Salivary gland swellings

Question 1

What medical term describes salivary gland swellings?

Answer 1

Sialadenitis.

Question 2

Where can salivary gland swellings present?

Answer 2

· On the side of the face, below and in front of the ear - parotid.

· Upper part of the neck - submandibular.

· Submucosal swelling - sublingual.

Question 3

What can salivary gland swellings often be mistaken for?

Answer 3

Cervical lymphadenopathy and chronic sialadenitis.

Question 4

Which glands are most affected?

Answer 4

Submandibular + parotid glands.

Question 5

What is the epidemiology of salivary gland swellings?

Answer 5

· Most common in males aged 30-60 years.

· Salivary gland stones account for half of major salivary gland disease.

Question 6

What is the aetiology of salivary gland swellings?

Answer 6

· Benign or malignant neoplasms.
· Sialolithiasis and ductal stenosis.
· Infections.
· Precursors for malignancy - Sjogren’s syndrome and HIV.
· Sialadenosis (generalised salivary gland swelling).
· Lymphadenopathy.

Question 7

What are the causes of sialadenosis (generalised salivary gland swelling)?

Answer 7

· Endocrine - diabetes, hypothyroidism, Cushing’s.
· Metabolic - alcoholism, anorexia, bulimia, coeliac disease, malnutrition.
· Drugs - anticholinergic drugs, heavy metals, psychotropics.
· Neurogenic - dysautonomia, depression.

Question 8

What are the potential risk factors?

Answer 8

· Elderly:

- Bacterial infections.
- Due to dehydration and lack of salivary flow or chronic obstruction. 

· Hx of skin cancer.
· Previous head and neck radiation.

Question 9

What are the typical signs and symptoms?

Answer 9

· Benign or malignant neoplasms.
· Sialolithiasis and ductal stenosis.
· Infections, such as mumps.
· Precursors for malignancy - Sjogren’s syndrome and HIV.
· Sialadenosis (generalised salivary gland swelling).
· Lymphadenopathy.
· Red flag features.

Question 10

What are the typical red flag features?

Answer 10

· Facial nerve weakness - e.g. mandibular trismus (inability to open mouth to full extent).
· Rapid increase in size.
· Ulceration or induration (or both) of the mucosa or skin.
· Overlying skin fixity.
· Paraesthesia or anaesthesia of neighbouring sensory nerves.
· Intermittent pain, increasing inexorably.
· Hx of previous skin cancer, Sjogren’s syndrome or previous head and neck radiation.

Question 11

What would be the typical signs and symptoms if the cause of the swelling was infection?

Answer 11

· Rapid onset of pain and facial swelling.
· Systemic symptoms - malaise, fever and lymphadenopathy.
· Bacterial - unilateral, overlying redness and tenderness.

Question 12

What investigations would you do to help diagnose sialadenosis?

Answer 12

· Bloods - raised WBC if infection is present.
· USS and FNA.
· MRI.
· Salivary ductal imaging.

Question 13

Differentials?

Answer 13

· Sialolithiasis.
· Chronic sialadenitis.
· Autoimmune disease.
· Lymphoproliferative disorders. 
· HIV. 
· Mumps.

Question 14

What are the current treatment options?

Answer 14

· Benign and malignant tumours typically need surgical excision with post-op radiotherapy.

· Intervention to relieve obstruction - lithotripsy.

· Anti-inflammatory’s or abx.

Question 15

Suggest some broad spectrum antibiotics which could be prescribed.

Answer 15

Amoxicillin/co-amoxiclav.

Question 16

How are stones in the intra-oral part of the duct usually treated?

Answer 16

Removed under general anaesthesia.

Question 17

How are stones in the parotid gland usually treated?

Answer 17

Treated conservatively with sialogogues and intermittent massage of the gland towards the duct.

Question 18

What do sialogogues do?

Answer 18

Promote secretion of saliva.

Question 19

Complications?

Answer 19

· Abscess - bacterial infection.
· Damage to the facial nerve.
· Haematoma.
· Salivary fistula.