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DS4102 > W5 - Salivary Gland Disorders - Thomson > Flashcards

W5 - Salivary Gland Disorders - Thomson Flashcards

(58 cards)

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1
Q

What are the 4 salivary glands

A
  1. Parotid
  2. Submandibular
  3. Sublingual
  4. Minor salivary glands
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2
Q

What type of saliva does the parotid, submandibular and sublingual glands produce, respectively?

A

Parotid - Serous

Submd - Mixed (10% mucinous)

Subling - Mixed (10% serous)

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3
Q

Where does the majority of saliva come from? (glands)

A

Submandibular (75%)

Parotid (25%)

Sublingual (5%)

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4
Q

Problems that salivary hypofunction / xerostomia cause (5)

A

Difficulty chewing and swallowing

Erythematous & atrophic oral mucosa

Lobulation & depapillation of tongue

Caries

Oral candidiasis / angular cheilitis

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5
Q

Primary causes of xerostomia (salivary gland pathology) (6)

A 
Aplasia (missing gland)
Excision / irradiation
Infection / obstruction
Sjogrens
HIV
Cystic Fibrosis
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6
Q

Secondary causes of xerostomia (4)

A

Anxiety
Neurological
Drug therapy
Fluid / electrolyte imbalance

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7
Q

What type of drugs cause xerostomia? (5)

A

antihistamines

antidepressants

antipsychotics

anti-cholinergics

diuretics

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8
Q

How can salivary gland diseases be classified (2)

A

Neoplastic

non neoplastic

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9
Q

Reasons for non-neoplastic salivary gland disease (7)

A 
Developmental
Obstructive
Inflammation
Ischaemic
Trauma
Infection
Autoimmune
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10
Q

4 classifications of salivary disease clinical presentation + examples

A
  1. Acute inflammatory swellings (acute sialadenitis)
  2. Recurrent swellings (sialolith)
  3. Persistent diffuse enlargement (sjogrens)
  4. Nodular enlargement (neoplasm, cyst, lymph node)
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11
Q

Synonym for sialolith

A

Salivary calculi

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12
Q

4 reasons for recurrent swelling of salivary gland

A
  1. Salivary calculi
  2. Papillary obstruction
  3. Duct Stricture
  4. Punctate sialectasis
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13
Q

What is acute sialadenitis? 3 types?

A

Infection causing acute inflammatory swelling

  1. Viral (mumps)
  2. Suppurative
  3. Granulomatous
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14
Q

3 reasons for persistent diffuse enlargement of salivary glands

A

Sjogrens syndrome

Sialosis

Sarcoidosis

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15
Q

What is sjogrens syndrome?

A

Chronic multisystem autoimmune exocrinopathy

  • affects middle aged / elderly females
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16
Q

2 types of sjogrens syndrome

A

Primary “Sicca syndrome” - salivary and lacrimal glands affected

Secondary - salivary/lacrimal glands, + connective tissue/autoimmune disease
- Rheumatoid arthritis, Systemic lupus erythematous

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17
Q

Features of sjogrens syndrome (4)

A

Persistent xerostomia - dry mouth, caries, depapillated tongue, etc.

Persistent xeropthalmia - dry eyes

Salivary and lacrimal gland enlargement

Parotitis - swollen parotid

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18
Q

Investigations / tests for sjogrens (5)

A

Unstimulated SFR - <1.5mL in 15 min

Sialography imaging

Labial gland biopsy

Schirmer test - tear production <5 mm / 5 min

Blood test - Rheumatoid factor, Anti-Ro, Anti-La antibodies

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19
Q

What is this

A

Sialography test for investigating sjogrens syndrome

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20
Q

What dangerous thing can histopathology show about sjogren syndrome?

A

Lymphocyte infiltration within intra-glanular septa, acinar atrophy and destruction -> risk of LYMPHOMA

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21
Q

Management of sjogrens syndrome

A

Keep in mind that salivary gland damage is irreversible -> focus on symptomatic relief

Biotene

Caries control

Management of infection and candidiasis

Regular parotid gland examination

Visits with opthamology and rheumatology

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22
Q

Benign vs malignant salivary gland tumour symptoms

A

Benign: slowly enlarging, symptomless lump

Malignant: 
Rapid enlargement
Pain
Ulceration
Bone destruction
Trismus
Facial paralysis
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23
Q

Pt says this has been growing slowly. Feels no pain

A

Benign salivary gland tumour

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24
Q

Pt says this has grown quickly, is painful, difficulty opening mouth

Study These Flashcards
A

Malignant submandibular salivary gland tumour

25
3 types of benign salivary gland tumour
Pleomorphic salivary adenoma Adenoma Adenolymphoma aka Warthin's tumour
26
5 examples of malignant salivary gland tumours
``` Mucoepidermoid carcinoma Acinic cell carinoma Adenoid cystic carcinoma Adenocarcinoma Carcinoma ```
27
What is the most common salivary gland tumour
75% Parotid (80% of these are benign) 15% Submandibular (60% benign) 10% Minor salivary glands (40% benign)
28
Features of pleomorphic salivary adenoma
"Mixed tumour" that makes up the majority of salivary gland tumours - Arising from duct epithelium or myoepithelial cells - Incomplete capsule with ductal, fibrous, elastic and cartilage tissue - Rubbery, lobulated swellings that slowly grow - Squamous metaplasia and keratin foci - Occasionally turns malignant
29
Pleomorphic salivary adenoma (PSA)
30
Features of adenoid cystic carcinoma (4)
- Slow growing malignant tumour - Late metastases - Bony invasion and infiltration along nerve sheaths - Cribiform "swiss cheese" histological appearance
31
Adenoid cystic carcinoma - bony invasion and infiltration along nerve sheaths "Swisscheese" cribiform histological appearance
32
How to investigate sus salivary glands (8)
1. Clinical exam / palpation 2. Salivary flow rate 3. Radiography 4. Ultrasound 5. Sialography 6. CT / MR scan 7. Scintiscanning 8. Sialadenoscopy
33
salivary gland pathology | - stone, tumour
34
salivary gland pathology
35
6 types of salivary gland surgery
1. Removal of calculi 2. Ductal repositioning 3. Excision of sublingual gland 4. Excision of submandibular gland 5. Parotidectomy (superficial, total) 6. Excision of minor salivary gland lesions / tumours
36
What important structures run through the parotid (5)
1. Facial nerve 2. Auriculotemporal nerve 3. External carotid 4. Retromandiular vein 5. Stylomandibular ligament
37
"Snowstorm appearance" - Sjorgrens syndrome S & S
38
Sialography Interruptions / holes in line (radiopaque dye) indicate presence of calculi
39
What are MR scans useful for?
Soft tissue evaluation | - not as good for bone
40
How does salivary gland scintiscanning work?
Demonstrates uptake and distribution of isotope - Assess salivary gland function - Demonstrates tumour formation
41
What is likely the cause of recurrent swelling during meal times
Sialolith
42
What sizes of sialolith can be removed by sialendoscopy? (3)
3-4mm - endoscopy 5-7mm - laser / lithotripsy >8mm - combined technique
43
Ranula | - fluid collection / cyst under the tongue
44
What is the problem with sublingual gland cyst surgery / ranula removal
Will also need to remove sublingual gland in addition to ranula - If you just remove the cyst, will likely return
45
What nerves can be affected by submandibular gland pathology
Hypoglossal nerve - motor supply to muscles of tongue Lingual nerve
46
Submandibular gland swelling
47
Sebaceous cyst / epidermoid cyst - Connected to skin - NOT in submandibular gland triangle thus cannot be submandibular swelling/pathology
48
Why do we cut here? (dotted line)
Avoids the marginal mandibular branch of the facial nerve
49
What is this and what went wrong
Mandibular branch of facial weakness - Surgeon did not cut two finger widths below md, knicked the nerve Should have cut like this pic
50
What does the auriculotemporal nerve innervate
TMJ and skin of ear lobe | - runs through parotid
51
Facial nerve palsy
52
What is freys syndrome
When auriculotemporal nerve is injured due to trauma from surgery near parotid Every time the patient salivates, sweat is also produced on the surface
53
Lump in the upper lip vs lower lip consideration
Be very wary - could be malignant tumour if in upper lip 38 min Lower lip lump more likely to be benign tumour
54
Mucocele or benign minor salivary gland tumour
55
Palatal swelling showing signs of potentially malignant tumour
56
Adenoid cystic carcinoma "swiss cheese histologic appearance" - malignant in this picture, dentist had extracted tooth bc they thought swelling was abscess. after the tooth healed the palatal swelling became ulcerated
57
"swiss cheese appearance" of adenoid cystic carcinoma | - malignant
57
"swiss cheese appearance" of adenoid cystic carcinoma | - malignant

DS4102 (37 decks)

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