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Salivary gland disorder Flashcards

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1
Q

size of parotid gland - general

A

up to TMJ

to mandible and behind

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2
Q

von frey syndrome

A

gustatory sweating

  • Result after trauma occured to the parotid region of the face

instead of going to parotid gland – goes to sweat gland

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3
Q

three major etiology of infections

A

viral - like mumps

from stones - like mucus plug (like secondary)

retrorade infection

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4
Q

high temp dysphagia trismus swelling and malaise - may be from?

A

pus draining from wharton’s duct - submandibular gland infection

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5
Q

features of chronic infection / blockage

A

diminshed salivary flow

turbind, viscous discharge

pain and swelling seen at meal time

moderate enlargment of the affected gland

scarring pattern seen on sialolith

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6
Q

typically swells at meal time

A

chronic paraotid infection

with turbid viscous discharge milked from duct

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7
Q

tx for glandular

A

hydration – water
plus acidic like lemons and pickles

stimulation

ductile dilation – probing - only chronic though - not acute infections

antibiotics

sialolothectomy

sialolithectomy

sialogram

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8
Q

‘easy’ sialothith to remove

A

can almost see it

  1. traction suture – suture ligation of duct

2.

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9
Q

clinically important parotid gland anantomy

A
  1. superficial / deep lobe
  2. facial nerve courses through
  3. retromandibualr relationship
  4. course of stenson’s duct
    - over masseteric muscle
  5. accessory gland

its large!
- also because wraps around behind - trismus could be associated

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10
Q

clinically important submandibular gland anatomy

A
  1. muscualr triangle
    - allow these muscsles to swallow
    - symptoms = difficulty swallowing
  2. facial nerve, artery and vein
  3. hypoglossal nerve
  4. whartons duct
  5. lingual nerve
    - crossing UNDER WHARTON’S DUCT
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11
Q

whartons duct?

A

from submandibular gland to oral cavity

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12
Q

stensons duct

A

from parotid gland

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13
Q

clinically important sublingual gland anatomy

A
  1. deceptively large size
  2. directly drains by 8-20 ductiles
    - can be injured
    - like mucocele formed
  3. bartholin’s duct into whartons
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14
Q

trauma examples

A
  1. mucocele
  2. ranula
  3. laceration of salivary duct
  4. salivary fistula
  5. von frey syndrome
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15
Q

ranula is

A

when the sublingual gland has been injured

mucous pulling underneath

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16
Q

typical mucocele

A

dome shaped

fluid filled

non ulcerated

moveable

can occur wherever minor salivary glands are

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17
Q

very large fluctuant swelling in the area of the sublingual gland

A

ranula

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18
Q

chance of reoccurence when marsupilization ? next what?

A

yes can happen – try again

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19
Q

ranula can be cause by - example he gave

A

trauma from sunction tip / high speed suction in dental procedure

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20
Q

pt. with x-ray of face with discontinuity defect

A

possible FRACTURE

STENSONS duct is injured – from parotid

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21
Q

typical acute submandibular gland infection

A

discrete swelling

som hurt to swallow

PUS milked from wharton’s duct

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22
Q

acute parotiditis presentation

A

sudden onset

mild trismus

fever

pre and infra auricular swelling

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23
Q

tx for the acute

A

antibiotics – not going to go into an acutely infected duct area

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24
Q

pt says has acute parotid glan infection but presents with multiple swellings

A

infection may be secondary to CANCER

  • had lymphoma
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25
not tender swollen parotid gland
lymphoma
26
pain that is suggestive of chronic infectin / blockade
pain and swelling at MEAL time
27
turbid viscous discharge milked from out of duct more likely to be
CHRONIC - typically swelling at meal times
28
treatment of infections
1. HYDRATION 2. stimulation - acidic / lemon/ pickles - right behind incisors -- get them to salivate 3. ductile dilation 4. antibiotics 5. sialolithectomy 6. sialogram - inject die into it 7. sialoendoscopy
29
when can yuo put something INTO the duct
during CHRONIC LOW GRADE infection NOT acute
30
dilate the duct
important in treatment in chronic low grade infection
31
what should see from sialogram
continual taper of the duct but with the die we can see the obstruction dialates BEHIND OBTRUCTION
32
main locations we see salivary stones in the mandible
1. orifice of duct 2. middle of it 3. point of exit -
33
always put what behind the gland when retrieving stone
TRACTION SUTURE | - if dont stone will be pushed back further
34
incision made where on lower? | making sure to keep away from?
in anterior portion of the mouth make incision TO THE MEDIAL ASPECT OF THE DUCT if cut into where sublingual will be -- too lateral can get ranula
35
ake incision too lateral?
can get secondary ranula
36
traction suture so | AKA
stone cannot go further back made BEFORE making any incision AKA LIGATION suture
37
indication to remove an acute salivary stone
based upon LOCATION -- lie if you can get it - get it
38
example with a long history of episodic pain and submandibular swelling which is getting worse dx by?
small round radio-opaque somewher ein the subMANDIBULAR area inject the DIE@@ - trying to push it in - and it is not working past the stone - so identitifed that the stone is in the duct
39
neoplasia aka
benign tumors
40
occurence of benign tumors from most to least
1. parotid (90% will be benign) 2. minor salivary glands ( 40- 60 % will be malignant) 3. submandibular 4. sublingual - has the most occurence of a MALIGNANT one
41
90% of the benign tumors are ___
pleomorphic adenomas
42
wharton's tumor?
8% of the parotid tumors commonly a BILATERAL tumor ELDERLY MEN
43
bilateral tumor in elderly men close to tail of parotid
WHARTON'S TUMOR
44
TUMORS CAN BECOME MALIGNANT
YES- TRUE
45
malignant salivary tumors
mucoepidermoid carcinoma adenoid cystic carcinoma adenocarcinoma malignant pleomorphic adenoma lymphoma squamous cell carcinoma acinic cell carcinoma
46
highlighted malignant
lymphoma (second most malignant in head and neck region and squamouos cell carcinoma
47
pleomorphic adenoma
can become malignant in a long standing
48
firm mass - cannot rule out
tumor -malignancy like a lymphoma
49
facial paralyiss can be a presentation associated with
cancer loss of lines in forehead close not closing
50
pt presented with TMJ pain and swelling in the pre-auricular area
metastic colon cancer to the parotid gland
51
statistically sublingual gland tumors should be
malignant | - but still can present as a pleomorphic adenoma
52
chance of malignacy from most to least
1. sublingual 2. submandibular 3. parotid
53
90% of the benign tumors are
pleomorphic adenomas
54
nicotinic stomatitis
inflammation of the minor salivary glands each one of them can become a tumor of one
55
6 months draining a lesion?
most likely not an infection tumor of salivary gland on the palate if locate NO SOURCE OF INFECTION -- doing a biopsy
56
doing incision and drainage on non odontogenic?
NO
57
mucocele should NOT present where
in the posterior retromolar pad area muco-epidermoid carcinoma or salivary gland tumor until we prove otherwise front or floor of mouth probably a mucocele
58
upper lip mass vs lower lip mass
lower - mucocele upper - tumor
59
indurated / hard mass on buccal mucosa associated with V2 parasthesia
think TUMOR adenomatoid cystic carcinoma
60
NON inflammatory enlargment of parotid glands
sialosis benign salivary hypertrophy
61
causes of sialosis
1. malnutrition 2. chronic alcoholism 3. diabetes 4. HIV disease
62
necrotizing sialometaplasia hallmark sign?
INTENE ACUTE PAIN necrotic slough of tissue frequently seen Patient will say something dropping / coming out of the roof of my mouth THIS WILL HEAL
63
___ puts at risk for developing lymphoma
sjorgen's syndrome -- 40% increased risk to develop lymphoma
64
presenting chatacteristics of sjorgen's syndrom
xerophthalmia - dryness in eye xerostomia rheumaotid arthritis 40X more likely to develop lymphomas
65
common presentation of sialosis
NON INFLAMMATORY ENLARGMENT -BILATERAL PAROTID ENLARGEMENT ``` SEEN IN - DIABETICS - ALCOHOLIC - MANLUTRITION HIV DISEASE ```

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