Week 5 Thomson- Salivary Gland Disorders Flashcards
Where does the submandibular gland lie?
Submandibular gland is in submandibular triangle and hugs back of mylohyoid muscle. Deep part of submandibular gland is in the back of mouth. Wharton’s duct runs over/through sublingual gland and opens in anterior FOM.
What can swellings on palate or lip possibly be?
Minor salivary gland swellings or tumours
What are the contributions of saliva from each saliva gland?
75% submandibular gland
25% parotid gland
5% sublingual gland
5% Sublingual Gland
How much saliva is produced per day?
1-1.5L/day
What are the resting and stimulated saliva flow rates?
Resting SFR: 0.25ml/L
Stimulated SFR: 1ml/min
What is xerostomia?
Subjective sensation of dry mouth
What are signs/symptoms with xerostomia? Who is most likely affected?
- Females / Elderly
- Difficulty in Chewing & Swallowing
- Erythematous & Atrophic Oral Mucosa
- Lobulation & Depapillation of Tongue
- Dental Caries
- Oral Candidiasis / Angular Cheilitis
What are examples of primary salivary gland pathology?
- Aplasia
- Excision/irradiation
- Infection/obstruction
- Sjogren’s syndrome
- Sarcoid
- HIV
- Cystic fibrosis
- Primary Biliary Cirrhosis
What are secondary (systemic disease) causes of xerostomia?
- Fluid/electrolyte imbalance
- Neurological
- Anxiety
- Drug therapy
What are drug therapies that can cause xerostomia?
- Antihistamines
- Antidepressants
- Antipsychotics
- Anti-cholinergics
- Diuretics
- Narcotics
What are non-neoplastic causes of salivary gland disease?
- Developmental
- Obstructive
- Inflammation
- Trauma
- Ischaemia
- Infections
- Autoimmune
- Sialosis
What are symptoms of mumps?
- Sudden parotid swelling, ear lob lift up
- Painful
- Bilateral swelling of submandibular glands
- Orchitis (testicular swelling)
- Most commonly caused by paramyxovirus
What are acute inflammatory salivary gland swellings?
Acute sialadenitis
- Viral (mumps)
- Suppurative
- Granulomatous
What are recurrent salivary gland swellings?
- Salivary Calculi
- Papillary obstruction (acute ulcerative or chronic fibrosis)
- Duct stricture
- Punctate sialectasis
What is duct stricture?
Following papillary obstruction (irritation from denture clasp or tooth etc) there can be narrowing of the salivary duct with scarring.
What are characteristics of punctate sialectasis?
- Swollen submandibular glands
- Damage to acinar structure of salivary gland
- Can develop recurrent mumps infections
- Snow storm appearance
What are persistent diffuse salivary gland enlargements?
- Sjogren’s syndrome
- Sialosis
- Sarcoidosis (infiltration with proteins and granulomatous tissue)
What are salivary disease nodular enlargements?
- Neoplasm (parotid tumour)
- Lymph node
- Cyst
What is Primary Sjogren’s Syndrome (sicca syndrome)?
Salivary and lacrimal glands affected
What is secondary sjogren’s syndrome?
- Salivary + lacrimal glands + connective tissue/autoimmune disease
- Rheumatoid arthritis or systemic lupous erythematous
What is sjogren’s syndrome?
Chronic multisystem autoimmune exocrinopathy commonly found in middle aged/elderly females.
Body reacts against exocrine glands. Long term syndrome
What are symptoms of sjogrens syndrome?
- Persistent xerostomia
- Persistent xerophthalmia (dry, gritty eyes, keratoconjunctivitis)
- Salivary and lacrimal gland enlargement
- Parotitis
- Bilateral parotid gland swelling
What are investigations for sjogren’s syndrome?
Unstimulated total SFR <1.5ml in 15 mins
Imaging- sialography
Labial gland biopsy- punctate sialectasis (snow storm appearance)
Blood tests
Schirmir test
What does labial gland biopsy histopathology show in pt with sjogren’s syndrome?
- Focal lymphocytic infiltrate replaces salivary acini
- Acinar atrophy and destruction
- Risk of lymphoma (rubbery hard nodules- look out for these!)
