Salivary glands & diseases

Question 1

Where the the largest salivary gland situated?

Answer 1

The parotid gland is situated below the acoustic meatus

between the ramus of mandible & sternomastoid muscle

Question 2

The deep cervical fascia is deficient at which part of the parotid gland?

Answer 2

deep cervical fascia forms parotid capsule that is deficient at the upper part

Question 3

What part of the parotid gland lies over the posterior part of the ramus of the mandible?

Answer 3

superficial part

Question 4

What part of the parotid gland lies behind the mandible & medial pterygoid muscle?

Answer 4

deep part (in relation to mastoid & styloid process)

Question 5

what is the accessory parotid gland?

Answer 5

prolongation of the gland along the parotid duct

Question 6

What are the structures that pass within the parotid gland?

Answer 6

• external carotid artery (with terminations maxillary & superficial temporal arteries)
• retromandibular vein (with terminations maxillary & superficial temporal veins)
• facial nerve & its branches (temporal, zygomatic, buccal, mandibular, cervical)
• intra-parotid lymph nodes

Question 7

What are the branches of the facial nerve & what do they supply?

Answer 7

MOTOR NERVES

• temporal -> auricularis anterior -> superficial part of frontalis
• zygomatic -> frontalis -> orbicularis oculi
• buccal -> buccinator -> elevators of lip
• mandibular -> lower lip muscles
• cervical -> platysma

Question 8

What is the duct of the parotid gland called?

Answer 8

STENSEN’S DUCT

• begins at angle of mandible
• runs over masseter
• passes through buccinator
• opens into oral mucosa OPPOSITE TO THE CROWN OF UPPER SECOND MOLAR TOOTH

Question 9

What is the blood supply & drainage of the parotid gland?

Answer 9

external carotid artery

- internal jugular vein

Question 10

What is the nerve supply of the parotid gland?

Answer 10

PARASYMPATHETIC: secretomotor from AURICULOTEMPMORAL NERVE

Question 11

What is the nerve supply of the parotid gland?

Answer 11

PARASYMPATHETIC: secretomotor from AURICULOTEMPORAL NERVE (from mandibular division of trigeminal)

SYMPATHETIC: vasomotor from PLEXUS AROUND EXTERNAL CAROTID ARTERY

Question 12

Where is the submandibular gland located?

Answer 12

in the anterior part of the digastric TRIANGLE

Question 13

Which part of submandibular gland lies in the submandibular triangle?

Answer 13

Superficial part: between the two bellies of the digastric muscle (superficial to mylohyoid & hyoglossus)

Question 14

which part of the submandibular gland lies in the floor of the mouth deep to the mylohyoid?

Answer 14

deep part

Question 15

What is the blood supply & venous drainage of the submandibular gland?

Answer 15

• FACIAL ARTERY

- anterior facial vein

Question 16

What is the name of the submandibular duct?

Answer 16

WHARTON’S DUCT

Question 17

What are the important structures related to the submandibular glands?

Answer 17

• LINGUAL NERVE (triple relation) -> related to Wharton’s duct
• submandibular gangilion (upper pole of gland)
• HYPOGLOSSAL NERVE -> deep to gland
• FACIAL ARTERY (double relation) -> enters gland from posterior & deep surface crosses lower border of mandible to enter face

Question 18

Where do the sublingual glands drain?

Answer 18

directly into mucosa or through a duct which drains into submandibular duct called BARTHOLIN DUCT

Question 19

What is Sialorrhoea & what is its cause?

Answer 19

increased salivary flow 
due to: 
- drugs 
- cerebral palsy 
- physically handicapped person
- children 
- psychiatry patients

Question 20

What is Xerostomia & what are its causes?

Answer 20

decreased salivary flow 
due to:
- post-menopause 
- depression 
- dehydration
- use of anti-depressant drugs
- anticholinergic drugs 
- Sjogren's syndrome 
- radiotherapy to head & neck

Question 21

What are the causes of acute sialadenitis?

Answer 21

STASIS -> dehydration & reduced salivary flow
-> obstruction of duct by stone or stricture

lack of oral hygiene

after major surgery, radiotherapy for oral malignancies

infection -> staph
-> mumps (common in parotid)

Question 22

What are the 2 presentations of acute sialedenitis?

Answer 22

1- acute submandbular sialadenitis

2- parotid abscess (acute suppurative parotitis)

Question 23

What is the presentation of acute submandibular sialedenitis?

Answer 23

• fever & toxemia
• pain, swelling, tenderness in submandibular region
• duct is inflamed & swollen

Question 24

What is the presentation of a parotid abscess?

Answer 24

• severe agonizing pain
• pyrexia, malaise, & trismus
• tender lymph nodes in the neck
• bacteremia if severe
• PUS or CLOUDY TURBID SALIVA expressed from parotid duct opening

Question 25

What is the first line of investigation in case of acute sialedenitis?

Answer 25

- neck & parotid ultrasound

Question 26

What investigations should be performed incase of acute sialedenitis?

Answer 26

- neck & parotid ultrasound - needle aspiration from the abscess (to confirm formation of pus) - Sialogram is CONTRAINDICATED in acute phase (will cause retrograde infection leading to bacteremia)

Question 27

How should the approach of treatment be decided?

Answer 27

before or after suppuration BEFORE -> conservative AFTER -> surgery (incise & drain)

Question 28

What are the causes of acute parotitis?

Answer 28

- mumps (self limiting painful parotid enlargement with fever) - staph aureus - endemic: parasitic infestation & protein malnutrition (bilateral parotid enlargement) - Sjogren's syndrome (bilateral parotitis) - allergic, HIV, radiotherapy, syphilis

Question 29

What is the most important factor in developing chronic sialadenitis?

Answer 29

presence of stone

Question 30

What are the symptoms of chronic sialedenitis?

Answer 30

- pain & swelling below the mandible (increases with meals) | - pain radiates to tongue (irritation of lingual nerve)

Question 31

What are the signs that confirm chronic sialedenitis?

Answer 31

- salivary colic: induced by meals & lemon juice - increased salivary secretions during mastication causes increased size of gland - Firm & tender swelling is palpable bidigitally & can't be rolled - stone is palpable in the floor of the mouth with inflammation & pus - Lingual colic: irritation of lingual nerve causes referred pain in the tongue

Question 32

What is the DD of chronic sialedenitis?

Answer 32

- submandibular lymphadenitis | - salivary neoplasm

Question 33

What investigations should be preformed to confirm diagnosis of chronic sialedenitis?

Answer 33

- intra oral X-ray (dental occlusion films) to see stones - ultrasound - FNAC of the gland to rule out other pathology

Question 34

How should chronic sialedenitis be treated?

Answer 34

NO STONE: conservative | STONE: submandibular sialedectomy

Question 35

What are the indications of submamndibular sialedectomy

Answer 35

- presence of stones - presence of tumor - recurrent severe condition

Question 36

What divides the submandibular gland into 2 parts?

Answer 36

mylohyoid muscle

Question 37

Where does salivary calculus most commonly occur?

Answer 37

in submandibular gland - due to its anatomy (against gravity) - because it has mucinous secretions - opening lies in the floor of the mouth so it gets obstructed by food particles

Question 38

What are the causes of salivary calculus?

Answer 38

- stasis | - infection (nucleus, exudate for sticking food particles, change saliva PH)

Question 39

What are the complications of salivary calculus?

Answer 39

- sialadenitis - sialectasis - fistula

Question 40

What investigations should be done for salivary calculus?

Answer 40

- x-ray -> stones - ultrasound -> chronicity - Sialography

Question 41

How is the treatment of salivary calculus decided?

Answer 41

according to the site of the stone: in DUCT: extraction from oral cavity In GLAND: submandibular sialadenectomy OR superficial conservative parotidectomy

Question 42

What is sialosis?

Answer 42

enlargement of salivary gland due to fatty infiltration | bilateral diffuse enlargement of parotid glands

Question 43

aspetic dilatation of salivary ductules cause grape-like dilatations is known as?

Answer 43

Sialectasis

Question 44

What are the causes of sialectasis?

Answer 44

- childhood type: familial | - adult type: secondary to Sjogren syndrome OR jobs that require chronic increase in intraoral pressure

Question 45

What is the clinical picture of sialectasis?

Answer 45

- painless smooth, soft swelling - increases in size during mastication - repeated attacks of infection

Question 46

What investigation is diagnostic incase of sialectasis? How should it be treated?

Answer 46

SIALOGRAM: shows grape-cluster like dilatations - treat conservatively but excision can be done in complicated cases

Question 47

What are the causes of a parotid fistula?

Answer 47

- after drainage or rupture of parotid abscess - after superficial parotidectomy - after biopsy or trauma - malignancy

Question 48

What are the clinical features of a parotid fistula?

Answer 48

- discharging fistula in parotid region with increased discharge during eating - tenderness, induration, & trismus

Question 49

What investigations should be performed for diagnosis of parotid fistula?

Answer 49

- sialography: to find out origin of fistula (from duct opening) - CT fistulogram: from fistula opening - discharge study - mri

Question 50

How should a parotid fistula be treated?

Answer 50

- Anticholinergics: decrease discharge - radiotherapy: destroy acini - surgical repair

Question 51

What is Sjogren's syndrome?

Answer 51

autoimmune disorder typically occurring in women where immune cells attack exocrine glands (salivary & lacrimal glands) resulting in KERATOCONJUCTIVITIS SICCA (dry eyes) & XEROSTOMIA (dry mouth)

Question 52

What are the types of Sjogren's syndrome?

Answer 52

PRIMARY - not associated with connective tissue disorders SECONDARY - associated with connective tissue disorders like - Primary biliary cirrhosis, SLE, & rheumatoid arthritis