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Year 4, Sem 2 > Week 5 Thomson- Salivary Gland Disorders > Flashcards

Week 5 Thomson- Salivary Gland Disorders Flashcards

1
Q

Where does the submandibular gland lie?

A

Submandibular gland is in submandibular triangle and hugs back of mylohyoid muscle. Deep part of submandibular gland is in the back of mouth. Wharton’s duct runs over/through sublingual gland and opens in anterior FOM.

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2
Q

What can swellings on palate or lip possibly be?

A

Minor salivary gland swellings or tumours

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3
Q

What are the contributions of saliva from each saliva gland?

A

75% submandibular gland

25% parotid gland

5% sublingual gland

5% Sublingual Gland

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4
Q

How much saliva is produced per day?

A

1-1.5L/day

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5
Q

What are the resting and stimulated saliva flow rates?

A

Resting SFR: 0.25ml/L

Stimulated SFR: 1ml/min

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6
Q

What is xerostomia?

A

Subjective sensation of dry mouth

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7
Q

What are signs/symptoms with xerostomia? Who is most likely affected?

A
  • Females / Elderly
  • Difficulty in Chewing & Swallowing
  • Erythematous & Atrophic Oral Mucosa
  • Lobulation & Depapillation of Tongue
  • Dental Caries
  • Oral Candidiasis / Angular Cheilitis
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8
Q

What are examples of primary salivary gland pathology?

A
  • Aplasia
  • Excision/irradiation
  • Infection/obstruction
  • Sjogren’s syndrome
  • Sarcoid
  • HIV
  • Cystic fibrosis
  • Primary Biliary Cirrhosis
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9
Q

What are secondary (systemic disease) causes of xerostomia?

A
  • Fluid/electrolyte imbalance
  • Neurological
  • Anxiety
  • Drug therapy
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10
Q

What are drug therapies that can cause xerostomia?

A
  • Antihistamines
  • Antidepressants
  • Antipsychotics
  • Anti-cholinergics
  • Diuretics
  • Narcotics
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11
Q

What are non-neoplastic causes of salivary gland disease?

A
  • Developmental
  • Obstructive
  • Inflammation
  • Trauma
  • Ischaemia
  • Infections
  • Autoimmune
  • Sialosis
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12
Q

What are symptoms of mumps?

A
  • Sudden parotid swelling, ear lob lift up
  • Painful
  • Bilateral swelling of submandibular glands
  • Orchitis (testicular swelling)
  • Most commonly caused by paramyxovirus
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13
Q

What are acute inflammatory salivary gland swellings?

A

Acute sialadenitis

  • Viral (mumps)
  • Suppurative
  • Granulomatous
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14
Q

What are recurrent salivary gland swellings?

A
  • Salivary Calculi
  • Papillary obstruction (acute ulcerative or chronic fibrosis)
  • Duct stricture
  • Punctate sialectasis
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15
Q

What is duct stricture?

A

Following papillary obstruction (irritation from denture clasp or tooth etc) there can be narrowing of the salivary duct with scarring.

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16
Q

What are characteristics of punctate sialectasis?

A
  • Swollen submandibular glands
  • Damage to acinar structure of salivary gland
  • Can develop recurrent mumps infections
  • Snow storm appearance
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17
Q

What are persistent diffuse salivary gland enlargements?

A
  • Sjogren’s syndrome
  • Sialosis
  • Sarcoidosis (infiltration with proteins and granulomatous tissue)
18
Q

What are salivary disease nodular enlargements?

A
  • Neoplasm (parotid tumour)
  • Lymph node
  • Cyst
19
Q

What is Primary Sjogren’s Syndrome (sicca syndrome)?

A

Salivary and lacrimal glands affected

20
Q

What is secondary sjogren’s syndrome?

A
  • Salivary + lacrimal glands + connective tissue/autoimmune disease
  • Rheumatoid arthritis or systemic lupous erythematous
21
Q

What is sjogren’s syndrome?

A

Chronic multisystem autoimmune exocrinopathy commonly found in middle aged/elderly females.

Body reacts against exocrine glands. Long term syndrome

22
Q

What are symptoms of sjogrens syndrome?

A
  • Persistent xerostomia
  • Persistent xerophthalmia (dry, gritty eyes, keratoconjunctivitis)
  • Salivary and lacrimal gland enlargement
  • Parotitis
  • Bilateral parotid gland swelling
23
Q

What are investigations for sjogren’s syndrome?

A

Unstimulated total SFR <1.5ml in 15 mins

Imaging- sialography

Labial gland biopsy- punctate sialectasis (snow storm appearance)

Blood tests

Schirmir test

24
Q

What does labial gland biopsy histopathology show in pt with sjogren’s syndrome?

A
  • Focal lymphocytic infiltrate replaces salivary acini
  • Acinar atrophy and destruction
  • Risk of lymphoma (rubbery hard nodules- look out for these!)
25
Q

What does blood test show in pt with sjogren’s syndrome?

A

Increased:

  • ESR
  • Anti-RO and Anti-La antinuclear antibodies
  • Rheumatoid factor
26
Q

What is Schirmer test?

A

Blotting paper test for tear production <5mm/5 mins

27
Q

What is the management for sjogren’s syndrome?

A

Salivary gland damage is irreversible

  • Symptomatic relief
  • Saliva stimulants (pilocarpine- stimulates saliva but side effects, artificial saliva substitutes)
  • Caries control
  • Management of oral infection and candidiasis
  • Regular parotid gland exam
  • Ophthalmology
  • Rheumatology
28
Q

What are symptoms of benign salivary gland tumours?

A

Slowly enlarging symptomless lump (unless impinging)

29
Q

What are symptoms of malignant salivary gland tumours?

A
  • Rapid enlargement
  • Pain
  • Bone destruction
  • Trismus
  • Facial paralysis
  • Ulceration
30
Q

What are some benign salivary gland tumours?

A
  • Pleomorphic salivary adenoma
  • Adenolymphoma
  • Adenoma
31
Q

Where are salivary gland tumours most common and which are most likely to be malignant?

A

75% parotid (80% benign- of these 80% PSA)

15% submandibular gland (60% benign- of these 95% PSA)

10% minor salivary glands (40% benign)

32
Q

What are examples of malignant salivary gland tumours?

A
  • Mucoepidermoid carcinoma
  • Acinic cell carcinoma
  • Adenoid cystic carcinoma
  • Adenocarcinoma
  • Carcinoma ex PSA
33
Q

What are signs/symptoms of pleomorphic salivary adenoma?

A
  • Benign but can occasionally undergo malignant change
  • ‘Mixed Tumour’ arising from duct epithelium or myoepithelial cells
  • Rubbery, lobulated swellings, slowly grow to great size
  • Removing PSA from parotid gland puts facial nerve at risk.
  • More common in females
  • Incomplete capsule
  • Squamous metaplasia & keratin foci
34
Q

What are adenoid cystic carcinomas?

A
  • Slow growing malignant tumour with late metastases
  • Characteristic cribriform or swiss cheese histological appearance
  • Bony invasion and infiltration along nerve sheaths
35
Q

What is papillary obstruction caused by?

A

Denture clasp or tooth can cause trauma to stensons duct papilla. Can lead to duct stricture

36
Q

If a pt comes in with swelling around angle of md what could it be?

A
  • Ameloblastoma
  • Parotid tumour (tends to raise the lobe of the ear)
37
Q

Where does accessory parotid gland lie?

A

Sits along parotid duct (swelling would be more prominent in cheek/buccinator)

38
Q

What type of saliva come from the salivary glands?

A

Parotid: seroud

Submandibular: mixed- mainly serous

Sublingual: mainly mucous

39
Q

Where are most minor salivary glands present?

A

Vault of palate

Tongue

Lips

40
Q

What is sialosis?

A
  • Non-neoplastic and non-inflammatory enlargement of salivary glands.
  • Lack of function
  • Can arise in patients with eating disorders, diabetes or HIV.
41
Q

What is the most common recurrent salivary gland swelling?

A

Sialolithiasis/salivary calculi

42
Q

What could bilateral parotid gland swelling also look like?

A

Larger underlying md bone (ramus and angle)

Bilateral masseter hypertrophy

Year 4, Sem 2 (38 decks)

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