Surgical Techniques in Oral and Maxillofacial Surgery
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Questions and Answers

What is the main reason for stasis in chronic calculus sialadenitis?

  • Sepsis
  • Stricture or FB (correct)
  • Infection
  • Poor oral hygiene

    • What is the ratio of submandibular gland to parotid gland involvement in chronic calculus sialadenitis?

  • 50:1 (correct)
  • 10:1
  • 20:1
  • 30:1

    • What is the composition of stones in chronic calculus sialadenitis?

  • Calcium, Phosphate, and Carbonate (correct)
  • Carbonate, Phosphate, and Magnesium
  • Calcium, Magnesium, and Phosphate
  • Magnesium, Phosphate, and Carbonate

    • What is the common complication of chronic calculus sialadenitis?

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

    What is the commonest gland involved in chronic non-calculus sialadenitis?

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

    What is the clinical feature of chronic non-calculus sialadenitis?

    <p>Male &gt; female, occurs in middle and old age</p> Signup and view all the answers

    What is the method used to drain pus in submandibular abscess?

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

    What is the main reason for imperfect drainage of acute sialoadenitis?

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

    What is the primary reason for the higher incidence of stone formation in the submandibular gland?

    <p>Higher calcium concentration in the saliva</p> Signup and view all the answers

    What is the clinical feature of salivary stones that causes painful gland swelling?

    <p>Blockage of the salivary ducts</p> Signup and view all the answers

    What is the investigation of choice for diagnosing sialolithiasis?

    <p>Plain x-ray, occlusal view</p> Signup and view all the answers

    What is the treatment of choice for stones in the submandibular gland?

    <p>Surgical removal of the stone</p> Signup and view all the answers

    What is the complication of untreated sialolithiasis?

    <p>Acute recurrent sialadenitis</p> Signup and view all the answers

    What is the term for abnormal dilatation of the small branches of the salivary ducts and alveoli?

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

    What is the investigation of choice for suspected sialectasis?

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

    What is the usual presentation of sialectasis?

    <p>Recurrent attacks of sialadenitis</p> Signup and view all the answers

    What is the primary cause of salivary stones?

    <p>Constituents of saliva</p> Signup and view all the answers

    What is the result of injury of the lingual nerve during submandibular sialadenectomy?

    <p>Loss of sensation of the anterior 2/3 of the tongue</p> Signup and view all the answers

    What is the treatment for a stone in the duct of the submandibular gland?

    <p>Remove stone under local anesthesia</p> Signup and view all the answers

    What is the complication of superficial parotidectomy?

    <p>Postoperative salivary fistula</p> Signup and view all the answers

    What is the differential diagnosis of enlarged submandibular lymph node?

    <p>Single swelling with positive lemon test</p> Signup and view all the answers

    What is the treatment for a stone in the gland of the submandibular gland?

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

    What is the result of injury of the hypoglossal nerve during submandibular sialadenectomy?

    <p>Deviation of the tongue to the same side</p> Signup and view all the answers

    What is the association between salivary stones and Sjogren's syndrome?

    <p>Salivary stones may complicate cases of Sjogren's syndrome</p> Signup and view all the answers

    Study Notes

    Drainage of Abscess

    • Hilton's method is used to drain pus from an abscess: a sinus forceps is introduced closed and then opened.
    • Submandibular abscess: skin incision is made parallel to the lower border of the mandible, 1.5 inches below and in front of the angle of the mandible, to avoid injury to the mandibular branch of the facial nerve.

    Chronic Sialadenitis

    • Etiology:
      • Chronic calculous sialadenitis: infection, stasis (sepsis, stricture, or foreign body)
      • Chronic non-calculous sialadenitis: poor oral hygiene, obstruction of salivary duct by food particles or foreign body, imperfect drainage of acute sialoadenitis
    • Pathology:
      • Chronic calculous sialadenitis: stones lie in the gland or duct, most common in the submandibular gland (50:1 ratio to parotid gland)
      • Chronic non-calculous sialadenitis: chronic inflammation of the gland and duct
    • Complications:
      • Chronic calculous sialadenitis: obstruction, infection, abscess, fistula, migration, malignancy
      • Chronic non-calculous sialadenitis: recurrent acute attacks, stone formation, sialectasis

    Clinical Features and Investigations

    • Clinical features: painful gland swelling while eating, calculus may cause acute or recurrent attacks of sialadenitis
    • Investigations: plain occlusal view radiograph (80% radio-opaque), ultrasound (can show almost all stones)

    Treatment of Salivary Stones

    • Treatment is surgical
    • Stones in the duct: removal through the mouth
    • Stones in the gland: removal with the submandibular or parotid gland
    • Parotidectomy for calcular disease requires high experience due to the difficulty of identifying the facial nerve

    Sialectasis

    • Definition: abnormal dilatation of the small branches of the salivary ducts and alveoli
    • Cause: unknown, but childhood type is known to be a familial disease
    • Presentation: recurrent attacks of sialadenitis
    • Investigation: sialography

    Differential Diagnosis

    • Enlarged submandibular salivary gland vs. enlarged submandibular lymph node
      • Multiple vs. single swelling
      • -ve lemon test vs. +ve lemon test
      • Can be rolled around mandible vs. cannot be rolled around mandible
      • Bidigital examination: palpated from outside vs. palpated from inside

    Treatment of Chronic Sialadenitis

    • Submandibular gland:
      • Stone in the duct: removal under local anesthesia
      • Stone in the gland: submandibular sialadenectomy
    • Parotid gland:
      • Stone in the duct: removal intraorally
      • Stone in the gland: total conservative parotidectomy

    Submandibular Sialadenectomy

    • Incision: parallel to the lower border of the mandible
    • Complications:
      • Injury of mandibular branch of facial nerve
      • Injury of hypoglossal nerve
      • Injury of lingual nerve
      • Injury of the pharynx

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    Description

    This quiz covers surgical techniques in oral and maxillofacial surgery, including the treatment of mandibular abscesses and chronic sialadenitis.

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