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Salivary Gland Pathologies

Salivary Gland Pathologies. Dave Pothier St Michael’s 2004. Anatomy. 3 pairs of (groups) of glands Parotid Submandibular Sublingual. Anatomy. Parotid In cheek and behind angle of mandible Stenson’s duct to inner cheek. Anatomy. Anatomy. Submandibular Medial to mandible

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Salivary Gland Pathologies

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  1. Salivary Gland Pathologies Dave Pothier St Michael’s 2004

  2. Anatomy • 3 pairs of (groups) of glands • Parotid • Submandibular • Sublingual

  3. Anatomy Parotid In cheek and behind angle of mandible Stenson’s duct to inner cheek

  4. Anatomy

  5. Anatomy Submandibular Medial to mandible Wharton’s duct around mylohyoid to either side of frenulum of tongue

  6. Anatomy

  7. Anatomy • Sublingual glands

  8. Pathologies • Congenital • Unusual • Atresia • Strictures • Aquired…

  9. Pathologies - Infective Parotitis: bacterial (staph, TB, actinomycoses) viral (mumps)

  10. Infective • Pus at duct opening • Tender, hot gland • IV Abx for bacterial infections • Cons Rx for viral

  11. Neoplastic It is benign or malignant? 50 / 50 split across all neoplasms Depends a lot on site…

  12. Neoplastic

  13. Parotid Rule of 80’s • 80% of parotid tumors are benign • 80% of parotid tumors are pleomorphic adenomas • 80% of salivary gland pleomorphic adenomas occur in parotid • 80% of parotid pleomorphic adenomas occur in the superficial lobe • 80% of untreated pleomorphic adenomas remain benign

  14. Types • Over 40 different types & grades! • Common Benign • Pleomorphic adenoma • Warthin’s tumour • Benign cyst • Common Malignant • Mucoepidermoid carcinoma • Adenocarcinoma • Acinic cell

  15. Approach to a lump • Hx General - eye + other sjogren’ signs - bulimia - TB etc

  16. Approach to a lump • Hx Specific - Duration of lesion Pain Neural symptoms

  17. Approach to a lump • Examination Look – skin, inside mouth Feel – mass: palpate, tenderness, bimanual - duct - for stones Neck

  18. Approach to a lump • Ix FNAB USS +/- MRI or CT

  19. Surgery • Benign disease: superficial parotidectomy • Malignant disease spectrum of surgery: Lesion + cuff radical parotidectomy + neck dissetion

  20. Complications • Scar, infection, bleeding, haematoma • VII nerve • Frey’s syndrome • Salivary fistula

  21. Sialolithiasis • Calculi in ducts • Recurrent swellings • Not infected • Tender, not hot • No pus at duct • Rx – cons/surgical

  22. Conclusions • Beware of non-parotid salivary swellings more than usual • Remember VII • Consent thoroughly for complications

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