Disorders of Salivary Glands

Question 1

What are the major salivary glands?

Answer 1

• parotid
• submandibular
• sublingual

Question 2

Describe the parotid gland

Answer 2

• largest

- anterior to the ear

Question 3

What courses through the parotid gland?

Answer 3

• CN VII (facial n.)

Question 4

What is the duct associated with the parotid gland and where does it enter the mouth?

Answer 4

• Stensen’s duct

- opposite the upper 1st and 2nd molar (inside the cheek)

Question 5

Describe the submandibular gland

Answer 5

• second largest

- anterior and inferior to the angle of the mandible

Question 6

What is the duct associated with the submandibular gland and where does it enter the mouth?

Answer 6

• Wharton’s duct

- bilaterally to the frenulum

Question 7

Describe the sublingual gland

Answer 7

• smallest (of the major salivary glands)

- inferior to the tongue (floor)

Question 8

What are some disorders of the salivary glands?

Answer 8

• xerostomia
• muicocele/ranula
• parotitis/sialadenitis
• sialolithiasis
• tumors

Question 9

What is xerostomia?

Answer 9

• dry mouth
• less than 50% salivary flow
• regardless of hydration/dehydration

Question 10

What are the signs and symptoms of xerostomia?

Answer 10

• dry mouth, lips, tongue
• difficulty chewing, swallowing, and speaking
• oral pain
• medication list

Question 11

What question should be asked in the examination for xerostomia and why?

Answer 11

• dryness in other areas of the body

- Sjogrens disease

Question 12

What will be observed in the physical exam for xerostomia?

Answer 12

• cracked/peeling lips
• pale mucosa
• smooth/red tongue with loss of papilation
• dental caries
• candidiasis
• angular cheilitis
• (+) tongue blade sign

Question 13

What is the work-up for xerostomia?

Answer 13

• check inflammatory markers if ? sjogrens

- review current rx list

Question 14

What are the 1st line treatments for xerostomia?

Answer 14

• preventative measures to prevent caries/erosion
• symptomatic (decrease risk factors)
• local salivary stimulant

Question 15

What are the 2nd line treatments for xerostomia?

Answer 15

• systemic salivary stimulation

- tx underlying dz

Question 16

What are disorders specific to the parotid gland?

Answer 16

• parotitis (sialadenitis)
• sialolithiasis
• tumors

Question 17

What do you look for on the physical exam from salivary gland enlargement?

Answer 17

• 5 cardinal signs of infection
• palpate for masses
• check openings of ducts
• dry mucous membranes
• cervical LAD (lymphadenopathy)

Question 18

What is indicative of a bacterial infection in the salivary glands?

Answer 18

• pus from Wharton’s or Stenson’s ducts

Question 19

What does decreased facial n. function with palpable salivary gland mass suggest?

Answer 19

• malignancy

Question 20

What will an XR of the salivary glands r/o?

Answer 20

• stones

Question 21

What will an US of the salivary glands assess?

Answer 21

• masses v. abscess

- stones

Question 22

What will sialography assess?

Answer 22

• stones

Question 23

What imaging should be done when a tumor is suspected?

Answer 23

• CT/MRI

Question 24

What is mumps parotitis?

Answer 24

• parotitis caused by parmyxovirus (mumps)

Question 25

When will mumps parotitis present?

Answer 25

- 4-6 y/o

Question 26

How is mumps parotitis spread?

Answer 26

- respiratory droplets

Question 27

What is the incubation period of mumps parotitis?

Answer 27

- 2-3w

Question 28

T/F: mumps parotitis has a long prodrome.

Answer 28

- False: short prodrome

Question 29

Which is the most commonly affected gland in mumps parotitis?

Answer 29

- parotid

Question 30

Describe the salivary gland enlargement in mumps parotitis

Answer 30

- sudden and painful | - worsens for 3 days then resolves in 1 w

Question 31

How is the diagnosis made of mumps parotitis?

Answer 31

- virus antibody screened by immunoassay

Question 32

What is the treatment for mumps parotitis?

Answer 32

- symptomatic

Question 33

What is bacterial parotitis/sialadenitis?

Answer 33

- acute and sudden onset of unilateral swollen and painful salivary gland

Question 34

Who is most commonly affected with bacterial parotitis/sialadenitis?

Answer 34

- elderly

Question 35

What is the most common pathogen of bacterial parotitis/sialadenitis?

Answer 35

- S. aureus including MRSA

Question 36

What are the risk factors for bacterial parotitis/sialadenitis?

Answer 36

- retrograde contamination by oral cavity bacteria | - obstruction

Question 37

What are the risk factors for bacterial parotitis/sialadenitis?

Answer 37

- dehydration - chronic illness - advance age - post op - immunocompromised - poor oral hygiene - Rx meds - trauma to duct - oral cavity neoplasm

Question 38

How does bacterial parotitis/sialadenitis present?

Answer 38

- sudden onset, unilateral or (B) parotid gland enlargement - painful, tender, indurated, and erythematous overlying tissue - purulent d/c from Stensen's duct

Question 39

What should be done with the d/c from Stensen's duct in bacterial parotitis/sialadenitis?

Answer 39

- culture

Question 40

How can mumps and bacterial parotitis be ddx'd?

Answer 40

- prodrome, none in bacterial

Question 41

How is a diagnosis made for bacterial parotitis/sialadenitis?

Answer 41

- clinical - culture d/c - labs (not necessary) - imaging when ? abscess

Question 42

What is the treatment for bacterial parotitis/sialadenitis?

Answer 42

- stimulate salivary flow - abx - I&D

Question 43

What is the outpatient abx treatment for bacterial parotitis/sialadenitis?

Answer 43

- augmentin

Question 44

When does non-bacterial parotitis/sialadenitis occur?

Answer 44

- with underlying disease

Question 45

What is non-bacterial parotitis/sialadenitis?

Answer 45

- (B) non-tender parotitis

Question 46

What causes sialolithiasis?

Answer 46

- etiology unknown

Question 47

Where does sialolithiasis most commonly occur?

Answer 47

- submandibular glands

Question 48

How does sialolithiasis present?

Answer 48

- hx or acute, painful and intermittent swelling of the gland

Question 49

When does swelling occur with sialolithiasis?

Answer 49

- with eating but will decrease ~1hr after

Question 50

How is sialolithiasis diagnosed?

Answer 50

- clinically/palpate - imaging: XR 1st then US, CT - sialoendoscopy

Question 51

What is the treatment of sialolithiasis?

Answer 51

- supportive | - refer to ENT for lithotripsy, sialoendoscopy, or surgery

Question 52

Where do most salivary gland tumors occur?

Answer 52

- parotid gland | - CHECK FACIAL N. INVOLVMENT

Question 53

T/F: Most of sublingual gland tumors are malignant

Answer 53

- True

Question 54

How do benign salivary gland tumors present?

Answer 54

- slowly - painless - non-tender - mobile - firm

Question 55

How do malignant salivary gland tumors present?

Answer 55

- enlarge over several weeks | - painless

Question 56

What is the most common benign salivary gland tumor?

Answer 56

- pleomorphic adenoma

Question 57

What is the most common malignant salivary gland tumor?

Answer 57

- mucoepidermoid carcinoma