Surgical Considerations for Salivary Pathologies Flashcards
We produce _____ of saliva daily
500-1500ml
Viscosity of Parotid secretions
watery
Viscosity of Submandibular
Semiviscous
Viscosity of Sublingual
Viscous
Viscosity of Minor glands
Viscous
Which gland produces the most saliva daily?
Submandibular
Surgical concerns by parotid gland
Facial nerve, mastoid
Surgical concerns in Submandibular gland
Marginal mandibular nerve, lingual nerve, hypoglossal nerve, facial artery
Surgical concerns in sublingual gland
Lingual nerve, submandibular duct
Surgical concerns in minor salivary glands
Dependent on location, oral cavity, pharyngeal, sinus/skull base
Acute sialadenitis most commonly
Parotitis
Chronic sialadenitis most commonly occurs in
Submandibular gland due to position of gland
Risk factors of sialadenitis
dehydration, immobility, immunocompromised state
Acute tx of sialadenitis
antibiotics and gland massage
Surgical intervention reserved for acute infections with
abscess
Salivary stones most common in
Submandibular gland
Salivary stones are made up of
Calcium phosphate+glycoproteins/mucopolysaccharides
Salivary stone clinically present as
recurring episodes of swelling and pain associated with meals
Imaging for salivary stones
CT, MRI, Ultrasound
_____ stones may be radiolucent on xray
Parotid
MRI sialography used more often than ____
digital
Stone tx
- small stones may be expressed by palpation
- transoral: <2 cm from Wharton’s duct (do not need to close), Parotid stones medial to masseter (stenting often required due to stenosis
- Larger, proximal stones require gland removal
Useful technique for chronic sialoadenitis and small stones.
Sialoendoscopy
Size of stone scopes
0.8-1.6mm
Techniques for stone scopes
- Irrigation of gland
- Steroid irrigation
- Stricture dilation
- Basket retrieval
- Drills/Laser
Pseudocyst arising from sublingual gland extending into submandibular space via defect in mylohyoid
Plunging ranula
Plunging ranula tx
Transoral resection of sublingual gland (Avoid transcervical approach)
Parotid tumors are
75% benign
Most common parotid salivary gland tumor
pleomorphic adenoma
T or F: Increasing incidence of malignancy with decreasing gland size
T (85% of minor salivary gland tumors are malignant)
Salivary tumors are
slow-growing and painless
_____ suggest malignancy
pain, numbness, nerve weakness
Fine needle aspiration has a ___ false negative rate
5%
Incision for parotidectomy
Modified Blair or Facelift incision
Parotidectomy can cause facial nerve injury and is permanent in ___ of cases
4%
Parotidectomy may cause
greater auricular nerve injury, salivary fistula, Frey’s syndrome and first bite syndrome.
Frey’s syndrome happens in 35-60% of cases and is
gustatory sweating
Encapsulated, 25% with pseudopodia or satellite lesions, 10-12 % isolated deep lobe/parapharyngeal tumors
Pleomorphic adenoma
Need to take a cuff of parotid tissue. Tissue spillage may lead to recurrence years later.
Pleomorphic adenoma
1.5% malignant transformation at 5 years (10% if >15 years)
Pleomorphic adenoma
Bilateral, multifocal with no malignant potential
Warthin’s tumors
___ are suspected is deep to retromandibular vein on CT
Deep lobe tumors
Transparotid approach of deep lobe tumors
High incidence of neuropraxia, often able to spare superficial lobe for facial contour, higher incidence of first bite syndrome
Facial nerve grafts grow about ___ per day
1mm
Management of eye lip with
lateral tarsal strip
Painless facial paralysis over 48-72 hours
Bell’s palsy
Facial paralysis with parotid tumor
Malignancy
Careful dissection around tumor with cuff of normal parotid without facial nerve identification.
Extracapsular dissection
Safe submandibular gland removal involves protection of the ____ and _____
marginal mandibular nerve, lingual nerve
In parotidectomy, every effort should be made to preserve the ____ nerve, even in malignancy
facial
____ nerve weakness signals malignanct
facial
In cases of skull base proximity or perineural invasion, ____________consultation is necessary.
neurotologic and/or neurosurgical
Minor salivary gland malignancy may occur anywhere in the upper aerodigestive tract and is treated with _____
complete surgical resection
Neck dissection is recommended for
high grade histologies, clinically positive nodes, and advanced T stage
Multidisciplinary care is often needed for treatment of
Salivary cancers
small stones may be treated with
trans-oral cut-down or sialadenoscopy
Larger, intraglandular stones require _____ of the gland
removal
Plunging ranula is treated by _____ of the sublingual gland transorally, despite the location of the pseudocyst in the submandibular triangle
resection
