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5th yr- CMS2 > salivary gland disorders > Flashcards

salivary gland disorders Flashcards

1
Q

How do we examine salivary glands

A
  1. Inspection from the front, side and hind the patient
  2. Compare left and right
  3. Palpate the submandibular gland
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2
Q

How many minor salivary glands are there in the oral mucosa

A

450 distributed throughout the mucosae, lips, cheeks, palates, floor of mouth and retro molar pad

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3
Q

What is saliva made up of

A

99.4% Water
0.6% Minerals and proteins

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4
Q

What makes up the inorganic portion of saliva

A
  1. Sodium
  2. Potassium
  3. Chloride
  4. Bicarbonate
  5. Hydrogen
  6. Iodine
  7. Flouride
  8. Calcium phospahte
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5
Q

What makes up the organic portion of saliva

A
  1. Urea
  2. Uric acid
  3. Amino acids
  4. Glucose
  5. Lactase
  6. Fatty acids
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6
Q

What makes up the macromolecules of saliva

A
  1. Serum protein
  2. Glycoproteins
  3. Perioxidases
  4. Amylase
  5. Lysozyme
  6. Lipase
  7. IgA, IgG, IgM
  8. Hormones
  9. Carbohydrates
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7
Q

How can we investigate salivary gland disease

A
  1. Sialometry
  2. Plane film radiography
  3. Ultrasounds
  4. Bloods
  5. MRI
  6. Biopsies
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8
Q

What does a sjogrens screen involve

A

1, FBC
2. HbA1c
3. Serum ACE levels
4. Serum immunoglobulins and electrophoresis
5. Hepatitis C serology and HIV serology if clinically suspicious

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9
Q

What is ultrasonography

A

High frequency sound waves

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10
Q

What is ultrasonography good for identifying

A
  1. Solid lesions
  2. Cysts
  3. Textural changes in Sjogrens
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11
Q

What is retrograde sialography

A

Radiographic examination of the ductal system using radio iodide as a contrast medium

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12
Q

What can retrograde sialography show

A
  1. Strictures
  2. Sialectasia (ductal dilatation)
  3. Filling defects
  4. Calculi, mucus pluds
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13
Q

What is Sialometry

A

Collection and investigation of whole saliva
Patient expectorates all saliva produced without forcing it for a timed 5 or 10 minutes

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14
Q

When might biopsies be indicated

A
  1. Excision for minor salivary glands
  2. Incisional for major salivary swellings
  3. A minor labial salivary gland biopsies
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15
Q

What are some symptoms for salivary gland problems

A
  1. Swelling
  2. Pain
  3. Discharge from duct
  4. Decreased saliva (Xerostomia)
  5. Increased saliva (Sialorrhoea)
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16
Q

How can we describe swellings in the salivary glands

A
  1. Localised vs generalised
  2. Unilateral or bilateral
  3. Persistent or transient
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17
Q

Give examples of salivary gland diseases we need to know about

A
  1. Obstructive Salivary Gland disease
  2. Xerostomia
  3. Sialorrhoea
  4. Sarcoidosis/HIV/GvHD related salivary gland disease
  5. Cancers
  6. Benign neoplasias e.g. pleomorphic adenoma and Warthin’s tumour
  7. Benign cysts/pseudocysts
  8. Acute/chronic sialadenitis
  9. Frey ’s syndrome
  10. Developmental abnormalities e.g. atresia or hypoplasia
  11. Primary and Secondary Sjogren’s syndrome
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18
Q

What is obstructive salivary gland disease due to

A
  1. Calculi
  2. Strictures
  3. Infections
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19
Q

What does sialadenitis

A

Inflammation of the salivary glands

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20
Q

What can sialadenitis be split into

A
  1. Infective sialadenitis
  2. Obstructive sialadenitis
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21
Q

What are salivary gland calculi termed

A

Sialoliths

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22
Q

What is the most common cause of obstructive sialadenitis in major glands

A

Calculi

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23
Q

What can structured be caused by

A

Trauma to the duct followed by fibrosis and often occur in conjunction with other pathologies

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24
Q

How can localised strictures be treated

A

Balloon dilation

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25
Q

What can acute obstruction be caused

A

Usually calculus or mucus plugs

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26
Q

What can acute obstruction present as

A

Recurrent pre prandial, painful swelling of a major salivary glands

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27
Q

How do we manage asymptomatic calculi

A

Acceptably to leave and monitor

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28
Q

How do we manage symptomatic calculi

A
  1. If they are small we can remove by incising the duct and releasing the stone
  2. Larger distal stones can be retrieved endoscopically via lithotripsy or by removal of the whole gland
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29
Q

What are the risks involved in surgical management of submandibular glands

A
  1. Damage to marginal mandibular nerve
    Damage to the lingual nerve (leads to diminished somatic sensory sensation to the lingual tissues)
    Damage to the hypoglossal nerve (leads to diminished motor function to tongue;
    tongue deviates to affected side)
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30
Q

What are the risks involved with surgical management of submandibular glands

A
  1. Damage to marginal mandibular nerve
  2. Damage to the lingual nerve
  3. Damage to the hypoglossal nerve
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31
Q

What can damage to the marginal mandibular nerve lead to

A

Diminished motor innervation of muscles that depress and evert the whereas muscles that elevate the lower lip continue to act normally

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32
Q

What can damage to the Lingual nerve lead to

A

Leads to diminished somatic sensory sensation to the lingual tissues

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33
Q

What can damage to the hypogloassal nerve lead to

A

leads to diminished motor function to tongue;
tongue deviates to affected side

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34
Q

What are the risks involved with surgical management of parotid glands

A

Damage to facial nerve
Freys Syndrome

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35
Q

What can happen if the facial nerve is damaged

A

may lead to unilateral facial weakness of all branches

36
Q

Define xerostomia

A

Subjective perception of a dry mouth

37
Q

Define hypo-salivation

A

Objective reduced saliva production

38
Q

What can xerostomia be due to

A
  1. Iatrogenic due to medication
  2. Diabetes mellitus
  3. Anxiety related
  4. Mouth breathing
  5. Dehydration
  6. Irradiation to the salivary glands
  7. Acute infection
  8. Recreational drug use
  9. Endogenous salivary gland disease eg sjogrens
39
Q

How can drugs suppress saliva production

A
  1. Central effects in the brain
  2. Anti muscarinic effects
  3. Sympathomimetics
40
Q

Give examples of drugs that commonly cause xerostomia

A
  1. Tricyclic depressants
  2. MAOIs
  3. Antihistamines
  4. Diuretics
  5. Antipsychotics
  6. Antiparkinsonian
41
Q

How can we manage dry mouth

A
  1. Smoking cessation
  2. Minimise alcohol intake
  3. Increase plain water consumption
  4. Avoid caffeinated drinks
  5. Sugar free chewing gum
  6. Use of high fluoride concentration toothpaste
  7. Increased frequency of dental check up
  8. Identify and treat oral candidoses
  9. Stringent OHI and Periodontal treatment
  10. Salivary substitutes
42
Q

Give examples of saliva substitutes we may prescribe

A
  1. Glandosane
  2. BioXtra
  3. Salica Ortana
43
Q

What are the limitations of galndosane

A

Is acidic so only use in edentulous patients to prevent tooth erosion

44
Q

What are the limitaitons of BioXtra

A

made from cow’s milk proteins so there may be reasons why it is unsuitable for a patient due to religious or dietary preferences

45
Q

What are the limitations of saliva orthana

A

produced from porcine proteins so may not be acceptable to Muslim or Jewish patients etc

46
Q

Define Ptyalism

A

Too much saliva

47
Q

What can true Ptyalism be due to

A
  1. Acute viral infection
  2. Parkinsons, cerebral palsy
  3. Rabies
  4. Pregnancy
  5. Teething
  6. New dentures
  7. Pancreatitis
  8. Poisoning with mercury, copper, arsenic
48
Q

How do we manage of sialorrhoea

A

Anti muscarinis
Botulinum toxin A
Surgical management eg excision of the glands (extreme)

49
Q

What is sarcoidosis

A

Chronic multi system non-caseating granulomatous inflammatory disease of unknown cause which may cause salivary Galen swelling or xerostomia

50
Q

In whom are HIV salivary gland diseases more commonly seen in

A

Children with HIV

51
Q

How does HIV salivary gland disease present

A

Usually involves uni/ bilateral parotid gland swelling

52
Q

What is graft versus host disease (GvHD) a consequence of

A

Transplants
May affect multiple organ systems

53
Q

What is commonly seen in graft versus host disease (GvHD)

A

Xerostomia and oral lichenoid lesions
Generalised mucosal inflammation, candidness and oral hairy leukoplakia

54
Q

Give examples of benign neoplasms

A

pleomorphic adenomas, Warthin’s tumour

55
Q

Give examples of malignant neoplasms

A

Primary tumours such as:
1. Lymphoma
2. mucoepidermoid (COMMON in parotid gland)
3. adenoid cystic carcinomas (common in submandibular gland)

56
Q

Which cells in the salivary gland are more susceptible to radiotherapy

A

Serous cells are more susceptible to damage from mucus cells

57
Q

What can happen to saliva production in pts undergoing radiotherapy

A

Saliva production drops and the saliva has a thick quality with altered biochemistry

58
Q

Where are Pleomorphic adenoma seen most commonly

A

More commonly in the parotid
Typically slowly enlarges over many years

59
Q

What is a mucoceles

A

A cyst of a minor salivary gland

60
Q

What is a ranula

A

A sialocyst arising in the floor of the mouth from one of the sublingual glands

61
Q

how are ranulas usually mamboed

A

Marsupialisation or rarely excision

62
Q

What can acute or chronic sialadenitis be caused by

A

Viral cause such as mumps, cytomegalovirus or HIV

63
Q

What can mumps cause orally

A

Can cause dramatic self limiting swelling of glandular tissue with an associated with transient xerostomia

64
Q

Which gland is more commonly affected by acute sialadenitis

A

Parotid

65
Q

Which gland is more commonly affected by chronic sialadenitis

A

Submandibular

66
Q

What is acute bacterial sialadenitis signs of

A

Acute inflammation pt may be systemically unwell and may have a foul taste in the mouth

67
Q

How can we manage acute bacterial sialadenitis

A
  1. Antibiotics
  2. Hydration and anti paretics
  3. Maintain oral hygiene
68
Q

Describe Chronic Bacterial Sialadenitis:

A

Typically low grade problem that eveovled over months
Chronically inflamed glands that becomes progressively more fibrosed

69
Q

What is Chronic Bacterial Sialadenitis often associated with

A

Calculi or strictures

70
Q

How might glands suffering from Chronic Bacterial Sialadenitis feel

A

Fibroses and small

71
Q

What are other terms for Freys syndrome

A

Gustatory sweating or auriculotemporal syndrome

72
Q

What is Freys syndrome common after

A

Parotid surgery
Thight to result from surgical damage to the autonomic nerves supplying salivary and skin sweat glads

73
Q

What is Freys syndrome

A

An inappropriate facial sweating and flushing in the distribution of the auriculotemporal nerve

74
Q

Describe sjogrens syndrome

A

A chronic multisystem inflammatory disease with a high morbidity more commonly seen in women
It affects internal exocrine tissues in the pancreas bowel and kidneys

75
Q

Give examples of systemic features in sjogrens

A
  1. Gernalsied fatigue
  2. Inflammatory disease
  3. Raynaud’s phenomenon
  4. Thyroditis
  5. Anaemia
76
Q

Give examples of symptoms of xerostimia

A
  1. Nutritional deficiencies
  2. Difficult swallowing/ chewing dry food
  3. Sensitivity to spicy food
  4. Altered salty bitter metalic taste
  5. Burning mucosa
  6. Lack or diminished taste
  7. Salivary gland swelling or pain
  8. Cough
  9. Voice disturbance
  10. Nocturnal discomfort
  11. Altered quality of saliva
  12. Difficulty speaking
77
Q

Describe the oral mucosa in sjogrens syndrome

A

dry, atrophic, wrinkled, ulcerated, increased debris, sticky when trying to move mirror around the mouth, frothy saliva, lack of pooling of saliva in the floor of the mouth

78
Q

Describe the tongue in sjogrens syndrome

A

Dry, red, lobulated, loss of papilla

79
Q

Describe the tongue in sjogrens syndrome

A

increased caries experience, failed restorations, frequent tooth/restoration fractures

80
Q

Describe the tongue in sjogrens syndrome

A

firm on palpation if swollen

81
Q

What is sicca syndrome

A

A term used to describe patients who complain of dry eyes and or dry mouth but dont fulfil the criteria for sjogrens syndrome

82
Q

How can we manage sjogrens

A
  1. Palliative measures such as lubrication, hood OH
  2. Therapeutic measures such as pilocarpine and immunomodulating afters
83
Q

What is sialosis

A

Painless enlargement of the major salivary glands

84
Q

Give some features of sialosis

A
  1. Usually bilateral and symmetrical
  2. Usually affects the parotids
  3. Soft to palpate
  4. No xerostomia
  5. No fever
  6. No trismus
85
Q

What is sialosis associated with

A

Alcoholism
Endocrine

5th yr- CMS2 (9 decks)

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