause 
- depression 
- dehydration
- use of anti-depressant drugs
- anticholinergic drugs 
- Sjogren's syndrome 
- radiotherapy to head & neck
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21
Q

What are the causes of acute sialadenitis?

A

STASIS -> dehydration & reduced salivary flow
-> obstruction of duct by stone or stricture

lack of oral hygiene

after major surgery, radiotherapy for oral malignancies

infection -> staph
-> mumps (common in parotid)

22
Q

What are the 2 presentations of acute sialedenitis?

A

1- acute submandbular sialadenitis

2- parotid abscess (acute suppurative parotitis)

23
Q

What is the presentation of acute submandibular sialedenitis?

A
  • fever & toxemia
  • pain, swelling, tenderness in submandibular region
  • duct is inflamed & swollen
24
Q

What is the presentation of a parotid abscess?

A
  • severe agonizing pain
  • pyrexia, malaise, & trismus
  • tender lymph nodes in the neck
  • bacteremia if severe
  • PUS or CLOUDY TURBID SALIVA expressed from parotid duct opening
25
Q

What is the first line of investigation in case of acute sialedenitis?

A
  • neck & parotid ultrasound
26
Q

What investigations should be performed incase of acute sialedenitis?

A
  • neck & parotid ultrasound
  • needle aspiration from the abscess (to confirm formation of pus)
  • Sialogram is CONTRAINDICATED in acute phase (will cause retrograde infection leading to bacteremia)
27
Q

How should the approach of treatment be decided?

A

before or after suppuration

BEFORE -> conservative
AFTER -> surgery (incise & drain)

28
Q

What are the causes of acute parotitis?

A
  • mumps (self limiting painful parotid enlargement with fever)
  • staph aureus
  • endemic: parasitic infestation & protein malnutrition (bilateral parotid enlargement)
  • Sjogren’s syndrome (bilateral parotitis)
  • allergic, HIV, radiotherapy, syphilis
29
Q

What is the most important factor in developing chronic sialadenitis?

A

presence of stone

30
Q

What are the symptoms of chronic sialedenitis?

A
  • pain & swelling below the mandible (increases with meals)

- pain radiates to tongue (irritation of lingual nerve)

31
Q

What are the signs that confirm chronic sialedenitis?

A
  • salivary colic: induced by meals & lemon juice
  • increased salivary secretions during mastication causes increased size of gland
  • Firm & tender swelling is palpable bidigitally & can’t be rolled
  • stone is palpable in the floor of the mouth with inflammation & pus
  • Lingual colic: irritation of lingual nerve causes referred pain in the tongue
32
Q

What is the DD of chronic sialedenitis?

A
  • submandibular lymphadenitis

- salivary neoplasm

33
Q

What investigations should be preformed to confirm diagnosis of chronic sialedenitis?

A
  • intra oral X-ray (dental occlusion films) to see stones
  • ultrasound
  • FNAC of the gland to rule out other pathology
34
Q

How should chronic sialedenitis be treated?

A

NO STONE: conservative

STONE: submandibular sialedectomy

35
Q

What are the indications of submamndibular sialedectomy

A
  • presence of stones
  • presence of tumor
  • recurrent severe condition
36
Q

What divides the submandibular gland into 2 parts?

A

mylohyoid muscle

37
Q

Where does salivary calculus most commonly occur?

A

in submandibular gland

  • due to its anatomy (against gravity)
  • because it has mucinous secretions
  • opening lies in the floor of the mouth so it gets obstructed by food particles
38
Q

What are the causes of salivary calculus?

A
  • stasis

- infection (nucleus, exudate for sticking food particles, change saliva PH)

39
Q

What are the complications of salivary calculus?

A
  • sialadenitis
  • sialectasis
  • fistula
40
Q

What investigations should be done for salivary calculus?

A
  • x-ray -> stones
  • ultrasound -> chronicity
  • Sialography
41
Q

How is the treatment of salivary calculus decided?

A

according to the site of the stone:

in DUCT: extraction from oral cavity
In GLAND: submandibular sialadenectomy OR superficial conservative parotidectomy

42
Q

What is sialosis?

A

enlargement of salivary gland due to fatty infiltration

bilateral diffuse enlargement of parotid glands

43
Q

aspetic dilatation of salivary ductules cause grape-like dilatations is known as?

A

Sialectasis

44
Q

What are the causes of sialectasis?

A
  • childhood type: familial

- adult type: secondary to Sjogren syndrome OR jobs that require chronic increase in intraoral pressure

45
Q

What is the clinical picture of sialectasis?

A
  • painless smooth, soft swelling
  • increases in size during mastication
  • repeated attacks of infection
46
Q

What investigation is diagnostic incase of sialectasis? How should it be treated?

A

SIALOGRAM: shows grape-cluster like dilatations

  • treat conservatively but excision can be done in complicated cases
47
Q

What are the causes of a parotid fistula?

A
  • after drainage or rupture of parotid abscess
  • after superficial parotidectomy
  • after biopsy or trauma
  • malignancy
48
Q

What are the clinical features of a parotid fistula?

A
  • discharging fistula in parotid region with increased discharge during eating
  • tenderness, induration, & trismus
49
Q

What investigations should be performed for diagnosis of parotid fistula?

A
  • sialography: to find out origin of fistula (from duct opening)
  • CT fistulogram: from fistula opening
  • discharge study
  • mri
50
Q

How should a parotid fistula be treated?

A
  • Anticholinergics: decrease discharge
  • radiotherapy: destroy acini
  • surgical repair
51
Q

What is Sjogren’s syndrome?

A

autoimmune disorder typically occurring in women where immune cells attack exocrine glands (salivary & lacrimal glands)
resulting in KERATOCONJUCTIVITIS SICCA (dry eyes) & XEROSTOMIA (dry mouth)

52
Q

What are the types of Sjogren’s syndrome?

A

PRIMARY
- not associated with connective tissue disorders

SECONDARY

  • associated with connective tissue disorders like
    • Primary biliary cirrhosis, SLE, & rheumatoid arthritis

Surgery M4 part 1 (47 decks)

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