Sialectasis Diagnosis and Treatment
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Questions and Answers

What percentage of parotid neoplasms are pleomorphic adenoma?

  • 50%
  • 60%
  • 90%
  • 75% (correct)

    • What is the usual location of Warthin's tumor?

  • Sublingual gland
  • Lower part of the parotid gland (correct)
  • Upper part of the parotid gland
  • Submandibular gland

    • What is the characteristic of pleomorphic adenoma in terms of capsule?

  • No capsule
  • Complete capsule
  • Thick capsule
  • Incomplete capsule (correct)

    • What is the risk of pleomorphic adenoma turning into carcinoma?

    <p>High risk after 10 years</p> Signup and view all the answers

    What is the age group most commonly affected by the autoimmune salivary disease?

    <p>Middle-aged and elderly women</p> Signup and view all the answers

    Which of the following is a type of malignant salivary neoplasm?

    <p>Mucoepidermoid carcinoma</p> Signup and view all the answers

    What is the age range when pleomorphic adenoma usually occurs?

    <p>Fourth decade of life</p> Signup and view all the answers

    What is the term 'benign' considered misleading in the context of autoimmune salivary diseases?

    <p>Due to its prelymphomatous potential</p> Signup and view all the answers

    What is the distribution of pleomorphic adenoma between males and females?

    <p>Equal distribution between males and females</p> Signup and view all the answers

    What percentage of autoimmune salivary disease cases develop into lymphomas?

    <p>20%</p> Signup and view all the answers

    What is the purpose of performing a needle biopsy in a patient with autoimmune salivary disease?

    <p>To rule out lymphoma</p> Signup and view all the answers

    What is the growth pattern of pleomorphic adenoma?

    <p>Slowly growing</p> Signup and view all the answers

    Which of the following is a metabolic cause of salivary gland enlargement?

    <p>Diabetes</p> Signup and view all the answers

    What is the term for salivary gland enlargement due to metabolic reasons?

    <p>Sialosis</p> Signup and view all the answers

    What is the treatment for a submandibular salivary fistula?

    <p>Submandibular sialadenectomy</p> Signup and view all the answers

    What is a predisposing factor for the development of a salivary fistula?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of taking films before and after the patient sucks a lemon?

    <p>To visualize the salivary ducts and branches</p> Signup and view all the answers

    What is the initial treatment approach for sialectasis?

    <p>Conservative treatment with citrus drinks and massage</p> Signup and view all the answers

    What is the cause of radiation sialectasis?

    <p>Radiation to the nasopharynx or skull base</p> Signup and view all the answers

    What is a common symptom of Sjogren's disease?

    <p>All of the above</p> Signup and view all the answers

    What is the suspected cause of Sjogren's disease?

    <p>Cytomegalovirus infection</p> Signup and view all the answers

    What is a complication associated with Sjogren's disease?

    <p>Increased risk of lymphoma</p> Signup and view all the answers

    What is characterized by progressive lymphocytic infiltration and diffuse enlargement of the salivary glands?

    <p>Benign lymphoepithelial lesions</p> Signup and view all the answers

    Which salivary glands are commonly affected in benign lymphoepithelial lesions?

    <p>Submandibular and parotid</p> Signup and view all the answers

    What is the purpose of frozen section examination during surgery?

    <p>To obtain a pathological diagnosis if not obtained prior to the operation</p> Signup and view all the answers

    What is the usual treatment for tumors that are clinically malignant?

    <p>Radical excision with cervical lymph node dissection</p> Signup and view all the answers

    Why is it important to preserve the facial nerve during parotid surgery?

    <p>To preserve facial expressions and functions</p> Signup and view all the answers

    What is a common complication of parotidectomy?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of Warthin's tumor?

    <p>It affects elderly people</p> Signup and view all the answers

    Why is the capsule of the parotid gland important during surgery?

    <p>It must be intact to prevent recurrence</p> Signup and view all the answers

    What is the role of radiotherapy in the treatment of parotid tumors?

    <p>It is used as a postoperative adjuvant therapy for high-grade malignancies</p> Signup and view all the answers

    What is the significance of the modified Blair incision in parotid surgery?

    <p>It is used to access the parotid gland</p> Signup and view all the answers

    What is the typical presentation of carcinoma ex pleomorphic adenoma?

    <p>A painless swelling that has been stationary for years and is now getting bigger</p> Signup and view all the answers

    What is the contraindication for open surgical biopsy of the major salivary glands?

    <p>Risk of seeding tumor cells</p> Signup and view all the answers

    What is the most useful method for assessing salivary neoplasms?

    <p>CT and MRI</p> Signup and view all the answers

    What is a characteristic feature of adenolymphoma and oncocytoma?

    <p>They show a hot spot on isotopic scanning</p> Signup and view all the answers

    What is a common complication of parotid surgery?

    <p>Facial nerve weakness that recovers spontaneously</p> Signup and view all the answers

    What is the majority of tumors that arise in the parotid gland?

    <p>Superficial to the facial nerve</p> Signup and view all the answers

    What is the commonest cause of submandibular sialadenectomy?

    <p>Stones</p> Signup and view all the answers

    What is the approach in managing low-grade mucoepidermoid carcinoma?

    <p>Attempt to preserve the facial nerve</p> Signup and view all the answers

    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.

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