salivary gland Flashcards
salivary glands
- parotid gland
- submandibular gland
- sublingual gland
- minor salivary gland 600-800
What important structure are in close relationship to the parotid?
- Facial nerve
- Terminal branches of external carotid artery
- Greater auricular nerve
parotid gland
- Facial nerve divides within the parotid gland
- Facial expression:
temporal , zygomatic, buccal , mandibular and cervical - Facial nerve do not supply the parotid gland!!!
lobes of parotid
Parotid are anatomically divided into two lobes
Superficial Vs deep
- Facial nerve intraoperatively
- Retromandibular vein radiologically
Deep lobe extend around the ramus of mandible
No histologic difference
sensory innervation of submandibular gland
- Marginal mandibular branch
- Lingual nerve
anterior and superior to deep portion - Hypoglossal nerve
inferior to deep portion - Facial artery and veins
parasympathetic nerve supply: parotid, SMG
parotid
- Glossopharyngeal nerve
- Lesser petrosal nerve, mandibular nerve
- Reach the gland via auriculotemporal branch of lingual nerve
SMG
- Facial nerve -> chorda tympani
- Chorda tympani joins lingual nerve
Saliva
- 1 litre per day
- regulated by autonomic nervous system
- 99% water, rest is protein and electrolytes
- Parotid watery , serous
- SMG - thick mucoid
- gustatory and oflactory stimulation is parotid secretion
- SMG has higher mucin content and basal flow rate
- Antimicrobial proteins: IgA, musin lysoenzyme histamine amylase and lactoferrin
acute silolithiasis
- Short history
- Erthyema, pain, swelling
- Firm swelling; pus discharged from affected duct
- Elderly, dehydration, trauma, major surgery, radiotherapy. immunosuppressed , chemo or Sjorogen
- S. areus
Acute Sialadenitis - treatment
- Short history
Eliminate salivary stasis
Treat infection
Rehydration - IV and PO fluids IV Abx Warm compress/ massage Sialogogues / citrus juice (lemon) Oral irrigations
Sialolithiasis
- ‘Salivary gland stone’
- 80% of cases -> SMG
- Recurrent sialolitihitis
- Pain and swelling of the gland particularly at meal time
- Ix X-Ray; sialogram; USS
- 1/3 of calculi are radiolucent
Sialolithiasis treatment
- Intraoral sialolithotomy
- Intraductal sialolithotomy with sialendocopy
- If stone is at the hilum of the gland; gland excision is appropriate
Autoimmune - Sjorgen
Autoimmune diesase
- dry eyes (xeropthalmia) and dry mouth (xerostomia)
- destruction acinar and ductal cells
- more common in woman
- unilateral or bilateral salivary gland hypertrophy
- Ix : +ve test for anti-Ro and anti-La serologies
histological diagnosis Bx sublabial minor salivary gland > lymphocyte infiltration
Sjogren’s Syndrome
May progress to non Hodgkin lymphoma and rarely Waldenstrom’s macroglobulinaemia
Associated with connective tissue disease (RA, SLE, polyarteritis nodosa)
Treatment: symtomatic: oral hygiene, salivary substitutes etc…
Salivary gland tumour: incidence
Incidence 3 per 100 000
5% of H&N malignancies
80% in parotid
80% benign
80% pleomorphic adenoma
Salivary gland tumour: benign tumour
Pleomorphic adenoma (benign-mixed tumours) Warthins tumour (adenolymphoma)
