Surgical Anatomy: Salivary Glands
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Questions and Answers

What is instilled into the duct during the procedure to visualize the salivary ducts?

  • A salivary stimulant
  • A contrast material (correct)
  • A citric acid solution
  • A local anesthetic

    • What is the initial treatment for sialectasis?

  • Radiation therapy
  • Antibiotics only
  • Surgical excision of the gland
  • Conservative treatment with citrus drinks and massage (correct)

    • What is a characteristic feature of a pleomorphic adenoma of the parotid?

  • It causes loss of superficial temporal pulse
  • It causes right facial paralysis
  • It raises the lobule of the ear (correct)
  • It affects the facial nerve

    • What is the primary cause of a true parotid enlargement?

    <p>Non-neoplastic salivary gland disease</p> Signup and view all the answers

    What is a possible cause of radiation sialadenitis?

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

    What is the role of a CT scan in the diagnosis of parotid tumors?

    <p>To show the extent of the tumor</p> Signup and view all the answers

    Which of the following is a characteristic of Sjogren's disease?

    <p>Dryness of the mouth and eyes</p> Signup and view all the answers

    What is the possible etiology of Sjogren's disease?

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

    What is the primary treatment for salivary neoplasms?

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

    What is the significance of a cold spot in isotope scanning?

    <p>It indicates a salivary neoplasm</p> Signup and view all the answers

    What is a complication of Sjogren's disease?

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

    What is a characteristic of benign lymphoepithelial lesions?

    <p>Progressive lymphocytic infiltration of the salivary glands</p> Signup and view all the answers

    What is the investigation of choice for a pleomorphic adenoma?

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

    Which salivary glands are most commonly affected in benign lymphoepithelial lesions?

    <p>Parotid and submandibular glands</p> Signup and view all the answers

    What is the characteristic feature of hypertrophy of the masseter?

    <p>It is bilateral in most cases</p> Signup and view all the answers

    What is the most common cause of acute suppurative sialadenitis?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    Which of the following is a complication of acute suppurative sialadenitis?

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

    Why is an open surgical biopsy of the major salivary glands contraindicated?

    <p>It may cause tumour seeding</p> Signup and view all the answers

    What is the primary route of entry for acute suppurative sialadenitis?

    <p>Direct along the duct from the mouth</p> Signup and view all the answers

    What is the commonest gland involved in acute suppurative sialadenitis?

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

    What is the primary treatment for acute suppurative sialadenitis?

    <p>Conservative treatment</p> Signup and view all the answers

    What is the indication for incision and drainage in acute suppurative sialadenitis?

    <p>Failure of conservative treatment</p> Signup and view all the answers

    What is the name of the procedure used in parotid abscess?

    <p>Hilton's method</p> Signup and view all the answers

    What is the name of the condition that can occur if acute suppurative sialadenitis spreads locally?

    <p>Ludwig's angina</p> Signup and view all the answers

    How many pairs of major salivary glands are there?

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

    What is the approximate number of minor salivary glands?

    <p>600-1000</p> Signup and view all the answers

    In which week of gestation do the salivary glands start to develop?

    <p>6-8 weeks</p> Signup and view all the answers

    Which of the following is NOT a location of minor salivary glands?

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

    What is the name of the duct that arises from the anterior border of the parotid gland?

    <p>Stensen's duct</p> Signup and view all the answers

    What is the position of the parotid gland?

    <p>In front of and below the lower half of the ear</p> Signup and view all the answers

    What is the length of the parotid duct?

    <p>5 cm</p> Signup and view all the answers

    Which of the following is a characteristic of the parotid gland?

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

    What is the cause of Frey's syndrome?

    <p>Injury to the auriculo-temporal nerve</p> Signup and view all the answers

    What is the easiest source of nerve graft in facial nerve surgeries?

    <p>Great auricular nerve</p> Signup and view all the answers

    What is the characteristic of a submandibular salivary gland swelling?

    <p>Single, cannot be rolled over the lower border of mandible</p> Signup and view all the answers

    What is the treatment option in hopeless cases of facial nerve injuries?

    <p>Plastic operation</p> Signup and view all the answers

    What is the characteristic of a submandibular lymph node swelling?

    <p>Multiple, can be rolled over the lower border of mandible</p> Signup and view all the answers

    What is the manifestation of Frey's syndrome?

    <p>Flushing and sweating of the skin with salivation</p> Signup and view all the answers

    Study Notes

    Salivary Glands

    • There are two types of salivary glands: major and minor.
    • Major salivary glands include:
    • Parotid salivary glands (pair)
    • Submandibular salivary glands (pair)
    • Sublingual salivary glands (pair)
    • Minor salivary glands include:
    • Multiple scattered salivary glands (around 600-1000) found in the submucosa of the oral cavity, hard and soft palate, nasal cavity, nasal and paranasal sinuses, pharynx, and larynx.

    Embryology

    • The parotid gland develops between the 6th and 8th weeks of gestation.
    • The parotid gland grows in a posterior direction, surrounding the facial nerve.
    • The parotid gland is the last to become encapsulated, after the lymphatics develop, resulting in entrapment of lymphatics in the parenchyma of the gland.
    • This entrapment is thought to play a role in the development of Warthin's tumors and lymphoepithelial cysts within the parotid gland.

    Anatomy of Parotid Gland

    • The parotid gland lies in front of and below the lower half of the ear.
    • It is wrapped around the vertical ramus of the mandible, with its superficial portion projecting forwards on the surface of the masseter.
    • The gland reaches up to just below the zygomatic arch and down into the neck.
    • The parotid gland can be felt only in pathological conditions.

    Parotid Duct (Stensen's Duct)

    • The duct arises from the anterior border of the parotid and parallels the zygomatic arch.
    • The duct measures 5 cm in length and 5 mm in diameter.

    Acute Suppurative Sialadenitis

    • Pathology:
    • The parotid is the most common gland involved.
    • The gland and duct are congested, edematous, and may suppurate.
    • Complications:
    • Abscess formation
    • Chronicity and stone formation
    • Spread to surrounding tissues (e.g., Ludwig's angina)

    Clinical Picture

    • General symptoms:
    • Toxemic symptoms (e.g., fever, headache, anorexia, malaise)
    • Local symptoms:
    • Pain: early, dull aching, later severe throbbing
    • Swelling: elevating the lobule of the ear, red, warm, edematous, tender, and fluctuate
    • Opening of the duct: red, raised, and edematous, with possible discharge
    • Trismus: restricted movement of the TMJ

    Investigations

    • Leukocytosis
    • X-ray film may show calcifications or stones
    • Ultrasound

    Treatment

    • Conservative treatment:
    • General: rest, antibiotic (clindamycin), analgesics, and tonics
    • Local: hot fomentation, H2O2 mouth wash, and KI as sialogogue
    • Surgical treatment:
    • Indications: failure of conservative treatment, signs of suppuration (abscess formation)
    • Procedure: Hilton's method

    Sialectasis

    • The dilated ducts and branches are visualized as a snowstorm appearance on a contrast study.
    • Initial treatment is conservative, involving citric drinks to stimulate salivary flow and massage of the affected gland to squeeze out accumulating epithelial debris.

    Radiation Sialadenitis

    • Caused by radiation to the nasopharynx or skull base
    • Salivary secretion is temporarily suppressed, and the patient can be helped by the administration of sialagogues as citrus fruits.

    Autoimmune Salivary Diseases

    • Sjogren's disease:
    • More common in women
    • Manifestations include dryness of the mouth, dryness of the eye, and rheumatoid arthritis
    • Aetiology is not exactly known, but thought to be caused by a cytomegalovirus which affects the ducts of the salivary glands, rendering them antigenic.
    • Patients with Sjogren's disease are 44 times more prone to the development of lymphoma than the general population.

    Benign Lymphoepithelial Lesions

    • An uncommon disease characterized by progressive lymphocytic infiltration and diffuse enlargement of the salivary glands, particularly the submandibular and parotid.

    Malignant Parotid Tumors

    • Pleomorphic adenoma of the parotid:
    • Typically raises the lobule of the ear and does not affect the facial nerve
    • Differential diagnosis:
    • Extra parotid swellings (e.g., lymph nodes, sebaceous cysts, lipomas)
    • True parotid enlargement (e.g., non-neoplastic salivary gland disease)
    • Hypertrophy of the masseter

    Investigations

    • Not routine as in most cases, clinical diagnosis is reliable enough to proceed to treatment
    • Biopsy:
    • FNAC is allowed (reliable investigation that needs an expert cytologist)
    • Open surgical biopsy of the major salivary glands is contraindicated
    • Neck US
    • CT scan and MRI to show the extent of the tumor
    • Isotope scanning with technetium to show a cold spot in salivary neoplasms

    Treatment

    • Surgery is the only reliable form of treatment of salivary neoplasms

    Superficial Parotidectomy

    • The CT scan shows the left facial nerve and its branches preserved

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    Description

    This quiz covers the anatomy and physiology of salivary glands, including major and minor types, their locations, and functions. It's suitable for students of general and maxillofacial surgery.

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