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Questions and Answers
What percentage of parotid neoplasms are pleomorphic adenoma?
What is the usual location of Warthin's tumor?
What is the characteristic of pleomorphic adenoma in terms of capsule?
What is the risk of pleomorphic adenoma turning into carcinoma?
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What is the age group most commonly affected by the autoimmune salivary disease?
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Which of the following is a type of malignant salivary neoplasm?
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What is the age range when pleomorphic adenoma usually occurs?
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What is the term 'benign' considered misleading in the context of autoimmune salivary diseases?
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What is the distribution of pleomorphic adenoma between males and females?
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What percentage of autoimmune salivary disease cases develop into lymphomas?
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What is the purpose of performing a needle biopsy in a patient with autoimmune salivary disease?
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What is the growth pattern of pleomorphic adenoma?
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Which of the following is a metabolic cause of salivary gland enlargement?
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What is the term for salivary gland enlargement due to metabolic reasons?
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What is the treatment for a submandibular salivary fistula?
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What is a predisposing factor for the development of a salivary fistula?
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What is the purpose of taking films before and after the patient sucks a lemon?
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What is the initial treatment approach for sialectasis?
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What is the cause of radiation sialectasis?
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What is a common symptom of Sjogren's disease?
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What is the suspected cause of Sjogren's disease?
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What is a complication associated with Sjogren's disease?
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What is characterized by progressive lymphocytic infiltration and diffuse enlargement of the salivary glands?
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Which salivary glands are commonly affected in benign lymphoepithelial lesions?
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What is the purpose of frozen section examination during surgery?
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What is the usual treatment for tumors that are clinically malignant?
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Why is it important to preserve the facial nerve during parotid surgery?
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What is a common complication of parotidectomy?
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What is a characteristic of Warthin's tumor?
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Why is the capsule of the parotid gland important during surgery?
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What is the role of radiotherapy in the treatment of parotid tumors?
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What is the significance of the modified Blair incision in parotid surgery?
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What is the typical presentation of carcinoma ex pleomorphic adenoma?
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What is the contraindication for open surgical biopsy of the major salivary glands?
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What is the most useful method for assessing salivary neoplasms?
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What is a characteristic feature of adenolymphoma and oncocytoma?
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What is a common complication of parotid surgery?
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What is the majority of tumors that arise in the parotid gland?
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What is the commonest cause of submandibular sialadenectomy?
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What is the approach in managing low-grade mucoepidermoid carcinoma?
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Study Notes
Salivary Gland Diseases
- Sialectasis is a condition where the salivary ducts are dilated, and the cystic coalition of alveoli appears as a "snow storm" on imaging.
- Initial treatment of sialectasis is conservative, involving citrus drinks to stimulate salivary flow and massage to remove epithelial debris.
Radiation-Induced Sialadenitis
- This condition is caused by radiation to the nasopharynx or skull base, temporarily suppressing salivary secretion.
- Treatment involves administering sialagogues, such as citrus fruits.
Autoimmune Salivary Diseases
- Sjogren's disease is a commoner disease in women than men, characterized by:
- Dryness of the mouth (xerostomia)
- Dryness of the eye (xerophthalmia, keratoconjunctivitis sicca)
- Rheumatoid arthritis
- Salivary gland discomfort or sialomegaly
- The disease is thought to be caused by a cytomegalovirus that affects the ducts of the salivary glands, making them antigenic.
- Patients with Sjogren's disease are 44 times more prone to developing lymphoma than the general population.
- Benign lymphoepithelial lesions are characterized by progressive lymphocytic infiltration and diffuse enlargement of the salivary glands, particularly the submandibular and parotid glands.
Complications and Diagnosis
- 20% of cases develop lymphomas.
- Diagnosis involves lip biopsy and parotid sialography, which shows a non-specific appearance of narrowed ducts and sometimes punctate sialectasis.
- Treatment involves:
- Instillation of artificial tears to combat eye dryness
- Meticulous oral hygiene
- Needle biopsy if a palpable mass develops in the parotid gland
Drug-Induced, Metabolic, and Endocrine Salivary Gland Enlargement
- Drug-induced enlargement of the salivary glands can be caused by:
- Sulfisoxazole
- Phenylbutazone
- Iodide-containing compounds
- Thiouracils
- Hypotensive drugs
- Contraceptive pills
- Metabolic and endocrine causes include:
- Liver cirrhosis
- Diabetes
- Alcoholism
- Malnutrition
- Ovarian, pancreatic, or thyroid insufficiency
- Enlargement of the salivary gland due to metabolic reasons is called sialosis.
Salivary Fistula
- Predisposing factors include:
- Trauma
- Abscess
- Chronic inflammation with stone or stenosis of the duct
- Malignant tumors infiltrating the skin
- Types of salivary fistula include:
- Submandibular salivary fistula
- Hemangioma and lymphangioma
Salivary Neoplasms
- Classification of salivary neoplasms includes:
- Benign: Pleomorphic adenoma, Monomorphic adenoma, Warthin's tumor, Oncocytoma
- Malignant: Mucoepidermoid carcinoma, Adenoid cystic carcinoma, Acinic cell carcinoma, Adenocarcinoma, Carcinoma ex pleomorphic adenoma, Epidermoid carcinoma, Lymphoma
Pathology of Benign Salivary Neoplasms
- Pleomorphic adenoma (Mixed parotid tumor):
- The commonest tumor of salivary glands, representing 75% of parotid and 50% of submandibular gland neoplasms.
- Distribution is equal between males and females.
- It occurs in the fourth decade of life, but any age and sex may be affected.
- Pathology shows epithelial, myoepithelial, and stromal components with wide variations in cellular and architectural morphology.
- Adenolymphoma (Warthin's tumor):
- Usually found in the lower part of the parotid gland.
Malignant Salivary Neoplasms
- Tumors that are clinically malignant:
- Treatment involves radical excision, which entails wide surgical clearance with cervical lymph node dissection if necessary.
- Radiotherapy is of limited value, but is administered as a postoperative adjuvant therapy for tumors of high-grade malignancy.
Parotidectomy
- Superficial parotidectomy:
- Incision: Globlet incision or modified Blair incision.
- Identification of facial nerve: (See anatomy).
- Complications:
- Injury of facial nerve
- Injury of auriculo-temporal nerve (Frey's syndrome)
- Parotid fistula
- Recurrence: incomplete removal, multicentric, missed malignancy
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Description
This quiz assesses understanding of sialectasis diagnosis through cannulation of the salivary duct and treatment methods, including conservative approaches.
