salivary glands swelling and enlargment Flashcards
3 reasons why saliva glands can change in size
viral inflammation - mumps; HIV
secretion retention - mucocele; duct obstruction
gland hyperplasia - sialosis; sjorgrens syndrome
symptoms of mumps
8
- Headache
- Joint pain
- Nausea
- Dry mouth
- Mild abdominal pain
- Feeling tired
- loss of appetite
- Pyrexia of 38oC, or above
mumps
viral characteristics
Paramyxovirus
Droplet spread
Incubation 2-3 weeks
1/3 have no symptoms
Symptomatic treatment only
HIV salivary gland disease
Cause of Unexplained salivary swelling
* May have NO HIV symptoms when presenting
Generally does not improve with treatment
Lympho-proliferative enlargement of the glands
what are subacute obstructions
Swelling associated with meals
* increases as salivary flow starts
* reduces when salivary flow stops
Usually SUBMANDIBULAR occ. Parotid
Can be slowly progressive – over weeks
Eventually fixed & painful
cause of subacute obstructions
duct obstruction
* Usually duct blockage in submandibular
* Usually duct stricture in parotid
subacute obstructions aetiology causes
3
- Sialolith (stones)
- ‘mucous’ plugging – like eraser texture, sticky
- Ductal damage from chronic infection (scarring due to back pressure build up)
investigations for subacute obstructions
5
Low dose plain radiography
lower true occlusal
SIALOGRAPHY – when infection free
* Can loosen and remove a mucous plug, if no stone detected and infection free
Isotope scan if gland function uncertain
ultrasound assessment of duct ystem
do sialoliths always need intervention
no
can be asymptomatic incidental findsing
can pass by themselevs with time - even when large
duct stricture
what is it
how to tx
Due to damage over several years due to chronic low grade infection
can dilate gland using balloon
duc dilatation
what is it
how to tx
Defect prevents normal emptying
Micro-organisms grow and lead to persisting and recurrent sialadenits
Gland function gradually lost and persisting infection leads to gland removal
* May follow Recurrent Parotitis of Childhood at age 20-30
* Low grade damage over many years
Chronic Non-Specific Sialadenitis
histology in Chronic Non-Specific Sialadenitis
Ductal acinar loss and replaced with fibrous scar tissue in non-specific sialadenitis
causes ductal dilatation
management of subacture obstruction
3
- Surgical sialolith removal if practical
- Sialography for ‘no stone’ cases – washing effect
- Consider gland removal if fixed swelling and no obvious cause for obstruction found
outcome of subacute obstructions
3
Reformation of stone/obstruction
Deformity of duct – stasis & infection
Gland damage – low salivary flow, ascending infection
2 causes of inc in gland tissue (hyperplasia)
sialosis
sjogrens syndrome
can be bilateral or unilateral (less common)
sialosis
Major gland enlargement
Persistent and unexplained enlargement of 1 or more major salivary glands
* Dx of exclusion
No identified cause
* Alcohol abuse
* Cirrhosis
* Diabetes Mellitus
* Drugs
investigations for sialosis
Blood tests
* Glucose
* FBC, U&Es, LFTs, bilirubin
* BBV screen – HIV, Hep B, Hep C
* AutoAntibody Screen
* ANA, anti-Ro, anti-La
MRI of major salivary glands
USS for Sjögren’s changes
Labial gland biopsy
Tear film
Sialography – occasionally
Photography
presentation of sialosis
Bilateral, whole salivary gland enlargement
Generalise diffuse change
Hyperplasia of the tissue
Biopsy shows normal tissue
Not painful itself – but stretching of parotid capsule can cause discomfort (like mumps)
