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!)
What does blood test show in pt with sjogren’s syndrome?
Increased:
- ESR
- Anti-RO and Anti-La antinuclear antibodies
- Rheumatoid factor
What is Schirmer test?
Blotting paper test for tear production <5mm/5 mins
What is the management for sjogren’s syndrome?
Salivary gland damage is irreversible
- Symptomatic relief
- Saliva stimulants (pilocarpine- stimulates saliva but side effects, artificial saliva substitutes)
- Caries control
- Management of oral infection and candidiasis
- Regular parotid gland exam
- Ophthalmology
- Rheumatology
What are symptoms of benign salivary gland tumours?
Slowly enlarging symptomless lump (unless impinging)
What are symptoms of malignant salivary gland tumours?
- Rapid enlargement
- Pain
- Bone destruction
- Trismus
- Facial paralysis
- Ulceration
What are some benign salivary gland tumours?
- Pleomorphic salivary adenoma
- Adenolymphoma
- Adenoma
Where are salivary gland tumours most common and which are most likely to be malignant?
75% parotid (80% benign- of these 80% PSA)
15% submandibular gland (60% benign- of these 95% PSA)
10% minor salivary glands (40% benign)
What are examples of malignant salivary gland tumours?
- Mucoepidermoid carcinoma
- Acinic cell carcinoma
- Adenoid cystic carcinoma
- Adenocarcinoma
- Carcinoma ex PSA
What are signs/symptoms of pleomorphic salivary adenoma?
- Benign but can occasionally undergo malignant change
- ‘Mixed Tumour’ arising from duct epithelium or myoepithelial cells
- Rubbery, lobulated swellings, slowly grow to great size
- Removing PSA from parotid gland puts facial nerve at risk.
- More common in females
- Incomplete capsule
- Squamous metaplasia & keratin foci
What are adenoid cystic carcinomas?
- Slow growing malignant tumour with late metastases
- Characteristic cribriform or swiss cheese histological appearance
- Bony invasion and infiltration along nerve sheaths
What is papillary obstruction caused by?
Denture clasp or tooth can cause trauma to stensons duct papilla. Can lead to duct stricture
If a pt comes in with swelling around angle of md what could it be?
- Ameloblastoma
- Parotid tumour (tends to raise the lobe of the ear)
Where does accessory parotid gland lie?
Sits along parotid duct (swelling would be more prominent in cheek/buccinator)
What type of saliva come from the salivary glands?
Parotid: seroud
Submandibular: mixed- mainly serous
Sublingual: mainly mucous
Where are most minor salivary glands present?
Vault of palate
Tongue
Lips
What is sialosis?
- Non-neoplastic and non-inflammatory enlargement of salivary glands.
- Lack of function
- Can arise in patients with eating disorders, diabetes or HIV.
What is the most common recurrent salivary gland swelling?
Sialolithiasis/salivary calculi
What could bilateral parotid gland swelling also look like?
Larger underlying md bone (ramus and angle)
Bilateral masseter hypertrophy
