Salivary glands & diseases Flashcards
Where the the largest salivary gland situated?
The parotid gland is situated below the acoustic meatus
between the ramus of mandible & sternomastoid muscle
The deep cervical fascia is deficient at which part of the parotid gland?
deep cervical fascia forms parotid capsule that is deficient at the upper part
What part of the parotid gland lies over the posterior part of the ramus of the mandible?
superficial part
What part of the parotid gland lies behind the mandible & medial pterygoid muscle?
deep part (in relation to mastoid & styloid process)
what is the accessory parotid gland?
prolongation of the gland along the parotid duct
What are the structures that pass within the parotid gland?
- 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
What are the branches of the facial nerve & what do they supply?
MOTOR NERVES
- temporal -> auricularis anterior -> superficial part of frontalis
- zygomatic -> frontalis -> orbicularis oculi
- buccal -> buccinator -> elevators of lip
- mandibular -> lower lip muscles
- cervical -> platysma
What is the duct of the parotid gland called?
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
What is the blood supply & drainage of the parotid gland?
external carotid artery
- internal jugular vein
What is the nerve supply of the parotid gland?
PARASYMPATHETIC: secretomotor from AURICULOTEMPMORAL NERVE
What is the nerve supply of the parotid gland?
PARASYMPATHETIC: secretomotor from AURICULOTEMPORAL NERVE (from mandibular division of trigeminal)
SYMPATHETIC: vasomotor from PLEXUS AROUND EXTERNAL CAROTID ARTERY
Where is the submandibular gland located?
in the anterior part of the digastric TRIANGLE
Which part of submandibular gland lies in the submandibular triangle?
Superficial part: between the two bellies of the digastric muscle (superficial to mylohyoid & hyoglossus)
which part of the submandibular gland lies in the floor of the mouth deep to the mylohyoid?
deep part
What is the blood supply & venous drainage of the submandibular gland?
- FACIAL ARTERY
- anterior facial vein
What is the name of the submandibular duct?
WHARTON’S DUCT
What are the important structures related to the submandibular glands?
- 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
Where do the sublingual glands drain?
directly into mucosa or through a duct which drains into submandibular duct called BARTHOLIN DUCT
What is Sialorrhoea & what is its cause?
increased salivary flow due to: - drugs - cerebral palsy - physically handicapped person - children - psychiatry patients
What is Xerostomia & what are its causes?
decreased salivary flow due to: - post-menopause - depression - dehydration - use of anti-depressant drugs - anticholinergic drugs - Sjogren's syndrome - radiotherapy to head & neck
What are the causes of acute sialadenitis?
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)
What are the 2 presentations of acute sialedenitis?
1- acute submandbular sialadenitis
2- parotid abscess (acute suppurative parotitis)
What is the presentation of acute submandibular sialedenitis?
- fever & toxemia
- pain, swelling, tenderness in submandibular region
- duct is inflamed & swollen
What is the presentation of a parotid abscess?
- 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
What is the first line of investigation in case of acute sialedenitis?
- neck & parotid ultrasound
What investigations should be performed incase of acute sialedenitis?
- 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)
How should the approach of treatment be decided?
before or after suppuration
BEFORE -> conservative
AFTER -> surgery (incise & drain)
What are the causes of acute parotitis?
- 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
What is the most important factor in developing chronic sialadenitis?
presence of stone
What are the symptoms of chronic sialedenitis?
- pain & swelling below the mandible (increases with meals)
- pain radiates to tongue (irritation of lingual nerve)
What are the signs that confirm chronic sialedenitis?
- 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
What is the DD of chronic sialedenitis?
- submandibular lymphadenitis
- salivary neoplasm
What investigations should be preformed to confirm diagnosis of chronic sialedenitis?
- intra oral X-ray (dental occlusion films) to see stones
- ultrasound
- FNAC of the gland to rule out other pathology
How should chronic sialedenitis be treated?
NO STONE: conservative
STONE: submandibular sialedectomy
What are the indications of submamndibular sialedectomy
- presence of stones
- presence of tumor
- recurrent severe condition
What divides the submandibular gland into 2 parts?
mylohyoid muscle
Where does salivary calculus most commonly occur?
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
What are the causes of salivary calculus?
- stasis
- infection (nucleus, exudate for sticking food particles, change saliva PH)
What are the complications of salivary calculus?
- sialadenitis
- sialectasis
- fistula
What investigations should be done for salivary calculus?
- x-ray -> stones
- ultrasound -> chronicity
- Sialography
How is the treatment of salivary calculus decided?
according to the site of the stone:
in DUCT: extraction from oral cavity
In GLAND: submandibular sialadenectomy OR superficial conservative parotidectomy
What is sialosis?
enlargement of salivary gland due to fatty infiltration
bilateral diffuse enlargement of parotid glands
aspetic dilatation of salivary ductules cause grape-like dilatations is known as?
Sialectasis
What are the causes of sialectasis?
- childhood type: familial
- adult type: secondary to Sjogren syndrome OR jobs that require chronic increase in intraoral pressure
What is the clinical picture of sialectasis?
- painless smooth, soft swelling
- increases in size during mastication
- repeated attacks of infection
What investigation is diagnostic incase of sialectasis? How should it be treated?
SIALOGRAM: shows grape-cluster like dilatations
- treat conservatively but excision can be done in complicated cases
What are the causes of a parotid fistula?
- after drainage or rupture of parotid abscess
- after superficial parotidectomy
- after biopsy or trauma
- malignancy
What are the clinical features of a parotid fistula?
- discharging fistula in parotid region with increased discharge during eating
- tenderness, induration, & trismus
What investigations should be performed for diagnosis of parotid fistula?
- sialography: to find out origin of fistula (from duct opening)
- CT fistulogram: from fistula opening
- discharge study
- mri
How should a parotid fistula be treated?
- Anticholinergics: decrease discharge
- radiotherapy: destroy acini
- surgical repair
What is Sjogren’s syndrome?
autoimmune disorder typically occurring in women where immune cells attack exocrine glands (salivary & lacrimal glands)
resulting in KERATOCONJUCTIVITIS SICCA (dry eyes) & XEROSTOMIA (dry mouth)
What are the types of Sjogren’s syndrome?
PRIMARY
- not associated with connective tissue disorders
SECONDARY
- associated with connective tissue disorders like
- Primary biliary cirrhosis, SLE, & rheumatoid arthritis
