Salivary Gland Enlargement

Question 1

What are the causes of salivary gland enlargement?

Answer 1

Viral- HIV, mumps

Secretion retention- duct obstruction, mucocele (obstruction in minor gland)

Gland hyperplasia- Sjogren’s, Sialosis

Question 2

What are the features of the mumps virus?

Answer 2

Paramyxovirus

Droplet spread

Incubation 2-3 weeks

1/3 have no symptoms

Occurs between 3-5 years in unprotected population
-> more severe in older patients

Question 3

What are the signs and symptoms of mumps?

Answer 3

Headache

Joint pain

Nausea

Dry mouth

Mild abdominal pain- pancreas and testicles

Feeling tired

loss of appetite

Pyrexia of 38C, or above

Question 4

How is mumps treated?

Answer 4

MMR vaccine

Fluids

Analgesia

Question 5

How do HIV swellings differ from Mumps?

Answer 5

Major salivary glands enlarge significantly giving mumps like appearance (lympho-proliferitive enlargement)
-> Discomfort from distended tissue but no other mump like symptoms

Does not reduce with time- surgical reduction for cosmetic reasons is possible but not common

Question 6

What is a mucocele?

Answer 6

Swelling in mucosa filled with saliva from minor glands

Question 7

What are the types of mucocele?

Answer 7

Mucous retention cyst- within ductal system

Mucous extravasation cyst- saliva spills out into tissue from ruptured duct

Question 8

What are the common sites for mucoceles?

Answer 8

Lips

Junction between hard and soft palate

-> Areas of trauma

Question 9

What are the symptoms of mucoceles?

Answer 9

Recurrent swelling that bursts

Salty taste

Question 10

When may a mucocele be removed?

Answer 10

If it is fixed in size
-> OS may remove extravasated mucous or mucous in duct as well as gland

Question 11

What would happen if a mucocele was left alone?

Answer 11

Would not cause harm but may cause cosmetic defect

Question 12

What are the causes of subacute obstruction?

Answer 12

Blockage in submandibular (long duct pathway)
-> Mucous plugs
-> Sialoliths (stones)
-> damage from infection causing scarring

Strictures in parotid

Question 13

What are the signs and symptoms of subacute obstruction?

Answer 13

Swelling around meal times
-> Increases when salivary flow starts and reduces after

Can become fixed after a while
-> causing pain and swelling

Question 14

What investigations can be done for salivary gland obstruction?

Answer 14

Low dose plain radiography

Lower true occlusal (PA if parotid)

SIALOGRAPHY – when infection free (don’t want to wash more infection into gland)
-> can also help remove blockage

Isotope scan- to check secretion ability

Ultrasound assessment of duct system

Clinical visual assessment

Question 15

Why is lower exposure used in plain radiographs of sialoliths?

Answer 15

Due to low calcium content risking not been seen on normal exposure

Question 16

What are mucous plugs?

Answer 16

Hardened/sticky adherent mucous
-> Same symptoms but won’t be seen on radiographs

Question 17

How are sialoliths treated?

Answer 17

If symptom free (can be an incidental finding)- no treatment

If symptoms- surgery will involve removal of gland (must be beneficial to patient)

Question 18

What can happen if stone or plug is not removed?

Answer 18

Back pressure from blocked secretion will cause damage and scarring

Question 19

What causes duct strictures to occur?

Answer 19

When damage and infection has occurred in duct over a long period of time

Question 20

What can be used to investigated duct strictures?

Answer 20

Plain radiographs

3D CT

Question 21

How are strictures treated?

Answer 21

Using balloon catheters

Question 22

What is ductal dilatation?

Answer 22

Flabby ductal tree (sausage like defects) which prevent normal emptying of duct
-> Increased infection due to salivary stasis in dilated areas

Question 23

What condition is ductal dilatation associated with?

Answer 23

Recurrent parotitis which occurred in childhood leading to low grade damage over many years

Question 24

What occurs is chronic sialadenitis, how does it appear histologically?

Answer 24

Atrophy of normal glandular tissue around stone

Histologically- ducts and acini seen in health are replaced with fibrous scar tissue

Question 25

What are the management options for salivary gland obstruction?

Answer 25

• Rapid removal of stone should be arranged without delay
• If no stone visible- sialography
• Removal- if fixed swelling and no obvious cause found (if persistent and recurring infection consider removal)

Question 26

What is sialosis?

Answer 26

Persisting enlargement with no obvious glandular cause
- Diagnosis of exclusion- do tests for other diseases
- Tests will usually be within normal limits if Sialosis

Question 27

What are the conditions associated with sialosis?

Answer 27

Alcohol abuse
Cirrhosis
Diabetes Mellitus
Drugs

Question 28

How does sialosis appear on MRI and biopsy?

Answer 28

MRI- Diffuse enlargement (appears like hyperplasia)

Biopsy- normal

Question 29

What can cause pain in sialosis?

Answer 29

Stretching of the capsule around gland (esp in parotid)

Question 30

How is sialosis differentiated from Sjogren’s?

Answer 30

Patient rarely has dry mouth in sialosis