Throat- swallowing --> salivary glands Flashcards by Izzy Burns

4 stages of swallowing

Oral preparatory phase
Oral phase
Pharyngeal (invol, CNIX)
Oesophageal phase

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Oral preparatory phase of swallowing

Grinding of control

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Oral phase of swallowing

Tongue pushes food bolus towards oropharynx

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Pharyngeal phase of swallowing

Soft palate elevates + closes nasopharynx

Pharyngeal constrictor mm contracts from top to bottom, squeezing bolus inferiorly

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Oesophageal phase of swallowing

Bolus enters upper oesphageal sphincter
Cricopharyngeus relaxes
Peristalsis - food towards LOS

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Dysphagia pattern in malignant lesions

S –> L over w/m

+ W loss

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Dysphagia pattern in achalasia/pharyngeal pouch

Slow over years

+ regurg of undigested food

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Causes of aspiration (4)

Altered sensation to pharynx centrally
‘’ ‘’ pharynx peripherally (post radiotherapy)
Delays initiation of swallow + food slips in
Neuro/neoplasia –> faults in larynx

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What is acute dysphagia usually caused by?

Foreign bodies

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If Dysphagia has been occuring for >3 weeks - what investigations should be done?

TNO/FNE

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What Ix is good for pharyngeal pouches

Contrast studies

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What Ix is good for anatomy + coordination of phases of swallowing

Videofluroscopy

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What is Prebysphagia

Decreased ability to swallow with age

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Cause of prebysphagia

Decreased mm mass and strength

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PS Prebysphagia (2)

Chronic dysphagia + malnutrition

Aspiration

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Tx Presbysphagia (2)

Change consistency of food

Swallowing therapy

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Globus pharyngeus

Sensation of lump/tightness in throat w/ no organic cause

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Causes globus pharyngeus (2)

Inflamm larynx/hypopharynx

Psychogenic/depression

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What is a pharyngeal pouch?

Natural area of weakness in hypopharynx

Posteromedial herniation betw thyropharyngeus + cricopharyngeus

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How is a pharyngeal pouch distinguishable on examination?

Large midline lump that gurgles on palpation

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Who gets pharyngeal pouches?

Elderly men

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Sx pharyngeal pouch (5)

Progressive dysphagia 
W loss 
Regurg of undigested food 
Hallitosis 
Dysphagia 
Cough

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Tx pharnyngeal pouch

Endoscopic stapling

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Swallowing therapy interventions (2)

Head/body posture

Control of bolus flow

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Supraglottis

Above vocal chords | Including epiglottis + false VC

Inn supraglottis

Superior laryngeal nn

Glottis

True VC

Subglottis

From VC to trachea

Inn subglottis

Recurrent larygneal nn

Changes in vocal cords: Incr mass -->

Decr pitch of voice

Changes in vocal cords: Poor closure -->

Weak voice

Changes in vocal cords: Incr stiffness

Rough voice

Changes in vocal cords: Lesions on free edge

Irregular voice + breaking

How are the vocal cords examined?

FNE

How long does acute laryngitis last?

2 w

Tx acute laryngitis (4)

Fl Analgesia Anti-inflamm Dx Avoid using voice

RF Chronic Laryngitis

Smoking Alcohol Excessive use of voice

Mx Chronic Laryngitis (2)

SALT | Avoid RF

What can chronic laryngitis progress into?

Carcinoma

Causes of VC palsy (2)

Recurrent laryngeal nn Trauma Mediastinal mass/thyroid malig

Cause of vocal cord nodules

Recurrent trauma to edge VC | B/c XS voice production

Mx vocal cord nodules (2)

SALT | Rest voice

What is mm tension dysphonia?

Inco-ordination of laryngeal mm

Ix for all changes in voice

CXR/FNE

Red flags for voice (SCALD)

``` S- Smoker/stridor C - Consistent/cough blood A - Acute onset not related to URTI L - Loss of W D - Dyspnoea + dysphagia ```

The 3 groups of Voice Treatment

Voice therapy Medical therapy Surgical therapy

Voice therapy (4)

Vocal hygiene Lubrication Hydration Advice on caffiene/alcohol

Medical therapy voice (3)

ABx Anti-reflux meds Botox for spasmodic dysphonia

Surgical therapy for voice

Endolaryngeal surgery w/ laser

Which major salivary gland are most of the tumours in?

Parotid

Is Parotid mucous or serous

Serous

Name of Parotid duct

Stenson's duct

Where does Stenson's duct enter the mouth?

Level of 2nd upper molar

Which major salivary gland are most of the stones formed?

Submandibular gland

Is Submandibular gland mucous or serous?

Both

Name of Submandibular duct

Whartons

Where does Whartons duct enter the mouth

Either size of frenulum

Where is the sublingual gland?

Lines the floor of the mouth

Is the sublingual gland mucous or serous?

Mucous

Salivary stimuli (5)

``` Smell Taste Psychic stimuli Chewing/mastication Parasymp Dx - pilocarpine ```

Xerostomia

Dry mouth

Common causes of Xerostomia (6)

``` Depression Anxiety Drugs with antimuscarinic activity Drugs with sympathomimetic activity Sjorgren's syndrome Radiothearpy H+N region ```

Drugs with antimuscarinic properties that can cause xerostomia (7)

``` Atropine Ipratropium TCAs MOAIs Phenothiazines Anti-parkinson drugs AntiH ```

Drugs with sympathomimetic activity that can cause xerostomia (3)

Cold cures/decongestants Bronchodilators Appetite suppressants

What is the most common cause of bilateral parotid enlargement?

Mumps

Other causes of parotitis (apart from mumps) (4)

HIV Bacterial - staphy Fungal Sarcoid

Sialadenitis

Acute infection of partoid/SM gland

Sx Sialadenitis (6)

``` Pain Pyrexua Swollen glands Pus @ opening parotid ducts --> bad taste SM - swollen floor of mouth Less saliva ```

Who gets Sialadenitis?

Old patients w/ poor dental hygiene

Tx Sialadenitis (3)

High dose ABx Rehydration Oral care

Sialoithiasis

Formation of stones in salivary glands

Which gland does Sialolithiasis tend to occur?

SM glands

S+S Sialolithiasis (4)

Colicky pain Postprandial swelling Gland swollen Gland tender

Tx Sialolithiasis (2)

Fl | Sialogues

1' Sjorgens syndrome

Dry eyes + dry mouth

2' Sjorgens syndrome

Dry eyes + Dry mouth | CT disease

3 + 4 Sjorgens

``` 3 = Benign lymphoepithelial lesion 4 = Aggressive lymphocytic behaviour confined to parotid glands ```

Sx Sjorgens (4)

Dry eyes Keratoconjunctivitis Chronic hepatitis Vasculitis

Why does Sjorgen's syndrome occur?

Loss of suppressor T cell activity

Ix Sjorgens syndrome (3)

HLA/AI/DR3 Specific antigens - SSB/SSA Labial biopsy = diagnostic

Risks of having Sjorgens syndrome

1/6 --> Non-Hodgkins B cell lymphoma

Tx Sjorgens (2)

Steroids | Artificial tears, saliva, lubricants

Where are the majority of benign salivary gland tumours found?

Parotid gland

Which salivary glands has the highest % of being malignant?

Minor salivary glands

RF Benign salivary gland tumours

Previous radiation

What is the most common type of benign salivary gland tumour?

Pleomorphic adenoma

Where do you tend to find pleomorphic adenomas?

Parotid gland

Can pleomorphic adenomas become malignant?

Yes, over many years (only 10%)

Ix Pleomorphic adenoma

FNAC/CT

Tx Pleomorphic adenoma

Surgical excision

Where are Warthins tumours found

Partoid tails bilaterally

Who gets Warthin's tumours

Old men

Tx Warthins tumours

Surgical excision

How do malignancies in the salivaries glands present? (3)

Rapid growing Painful Involving other structures e.g. facial palsies

Features of high grade muco-epidermoid tumours

Painful Fully invasive Rapid growth

Mets for mucoepidermoid tumours (4)

Lungs Brain Bone Local lymph

Which gland is the majorty of muco-epidermoid tumours in?

Parotid

Tx low grade muco-epidermoid tumour

Local resection

Tx - high grade muco-epidermoid tumour

Radical neck dissection + radiotherapy

Prognosis Muco-epidermoid tumours

30% recurrence :(

Where are 99% of Acini cell tumours?

Parotid gland

Tx Acini cell tumours

Resection | Preserve CN 7

What is the most common salivary gland malignancy?

Adenoid cyst carcinoma

How does Adenoid cyst carcinoma spread?

Gradually | Invading extensively w/ infiltration along nn

Tx Adenoid cyst carcinoma

Radical excision | Radiotherapy

Prognosis Adenoid cyst carcinoma

15%

What is the most common type of lymphoma in salivary glands?

Non-Hodgkin's lymphoma

PS lymphoma in salivary glands (3)

Firm mass Rapidly enlarging Occasional LN met s

How would you diagnose a lymphoma/

Biopsy

Tx - Malignant salivary gland tumours

Partial superficial parotidectomy | Submandibular gland excision

Throat- swallowing --> salivary glands Flashcards

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