SG Swellings and Enlargement Flashcards
What causes changes in Gland size?
- Viral Inflammation
- Mumps
- HIV - Secretion retention
- Mucocele
- Duct obstruction of larger SG - Gland hyperplasia
- Sialosis
- Sjogrens Syndrome
Mumps infection
- MMR vaccine will protect most people against the virus
What do Mumps pts complain of?
- sore headache
- joint pain
- nausea
- dry mouth
- mild abdominal pain
- feeling tired
- loss of appetite
- pyrexia of 38C or above
- paramyxovirus
- droplet spread with incubation 2-3 weeks
- 1/3 have no symptoms
- symptomatic relief only
HIV Salivary Disease
- HIV can be a cause of salivary swelling
- cause of unexplained SS
- may have no HIV symptoms when presenting
- does not improve with tx
- Lympho- proliferative enlargement of glands
Differences in Mumps
- will find symptoms such as pyrexia and abdominal changes in adults with mumps
Tx for a child with Mumps
- symptomatic only
- no actual antiviral care
- analgesics to reduce painful symptoms
- reduce temp with fluid intake
- within a week, will recover
Mucocele
- due to obstruction of minor gland
- definition: swelling in the mucosa filled with saliva
- either within ductal system, a mucous retention cyst/ spit out into tissues from ruptured duct (mucous extrasavation cyst)
- commonly found in areas of trauma, ie: lower lip and soft palate
- recurrent swelling
- will burst in days; pressure within ductal system causes rupturing and glands will shrink back in size
- ‘salty’ taste
- do not require any tx
- if lesions become fixed in size, then may needd orla surgeons to remove mucocele by removing extravasated mucus/ mucus within the duct together with underlying gland
Major gland obstruction (Subacute obstruction)
- usually happen in submandibular gland as ductal pathway is longer
- associated with blockage within the duct, either by stones/ mucus plugging
- complain of swelling of glands associated with meals; increase as SF increases; meal pass, stimulation drops, and then swelling will reduce
- progressive over several weeks
- peak at mealtimes; eventually become fixed and saliva cannot escape due to duct obstruction
1. duct blockage in submandibular
2. duct stricture in parotid
Stones within submandibular duct
True occlusal films
- taken in reduced exposure as calcium content of salivary stones are low
- will not show if true occlusal radiation exposure is permitted
Cause
- Sialolith (stones)
- mucous plugging
- ductal damage from chronic infection (scarring)
Investigations for MSG obstruction
- low dose plain radiography
- lower true occlusal
- sialography when infection is free
- isotope scan if gland function is uncertain
- ultrasound assessment of duct system
Stones
- do not always happen in ductal system, sometimes happen within the gland
- submandibular gland stone
- if no symptoms, then leave it
Duct Stricture
- when there is damage of infection in the duct
- more tx options, ie: stretching of gland using balloon catheters
Duct Dilatation
- sausage like apperance
- defect prevents normal emptying
- micro-organisms grow and lead to persisting and recurrent sialadenitis
- gland function gradually lost and persisting infection leads to gland removal
- no particular tx, normally is to remove glands
Management of Subacute Obstruction
- surgical sialolith removal if practical
- sialography for no stone cases - washing effect
- gland removal if fixed swelling
Outcome of management
- reformation of stone/ obstruction
- deformity of duct - stasis/ infection
- gland damage- low salivary flow, ascending infection
Other changes in Gland size
Hyperplasia - increase in gland tissue
1. Sialosis
2. Sjogrens syndrome
Investigating sialosis
