Salivary Glands Overview

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Questions and Answers

Which statement accurately describes the attachment of the parotid gland?

It lies entirely within the neck without overlapping any muscles.

The anteromedial surface is related only to the medial pterygoid muscle.

The superficial surface lacks any connections to the facial nerve.

The posterior surface is related to the mastoid and attached muscles. (correct)

What is the primary distinction between the superficial and deep lobes of the parotid gland?

The deep lobe lies superficial to the facial nerve.

The superficial lobe is larger than the deep lobe.

The superficial lobe is covered by skin while the deep lobe is not. (correct)

The deep lobe is situated anteriorly compared to the superficial lobe.

What structure at the anterior aspect of the submandibular gland does the Wharton's duct cross?

It runs alongside the hypoglossal nerve.

It crosses over the lingual nerve twice. (correct)

It parallels the mylohyoid muscle without any crossing.

It directly connects to the facial nerve.

What separates the external carotid artery from the posterior surface of the parotid gland?

The styloid process and associated muscles. Signup and view all the answers

What type of gland is the submandibular gland classified as?

A mixed salivary gland. Signup and view all the answers

Which imaging technique is considered unreliable for assessing hot masses in salivary glands?

Sialography Signup and view all the answers

What is NOT a recognized complication following parotidectomy?

Hypothyroidism Signup and view all the answers

What characterizes the oral phase of swallowing?

Formation and transfer of the bolus Signup and view all the answers

Which condition is associated with a postcricoid web and iron deficiency anemia?

Plummer-Vinson syndrome Signup and view all the answers

Which imaging modality is less commonly indicated for patients with parotid disease following advances in technology?

Sialography Signup and view all the answers

Which of the following phases of swallowing is primarily involuntary?

Pharyngeal phase Signup and view all the answers

What is the most common benign tumour of the salivary glands and responsible for 70 percent of parotid tumours?

Pleomorphic adenoma Signup and view all the answers

Which salivary gland tumour is known to have a female to male ratio of 3:2 and typically occurs in the 5th decade of life?

Pleomorphic adenoma Signup and view all the answers

What is the rate of recurrence after superficial parotidectomy for pleomorphic adenoma?

5% Signup and view all the answers

What is the only well-documented risk factor for salivary gland cancer?

Ionizing radiation Signup and view all the answers

What percentage of malignant salivary gland tumours typically present with pain?

12-24% Signup and view all the answers

Which condition is linked to the compression of the esophagus by an anomalous arterial structure?

Dysphagia lusoria Signup and view all the answers

What is the preferred treatment for achalasia that involves muscle layer division?

Heller's cardiomyotomy Signup and view all the answers

Which of the following is a primary characteristic symptom of long-standing achalasia?

Regurgitation of undigested food Signup and view all the answers

Which non-invasive diagnostic test can visualize the pharyngeal pouch during assessment?

Barium swallow Signup and view all the answers

In which demographic is postcricoid carcinoma primarily found?

Females with Paterson-Kelly syndrome Signup and view all the answers

What may be indicated by symptoms of glossitis and koilonychias?

Esophageal webs Signup and view all the answers

Which characteristic finding is associated with carcinoma of the esophagus on imaging studies?

Irregular filling defect Signup and view all the answers

What is the gold standard treatment for a pharyngeal pouch?

Excision of the pouch via an external approach Signup and view all the answers

What is the implication of a solitary thyroid nodule associated with ipsilateral Horner's syndrome?

It can be a sign of malignancy with extra-thyroidal spread. Signup and view all the answers

In patients with multinodular goitre, how should a dominant nodule be approached for management?

It should be managed as if it were a solitary nodule due to potential malignant degeneration. Signup and view all the answers

What proportion of patients with malignant thyroid nodules are typically asymptomatic and euthyroid?

95% Signup and view all the answers

What is a critical limitation of fine needle aspiration (FNA) cytology in diagnosing thyroid lesions?

It cannot distinguish follicular adenoma from follicular carcinoma. Signup and view all the answers

What characteristic of nodules is highly suggestive of malignancy during a physical examination?

Nodules that are hard, gritty, or fixed to surrounding structures. Signup and view all the answers

Which radionuclide is primarily used for therapeutic purposes rather than for routine thyroid scanning?

I-131 Signup and view all the answers

What is the primary autoimmune disorder associated with hyperthyroidism that accounts for 85% of thyrotoxicosis cases?

Grave's Disease Signup and view all the answers

Which of the following treatments is usually not recommended for patients under 40 years with thyrotoxicosis?

Radioiodine 131 Signup and view all the answers

What effect does thyroxine supplementation have on hyperplastic areas of the thyroid gland in early goitre development?

It causes regression of hyperplastic areas Signup and view all the answers

Which of the following symptoms is commonly associated with Grave's Disease?

Tremors and palpitations Signup and view all the answers

Which thyroid complication is characterized by cystic degeneration and calcification in multinodular goitres?

Hyperplasia Signup and view all the answers

In the management of thyroid nodules, which symptom strongly suggests malignancy?

Vocal cord palsy on the same side as a thyroid nodule Signup and view all the answers

What should be the first consideration when a patient presents with a thyroid nodule and a history of radiation exposure?

Investigate for malignancy Signup and view all the answers

Which factor increases the risk of malignant thyroid nodules in men specifically?

Age and sex Signup and view all the answers

Which of the following forms of thyroid cancer is most commonly non-sporadic?

Medullary carcinoma Signup and view all the answers

What is a common effect of excessive thyroxine in the body?

Hypermetabolic symptoms Signup and view all the answers

Study Notes

Major Salivary Glands

Three main salivary glands: parotid, submandibular, and sublingual.
Hundreds of minor salivary glands are scattered throughout the oral cavity and nearby structures.

Parotid Gland

Largest salivary gland; serous in nature.
Three surfaces: anteromedial, posteromedial, and superficial (lateral).
Anteromedial surface envelops the ramus of the mandible, flanked by the masseter and medial pterygoid muscles.
Posteromedial surface associated with the mastoid, sternomastoid, and digastric muscle attachments.
Contains the external carotid artery and is distanced from the internal carotid artery and jugular vein.
Extends superiorly to the zygomatic arch and inferiorly into the neck, overlapping sternomastoid.
Divided into superficial and deep lobes by the facial nerve.

Submandibular Gland

Mixed gland, divided into superficial and deep lobes by mylohyoid muscle.
Lingual and hypoglossal nerves are closely associated with the gland.
Wharton's duct emerges from the deep lobe and crosses the lingual nerve.

Salivary Gland Tumours

Represent 3-6% of head and neck tumours, predominantly occurring in the parotid gland.
65-85% of salivary gland tumours are found in the parotid; 80% of parotid tumours are benign.
Racial tendencies: slight prevalence in African Americans compared to Caucasians.
Incidence of malignant tumours in Kingston, Jamaica: 1.2 per 100,000 males, 0.5 per 100,000 females.

Classification of Tumours

Parotid tumours categorized as epithelial (benign and malignant) or non-epithelial.
Benign epithelial examples: pleomorphic adenoma (70% of cases), Warthin's tumour.
Malignant types include mucoepidermoid carcinoma and acinic cell carcinoma.

Pleomorphic Adenoma

Most common benign tumour in salivary glands, more common in females.
Typically occurs in the 5th decade of life, slow-growing.
Malignant transformation observed in 2-10% of cases present for over 10 years.

Diagnosis of Tumours

Assess symptoms like mass presence, pain tied to inflammation, and potential facial nerve palsy.
Imaging techniques: X-rays (limited), CT, MRI, fine needle aspiration cytology (FA).

Management of Tumours

Surgical options include parotidectomy, radical neck dissection, and radiotherapy for aggressive types.
Complications of parotidectomy: facial nerve palsy, haemorrhage, Frey's syndrome.

Dysphagia

Defined as difficulty in swallowing, linked to various anatomical or neurological issues.
Oesophagus has three areas of narrowing related to swallowing.
Phases of swallowing: oral (voluntary), pharyngeal (complex), and oesophageal (peristaltic).

Classification of Dysphagia

Oral lesions: tumors of the tongue, inadequate saliva.
Pharyngeal lesions: tumors of the oropharynx, webs, and strictures.
Oesophageal lesions: strictures and tumors, both benign and malignant.

Diagnosis and Treatment of Dysphagia

Key diagnostic tools: history, examination, barium swallow, endoscopy, videofluoroscopy.
Management varies according to the underlying condition, e.g., cricopharyngeal myotomy for pharyngeal pouch.

Thyroid Gland Swellings

Thyroid is surrounded by pretracheal fascia and attached to trachea.
Assessment factors include thyroid function, potential neoplasm, local compression effects, inflammation, and cosmetic concerns.### Classification of Thyroid Swellings
Patients with thyroid swellings can be classified into diffuse non-toxic goitre, diffuse toxic goitre, and nodular goitre (which can be solitary or multiple and toxic or non-toxic).
Most thyroid masses are multinodular goitres; solitary, non-toxic goitres are common in thyroid neoplasms.
Inadequate thyroxine production from poor iodine intake leads to elevated TSH levels, causing hyperplasia of the gland.

Goitre Development and Management

Thyroxine supplementation in early hyperplastic goitres reduces TSH secretion and can promote regression of hyperplastic areas.
Surgical intervention is indicated for goitres compressing the trachea, oesophagus, or recurrent laryngeal nerves.

Grave's Disease

Accounts for 85% of thyrotoxicosis cases, presenting with diffuse goitre, hyperthyroidism, and ophthalmic symptoms.
Autoimmune disorder driven by thyroid-stimulating immunoglobulins leading to hyperplasia.
Symptoms include palpitations, weight loss, heat intolerance, and ophthalmic features like exophthalmos and lid retraction.
Elevated T4 and T3 levels with suppressed TSH levels; thyroid scans show diffuse increased uptake.

Treatment Options for Grave's Disease

Medical Therapy: Antithyroid drugs (e.g., carbimazole), often combined with beta-blockers; 50% recurrence rate after 2 years.
Radioiodine (I-131): Administered as a drink, effective but with slow onset and theoretical risks.
Surgery: Rapid response but carries risks such as permanent hypoparathyroidism and recurrent laryngeal nerve palsy; indicated for large goitres or compression symptoms.

Thyroid Nodules

Palpable thyroid nodules occur in 5% of adults; autopsy shows nodules in 50% of non-thyroidal disease patients.
Benign nodules may need surgical intervention for compression symptoms or cosmetic reasons.
Major forms of thyroid cancer include papillary, follicular, medullary, and anaplastic carcinoma.

History and Physical Examination

Important features include patient age and gender; nodules in men are more likely to be malignant.
History of low-dose gamma radiation exposure increases risk for nodules.
Family history can indicate risks for medullary carcinoma or other thyroid cancers.
Symptoms like hoarseness suggest malignancy; dysphagia and dyspnoea are non-specific.

Examination Findings

Hard, gritty nodules or those fixed to surrounding structures are likely malignant.
Non-tender cervical lymphadenopathy is a strong indicator of thyroid malignancy.

Investigation of Thyroid Nodules

Diagnostic methods include ultrasound, thyroid scan, and fine needle aspiration (FNA).
Ultrasound: Differentiates solid from cystic lesions, assesses nodule size, and checks for lymphadenopathy.
Thyroid Scan: Classifies nodules as cold, warm, or hot based on radioactive iodine uptake; does not definitively distinguish benign from malignant.
FNA Cytology: High accuracy in diagnosing thyroid nodules; results can be benign, suspicious, or malignant.

Surgical Management

Decision between total and partial thyroidectomy utilizes several factors including the presence of extrathyroidal disease, nodal metastases, and the overall prognosis based on age, tumor size, and histologic type.
Total thyroidectomy indicated for aggressive cancers; lobectomy may suffice for less aggressive types.
Following lobectomy, careful monitoring for recurrence is necessary due to risks of residual disease.

Recommendations for Thyroid Cancer Management

Total thyroidectomy considered safe with low incidence of nerve injury; enhances effectiveness of postoperative radioactive iodine therapy.
Papillary carcinoma may be treated with lobectomy unless associated with high-risk factors; modified radical neck dissection for nodal metastases.
Medullary carcinoma requires total thyroidectomy, while anaplastic carcinoma is often non-resectable.

Neck Injuries

Zone I: from sternal notch to cricoid cartilage, highest fatality risk.
Zone II: from cricoid cartilage to angle of mandible.
Zone III: above angle of mandible; careful consideration needed for injuries in the anterior triangle of the neck. ### Management of Penetrating Neck Injuries
Hospitalization is traditionally indicated for injuries penetrating the platysma, though this may apply to nearly all neck injuries.
Initial management focuses on the ABCs: Airway, Breathing, and Circulation.
Airway control is crucial; signs of airway injury include stridor, hoarseness, and surgical emphysema.
If available, flexible endoscopy can assess the upper airway and assist with intubation.
Gunshot injuries may necessitate a tracheostomy as endotracheal intubation can worsen airway damage.
Always protect the cervical spine; tracheostomy may be performed with the neck in a neutral position.
Assess for tension pneumothorax, especially in shock patients with distended neck veins.

Clinical Signs of Neck Injury

Airway Injury: Indicators include stridor, dyspnea, and subcutaneous emphysema.
Vascular Injury: Presenting with shock, expanding hematoma, or reduced pulses.
Oesophageal Injury: Symptoms may include hemoptysis, dysphagia, or odynophagia.
Neurological Signs: Watch for deterioration in consciousness and specific sensory deficits.

Investigations for Neck Injuries

Blood tests including CBC and cross-match.
Imaging: Neck and chest X-rays, Doppler ultrasound, or angiography.
Barium swallow and endoscopy can be useful.
Urgent neck exploration is required for unstable patients in circulatory shock.

Tonsils and Adenoids

Tonsils and adenoids are crucial components of Waldeyer's ring, responding to foreign pathogens.
Surgery (tonsillectomy and adenoidectomy) may be needed for obstruction or recurrent infections.
Surgical outcomes do not significantly affect the infection rates due to compensatory functions of other lymphatic tissues.

Indications for Tonsillectomy and Adenoidectomy

Infections: Chronic tonsillitis, recurrent acute tonsillitis (e.g., 4 episodes/year in children), peritonsillar abscess, and febrile convulsions due to tonsillitis.
Obstruction: Issues affecting eustachian tubes, nasal sinus drainage, or airway leading to sleep apnea.
Miscellaneous: Unilateral tonsil enlargement, metastatic lymph nodes, and specific surgical conditions.

Complications of Tonsillectomy

Primary or secondary hemorrhage is the main complication.
Vascular supply includes branches from facial, maxillary, and lingual arteries.

Stridor

Stridor indicates laryngeal or tracheal obstruction; it can be high or low pitched.
Types:
- Glottic obstruction: Inspiratory stridor.
- Subglottic/trachea obstruction: Both inspiratory and expiratory stridor.

Common Causes of Stridor

Adults: Upper aerodigestive cancers, thyroid cancers, bilateral vocal cord palsy, cervical injuries.
Children: Congenital issues (laryngomalacia, subglottic stenosis) and acquired problems (croup, epiglottitis).

Croup Syndrome

Affects children aged 6 months to 7 years; often concurrent with upper respiratory infections.
Distinguished by symptoms such as low-grade fever and drooling absence in croup vs. high fever and marked dysphagia in epiglottitis.

Tracheostomy Procedure

Indicated for upper airway obstruction and conditions needing protection of the tracheobronchial tree.
Ideally performed electively; requires adequate lighting and suction.
Involves creating an incision below the cricoid and inserting a tracheostomy tube.

Complications of Tracheostomy

Perioperative: Bleeding, recurrent laryngeal nerve injury, esophageal injury, pneumothorax.
Long-term: Apnea in patients with long-standing airway obstruction, among others.

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Description

Explore the anatomy and functions of major and minor salivary glands, including the parotid, submandibular, and sublingual glands. This quiz covers their relationships, surfaces, and anatomical significance. Test your knowledge of this essential topic in human anatomy!