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Salivary glands 2 Flashcards

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1
Q

How much saliva is produced in total and what % is from each salivary gland

A

1L/ day

70% parotid
25% submandibular
5% sublingual and minor salivary glands

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2
Q

What are the components of saliva

A
  • Water, Nacl,HCO3(Buffer)
    -Enzymes: amylase, lysoszyme, perioxidase
  • Immunoglobulins (IgA- secretory antibiody for mucosal immunity)
    (IgG related to systematic immunology)
    pH= 8
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3
Q

where is saliva produced?

A

acini

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4
Q

What cells are present in acini

A

serous (produces thin watery- parotid)
mucus (produces thicker mucus - sublingual)

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5
Q

Where is saliva stored

A

in ducts- vary in size & drain towards duct orifices

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6
Q

What type of saliva is produced by the parotid

A

thin watery saliva (serous> mucus)

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7
Q

What type of saliva is produced by sublingual gland

A

thick mucus

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8
Q

What type of saliva is produced by submandibular

A

Serous= Mucus

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9
Q

What do salivary glands contain

A
  • Vessels
    -Lymphatics
    -Lymphoid tissue
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10
Q

What are salivary glands controlled by & how is it stimulated

A

Parasympathetic (most of flow of saliva) and sympathetic nervous system (composition)

trigger: taste/ smell stimulates salivary nuclei
- trigger causes salivary glands to produce saliva in rest and digest

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11
Q

What is the neurone pathway for submandibular gland stimulation

A
  1. Salivar nucleus
  2. Chorda Tympani (Vii- also carries taste)
  3. Lingual nerve
  4. Submandibular ganglion
  5. Submandibular gland
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12
Q

What is the neurone pathway for parotid gland

A
  1. salivary nucleus
  2. IX- glossopharyngeal
  3. Otic ganglion
  4. Parotid
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13
Q

What is the mechanism for salivary glands acini to produce saliva

A

Cholinergic nerurotransmission: similar to neuromuscula junction
- acetylcholine is released into space between end plate and receptor
- ActH binds to receptors trigger intracellular processes (causing release of saliva)

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14
Q

How can excess saliva be treated?

A

Botulinum toxin (botox- typically used to reduce appearance of wrinkles and muscle spasms)- less saliva is produced

  • central inhibition (antimuscarinic effect) e.g antidepressants
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15
Q

When is excess salivia considered ‘normal’

A

Normal drooling :when children, when sleeping, in reduced consciousness, dementia, learning difficulties, head and neck surgery/ pathology

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16
Q

What is the consequence of excess saliva

A

eczema/ skin rash (due to bacteria/ enzymes)
management: treating eczema & keeping skin free from saliva

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17
Q

What conditions are associated with true excess saliva

A
  • drug poisoning
  • Parkinsons
    -Myasthenia gravis (neurological problem treated with cholinesterase inhbition- more acetyl choline is present at the nerve junction and so stimulates saliva
  • psychosis
    -dementia

poisons: mercury, insecticides, heavy metal, nerve agents

sore mouth: lumps, ulcers- trigger salivary nuceli

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18
Q

What are the causes of a dry mouth and how is a dry mouth measured?

A

Causes of dry mouth: anxiety, dehydration, drugs, salivary gland damage

assessed by Challecombe scale

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19
Q

What drugs cause a dry mouth

A

antidepressents (nortiptyline, amitrypts)
- antihistamines
-diuretics
-PPis

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20
Q

What are causes for Salivary gland damage

A
  • sjogrens syndrome
    -radiotherapy
    -sarcoidosis
    -HIV
    -Hep C
    -Cystic fibrosis (affect secretions)
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21
Q

What is saliva like in cystic fibrosis patients

A

Less watery saliva and more mucousy

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22
Q

What are the consequences of a dry mouth?

A
  • Mechanical (affects swallowing, speech, denture wear and debris in mouth)

-loss of taste
-caries & periodontal disease

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23
Q

What oral problems (diseases/ features) are associated with a dry mouth

A
  • dry lobulated tongue
    -Angular chelitis
  • Candidiasis (erythematous thrush/ discomfort/ taste chabge)
  • caries, perio, lack of taste
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24
Q

How do you investigate a dry mouth?

Study These Flashcards
A
  1. Clinical examination (is the mouth dry)
  2. Diagnosis of why it is dry
    - 3 months+ of a dry mouth suspect sjogrens
25
How can you objectively assess the level of saliva produced?
1. Saliva flow rate ( see in a cup how much saliva they produce) 2. Stimulated parotid saliva- Use carlson-crittenden cup (sits over parotid) Stimulate saliva with citric acid on tongue
26
What imaging techniques can be done to investigate saliva production
Sinalography: Use dye to see salivary glands- stones can be seen Ultrasound : bounce soundways off tissues Water Filled can pass sounds ways easily through them→ stones can be see, Stricture of duct: thinner and more constricted
27
What is meant by Punctate sialectasis and how can it be detected
- balls of dye at end of tree of salivary ducts) - Sign of sjogren's disease - can be seen via sinalography & ultrasounds
28
What is primary sjogrens syndrome?
dry mouth and dry eyes, no connective tissues disease (RA/ CTD/ SLE )
29
What is secondary sjogrens syndrome?
Secondary sjogrens syndrome: dry mouth, dry eyes, autoimmune disorder RA/ CTF/ SLE
30
What is the cause of sjogrens syndrome & incidence?
Autoimmune disease causing destruction of salivary acini- Autoantibodies produced by the body Can affect other tissues (glandular tissues) Incidence: 50 per 100k F:m = 10:1 Peak age of 50-60 years HLA association: as connective tissues
31
How is sjogren's syndrome diagnosed?
Oral symptoms: - dry mouths daily 3/12 m - Persistent/ recurrent salivary gland swelling - Need to take water to swallow Eye symptoms→ dry eyes daily 3/12m -sand/ grit sensation in eyes - Tear substitutes/ drops >3/day Objective criteria Salivary flow Schirmer test: tears on blotting paper, measure speed tears flow down scarring/ ulceration of cornea Auto-antibodies Labial gland biopsy: looking for focal inflammation infiltrate
32
What are the complications of sjogrens syndrome?
dental complications: reduced QoL, Caries, perio eyes: scarring & reduced vision lymphoma: 5% risk of lymphoma
33
What is the management of dry mouth/ salivary glands obstruction
- Advise to see ophthalmologist - Educate lymphoma risk - Specialist referral
34
How can symptoms of sjogrens syndrome be managed
1. Diet, Fluoride, OHI 2. Manage fungal/ bacterial infectionsm 3. Stimulate Saliva 4. Sugar free sweets/ chewing gums 5. Sialogogues: pilocarpine 6. Artificial saliva
35
What are the causes of mechanical blockages of salivary glands
Stone/ strictures→ due to protein/ minerals together - Most commonly submandibular - Usually affect one gland at a time -Saliva flow cannot escape and increase pressure causing swelling
36
How can salivary gland blockages be investigated
Investigate if occurs during meal times (on tasting/ thinking of food) - O/E: no saliva draining from duct when message, feel stones in the floor of mouth - X-rays can show up
37
What are the treatment options for salivary gland blockages
- Papillotomy: - Duct dilation via lacrimal probes: - Basket retrieval: - Sialography:
38
What is meant by Papillotomy
ncision at duct orifice to extract
39
What is meant by Duct dilation via lacrimal probes
indications : if duct is too small Introduce lacrimal probes (smallest to largest)
40
What is meant by Basket retrieval
indications: if stones are further back -Sialendoscopy is introduced into duct, stone is trapped by basket and removed out
41
What is meant by Sialography
pump small volume of liquid under pressure, dislodge stone
42
What are the causes of acute infections of salivary glands
Caused by Reduced salivary flow rate: - Less saliva, reduced pressure gradient, bacteria can move from mouth into salivary orifice into gland causing an infection
43
Who do acute salivary gland infections affect?
Elderly, young, dehydration
44
What are the symptoms of acute infections of salivary glands
Feel acutely unwell, high temperature, raised WCC, swelling over gland, hot, red swelling
45
How are acute infections of salivary glands treated
rehydrate, analgesia, antibiotics
46
What are the symptoms of chronic infections of salivary glands
little/ no symptoms, recurrent swelling, pain, affect at meal times due to scarring Each time occurs, more scarring
47
How are chronic infections of salivary glands treated
supportive (removal of glands parotidectomy, remove damage gland), antibiotics, surgery: difficult due to scarring
48
What is sialosis & its causes
Painless swelling of the glands (usually parotids & bilateral) Causes: diabetes, alcohol, drugs
49
How is sialosis treated?
Treatment not necessary, remove gland
50
What is a cyst?
pathological epithelial lined cavity
51
What are the 2 types of salivary gland cysts
1. Mucus retention 2. Mucus extravasation
52
What is a mucus retention cyst?
blockage of salivary gland within gland/ duct minor glands
53
What is a mucus extravasation cyst?
escape of saliva from traumatised gland/ ducts minor glands/sublingual
54
What is a ranula & what is the appearance
-occurs in floor of mouth Non-developmental cysts Looks like a frog belly (latin for frog) Appearance: Blueish, firm, feel full of fluid, round and smooth, floor of mouth
55
What is a plugging ranula & what is the appearance
(extends through mylohyoid muscle into neck) Neck swelling Has 2 elements: intra-oral and extra-oral Extra-oral: in the neck
56
What is the treatment of a plugging ranula
remove intra-oral/ extra-oral element Operation on mouth / neck If do one it will come back
57
How can you differentiate between mucus retention/ extravasation cysts
cannot tell unless remove
58
What is a lip mucocele? - what is the appearance?
blockage of minor salivary gland -occur lower lip - if upper maybe minor salivary gland tumour appearance: painless soft fluid filled swelling, may appear bluish
59
What is the treatment for lip mucoceles?
Cryotherapy: (CO2/ liquid nitrogen to cool down probe end), forms iceball, ice crystals within tissues form, crystals burst cells and damage them, cyst is destroyed Excision: cut in the lip, risk of recurrence, scar/ swelling/ bleeding/ bruising

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