Salivary Gland Written Notes PDF

# Short Essay 1. Complications and investigations of malignant salivary tumors 2. Classification of salivary tumors 3. Differential diagnosis between submandibular salivary gland and submandibular lymph node enlargement 4. Complications of Submandibular sialadenectomy 5. Differential diagnosis of a...

# Short Essay 1. Complications and investigations of malignant salivary tumors 2. Classification of salivary tumors 3. Differential diagnosis between submandibular salivary gland and submandibular lymph node enlargement 4. Complications of Submandibular sialadenectomy 5. Differential diagnosis of a swelling in the parotid region # Salivary Gland Tutor ## Classifications ### Benign * **Epithelium:** * Pleo Morphic * Oncocoytoma * Mono Morphic * **CT:** * Hemangioma * Lymphangioma * Neurofibroma * Lipoma ### Malignant * **Epithelium:** * Carcinoma * Acinic * Adenoid * Carcinoma ex Pleomorphic * Adenocarcinoma * **CT:** * Sarcoma * Lymphomas * Epidermoid/Mucoepidermoid ## Major Salivary Glands * **Introduction:** * **Major:** Parotid, Submandibular, Sublingual * **Minor:** 600 - 1000 * **Location:** * Open in Oral Cavity by one open * Found in Submucosa of * Oral Cavity * Nasal Cavity * Larynx * Pharynx * Nasal & Paranasal Sinuses * **Production:** * 1.5 Liters per day * **Most Common:** * Parotid: 45% * Submandibular: 45% * Sublingual: 5 % * Minor: 5% * **Comparison:** * **Parotid:** * Watery Serous * Salivary Rich in Amylase * Stenson's duct * **Submandibular:** * More Mucinous * Wharton's duct * **Sublingual:** * Viscous * Duct of Rivinus * Bartholin # Minor Salivary Glands * **Location:** * Below the Circumvallate of the tongue * **Secretions:** * Serous * **Names:** * Von Ebner * Blandin Nuhn * Palatine - Glossopalatine glands * Weber # Parotid Gland ## Surgical Anatomy of Parotid (MCP-TIF) * **Which gland has intraparenchymal LN?** * Parotid only ## Parotid Relations * **Anterior Medial Surface (Ant):** * Masseter * Mandible * Medial Pterygoid * **Posterior Medial (Post)** * Styloid process * Structures attached to it * Mastoid process * Sternomastoid muscle * Posterior belly of digastrics * ICA-IJV - Last 4 Cranial nerves * Nerves deep to styloid process * Facial ECA # Swellings of Parotid Region ## Four Special Characters of Parotid Swelling 1. Fills the hollowness between Mastoid process and angle of the mouth: may elevate ear lobule 2. More prominent on pressure on teeth 3. Pain referred to ear: pain during mastication 4. D.D. of Swelling in Parotid Region ## D.D. OF Swelling In Parotid Region 1. Pre-auricular LN * Lymphadenitis (acute, chronic) * Tumor (lymphoma, metastatic tumor) 2. Parotid Gland * Inflammation: * Chronic Sialadenitis * Autoimmune: Sjogren's disease * Stone: * Benign * Malignant * Skin/Subcutaneous Tissue * Dermoid cyst * Haematoma * Abscess * Lipoma * Masseter * Haemangioma * Sebaceous cyst * Fibro-sarcoma * Mandible * Hypertrophy * Inflammation: Osteomyelitis * Tumor: Adamantinoma * Dental: Brachial cyst # Surface Anatomy of the Parotid ## Main Part * **Head of the Mandible** * **Centre of the Masseter** * **Centre of Mastoid Process** * **Point 2 cm below and behind angle of the Mandible** * **Parotid Duct:** Middle third of line extended from tragus of ear to point midway between ala of the nose and angle of the mouth ## Five Branches of Facial Nerve Terminal * **Superficial Temporal** * **Buccal** * **Zygomatic** * **Cervical** * **Mandibular** ## Structures Inside the Gland (Parotid) * **Facial Nerve:** and its five terminal branches that serve the gland to superficial part and deep part * **Retro-mandibular Vein** * **External Carotid Artery:** Divided to two terminal branches, superficial temporal and maxillary. # Why Stone is More Commen in Submandibular Gland 1. **Submandibular secretions:** Is more viscous with a concentration of Ca.. 2. **Drainage of Submandibular duct upwards:** Is inadequate. 3. **Foreign Particles:** Are liable to lodge in Submandibular duct # Treatment of Stone 1. **Stone in Duct:** * **At orifice:** Removed through meatatomy. * **In the duct:** Removal surgically through floor of the mouth. * **If recurrence:** or associated with stone in gland, submandibular sialadenectomy. 2. **Stone in gland:** submandibular sialaadenectomy or superficial conservative parotidectomy. # Anatomy of Submandibular Triangle (Diagastric) * **Boundaries:** Inferior border of mandible * **Floor:** Two bellies of digastric * Hypoglossus muscle * Mylohyoid muscle * **Content:** Submandibular salivary gland and LN. * Facial artery and vein * Hypoglossal nerve * Lingual nerve # Nerves That May Be Affected In Sialadenectomy * **Lingual Nerve:** Loss of taste in anterior 2/3 of tongue * **Hypoglossal Nerve:** Hemiatrophy - deviation of tongue on the same side * **Marginal mandibular branch of facial:** Witering of angle of the mouth # D.D. OF Swellings In Submandibular Region * **Submandibular LN Swellings:** * Lymphadenitis * Tumor (lymphoma, metastatic) * **Submandibular Gland Swelling:** * Inflammation: * More common chronic sialadenitis * Autoimmune: Sjogren's disease * Degenerative: Sialectasis * Tumor: * Benign * Malignant * **Skin Isc:** * Dermoid cyst * Lipoma * Haemangioma * Sebaceous cyst * Abscess * Haematoma * **Mandible:** * Inflammation: Osteomyelitis * Tumors: Sarcoma-adamantinoma # Relation To Meal in Observation of Duct * **Submandibular LN:** Has no relation to meal. * **Number:** Usually multiple. * **Lemon test:** Normal * **Bimanual exam:** Felt in neck, not in floor of the mouth. * **Examination:** Can be rolled over. * **Relation to mandible:** Lower border of mandible. * **Submandibular Gland:** **In obstruction of duct:** * **Pain and swelling:** During meal * **Number:** Single. * **Lemon test:** Congested and discharging pus * **Bimanual exam:** Swelling and pain * **Examination:** Felt in neck, and floor of the mouth. * **Relation to mandible:** Can't as it is deep to deep fascia of neck.