Surgical Considerations for Salivary Pathologies

Question 1

We produce _____ of saliva daily

Answer 1

500-1500ml

Question 2

Viscosity of Parotid secretions

Answer 2

watery

Question 3

Viscosity of Submandibular

Answer 3

Semiviscous

Question 4

Viscosity of Sublingual

Answer 4

Viscous

Question 5

Viscosity of Minor glands

Answer 5

Viscous

Question 6

Which gland produces the most saliva daily?

Answer 6

Submandibular

Question 7

Surgical concerns by parotid gland

Answer 7

Facial nerve, mastoid

Question 8

Surgical concerns in Submandibular gland

Answer 8

Marginal mandibular nerve, lingual nerve, hypoglossal nerve, facial artery

Question 9

Surgical concerns in sublingual gland

Answer 9

Lingual nerve, submandibular duct

Question 10

Surgical concerns in minor salivary glands

Answer 10

Dependent on location, oral cavity, pharyngeal, sinus/skull base

Question 11

Acute sialadenitis most commonly

Answer 11

Parotitis

Question 12

Chronic sialadenitis most commonly occurs in

Answer 12

Submandibular gland due to position of gland

Question 13

Risk factors of sialadenitis

Answer 13

dehydration, immobility, immunocompromised state

Question 14

Acute tx of sialadenitis

Answer 14

antibiotics and gland massage

Question 15

Surgical intervention reserved for acute infections with

Answer 15

abscess

Question 16

Salivary stones most common in

Answer 16

Submandibular gland

Question 17

Salivary stones are made up of

Answer 17

Calcium phosphate+glycoproteins/mucopolysaccharides

Question 18

Salivary stone clinically present as

Answer 18

recurring episodes of swelling and pain associated with meals

Question 19

Imaging for salivary stones

Answer 19

CT, MRI, Ultrasound

Question 20

_____ stones may be radiolucent on xray

Answer 20

Parotid

Question 21

MRI sialography used more often than ____

Answer 21

digital

Question 22

Stone tx

Answer 22

• small stones may be expressed by palpation
• transoral: <2 cm from Wharton’s duct (do not need to close), Parotid stones medial to masseter (stenting often required due to stenosis
• Larger, proximal stones require gland removal

Question 23

Useful technique for chronic sialoadenitis and small stones.

Answer 23

Sialoendoscopy

Question 24

Size of stone scopes

Answer 24

0.8-1.6mm

Question 25

Techniques for stone scopes

Answer 25

- Irrigation of gland - Steroid irrigation - Stricture dilation - Basket retrieval - Drills/Laser

Question 26

Pseudocyst arising from sublingual gland extending into submandibular space via defect in mylohyoid

Answer 26

Plunging ranula

Question 27

Plunging ranula tx

Answer 27

Transoral resection of sublingual gland (Avoid transcervical approach)

Question 28

Parotid tumors are

Answer 28

75% benign

Question 29

Most common parotid salivary gland tumor

Answer 29

pleomorphic adenoma

Question 30

T or F: Increasing incidence of malignancy with decreasing gland size

Answer 30

T (85% of minor salivary gland tumors are malignant)

Question 31

Salivary tumors are

Answer 31

slow-growing and painless

Question 32

_____ suggest malignancy

Answer 32

pain, numbness, nerve weakness

Question 33

Fine needle aspiration has a ___ false negative rate

Answer 33

5%

Question 34

Incision for parotidectomy

Answer 34

Modified Blair or Facelift incision

Question 35

Parotidectomy can cause facial nerve injury and is permanent in ___ of cases

Answer 35

4%

Question 36

Parotidectomy may cause

Answer 36

greater auricular nerve injury, salivary fistula, Frey's syndrome and first bite syndrome.

Question 37

Frey's syndrome happens in 35-60% of cases and is

Answer 37

gustatory sweating

Question 38

Encapsulated, 25% with pseudopodia or satellite lesions, 10-12 % isolated deep lobe/parapharyngeal tumors

Answer 38

Pleomorphic adenoma

Question 39

Need to take a cuff of parotid tissue. Tissue spillage may lead to recurrence years later.

Answer 39

Pleomorphic adenoma

Question 40

1.5% malignant transformation at 5 years (10% if >15 years)

Answer 40

Pleomorphic adenoma

Question 41

Bilateral, multifocal with no malignant potential

Answer 41

Warthin's tumors

Question 42

___ are suspected is deep to retromandibular vein on CT

Answer 42

Deep lobe tumors

Question 43

Transparotid approach of deep lobe tumors

Answer 43

High incidence of neuropraxia, often able to spare superficial lobe for facial contour, higher incidence of first bite syndrome

Question 44

Facial nerve grafts grow about ___ per day

Answer 44

1mm

Question 45

Management of eye lip with

Answer 45

lateral tarsal strip

Question 46

Painless facial paralysis over 48-72 hours

Answer 46

Bell's palsy

Question 47

Facial paralysis with parotid tumor

Answer 47

Malignancy

Question 48

Careful dissection around tumor with cuff of normal parotid without facial nerve identification.

Answer 48

Extracapsular dissection

Question 49

Safe submandibular gland removal involves protection of the ____ and _____

Answer 49

marginal mandibular nerve, lingual nerve

Question 50

In parotidectomy, every effort should be made to preserve the ____ nerve, even in malignancy

Answer 50

facial

Question 51

____ nerve weakness signals malignanct

Answer 51

facial

Question 52

In cases of skull base proximity or perineural invasion, ____________consultation is necessary.

Answer 52

neurotologic and/or neurosurgical

Question 53

Minor salivary gland malignancy may occur anywhere in the upper aerodigestive tract and is treated with _____

Answer 53

complete surgical resection

Question 54

Neck dissection is recommended for

Answer 54

high grade histologies, clinically positive nodes, and advanced T stage

Question 55

Multidisciplinary care is often needed for treatment of

Answer 55

Salivary cancers

Question 56

small stones may be treated with

Answer 56

trans-oral cut-down or sialadenoscopy

Question 57

Larger, intraglandular stones require _____ of the gland

Answer 57

removal

Question 58

Plunging ranula is treated by _____ of the sublingual gland transorally, despite the location of the pseudocyst in the submandibular triangle

Answer 58

resection