Surgery Endocrine

Salivary gland disorders

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8 أقسام

سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

Background

  • Diseases of the salivary glands include sialadenosis, sialodenitis, sialolithiasis and neoplasms

 

سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

Background Version 2

  • Definition: Diseases affecting the major salivary glands (parotid, submandibular, sublingual) and minor salivary glands
  • Epidemiology:
    • Sialolithiasis: ★Most common (1% of population)
    • Acute sialadenitis: 0.01-0.02% hospital admissions
    • Salivary tumors: 3-4% of all head/neck tumors
  • Key anatomical relationships:
    • Parotid: Facial nerve runs through it
    • Submandibular: Wharton's duct opens near frenulum
    • Sublingual: Multiple small ducts (Rivinus ducts)
Comparison of Major Salivary Gland Disorders
Feature Sialadenosis Sialolithiasis ★ Acute Sialadenitis Chronic Sialadenitis Tumors
Most common location Parotid (bilateral) Submandibular (80%) Parotid Parotid Parotid (80%)
Age group Adults 40-60 Adults 30-60 Elderly, postop Any age Adults >40
Pain Painless Painful with meals Painful, constant Intermittent pain Usually painless
Key finding Bilateral swelling "Salivary colic" Purulent discharge Recurrent swelling Facial palsy = malignant

 

سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

Sialadenosis

Sialadenosis
Definition
  • Noninflammatory swelling of the salivary glands
Clinical presentation
  • Nontender enlargement of the submandibular glands
Risk factors
  • Advanced liver disease
  • Altered dietary patterns
  • Malnutrition (diabetes, bulimia)
Differential diagnosis
  • Sialadenitis
  • Salivary gland stones (sialolithiasis)
  • Malignancy
Treatment
  • No management is required

 

 

 

Version 2

 

Sialadenosis (Sialosis)
Definition
  • Noninflammatory, bilateral swelling of salivary glands
  • Acinar cell hypertrophy without inflammation
Epidemiology
  • Most common in: Middle-aged adults (40-60 years)
  • Associated with systemic conditions in 50% of cases
Clinical presentation
  • ★Painless, bilateral parotid enlargement (classic)
  • Soft, non-tender glands
  • Normal overlying skin
  • No fever or systemic symptoms
Risk factors/Causes
  • Metabolic:
    • Diabetes mellitus (most common)
    • Chronic liver disease/cirrhosis
    • Malnutrition
  • Medications: Beta-blockers, thiourea
  • Eating disorders: Bulimia nervosa
  • Chronic alcoholism
Diagnosis
  • Clinical diagnosis (bilateral painless swelling)
  • Best initial test: None needed if classic presentation
  • If uncertain: Ultrasound shows enlarged, hyperechoic glands
  • Sialography: "leafless tree" appearance
Treatment
  • Treat underlying condition
  • No specific treatment required
  • Reassurance
سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

Sialolithiasis

Sialolithiasis
Definition
  • Stone formation in the ducts of the major salivary glands (parotid, submandibular or sublingual)
Risk factors
  • Associated with salivary stasis (eg, dehydration) and trauma
Clinical presentation
  • Recurrent, significant pain before and while eating in the affected gland
  • Partial swelling of the glands
Diagnosis
  • Sonography or CT scan
Treatment
  • Conservative (NSAIDs, warm compresses, and massages)
  • Invasive (lithotripsy)

 

 

Version 2

 

 

Sialolithiasis (Salivary Stones)
Definition
  • Stone formation in salivary gland ducts
  • ★80% occur in submandibular gland (Wharton's duct)
  • 15% in parotid (Stensen's duct)
Pathophysiology
  • Calcium phosphate/carbonate precipitation
  • Submandibular predisposition due to:
    • Alkaline saliva
    • Higher calcium concentration
    • Upward ductal course
    • Longer, narrower duct
Clinical presentation
  • ★Classic: "Salivary colic" - sudden pain/swelling with meals
  • Symptoms resolve 30-60 minutes after eating
  • Palpable stone in floor of mouth (50%)
  • Reduced/absent salivary flow
Diagnosis
  • Best initial test: Bimanual palpation
  • Imaging:
    • Plain radiograph: 80% submandibular stones radiopaque
    • Ultrasound: First-line imaging
    • CT without contrast: Most accurate
    • Sialography: Contraindicated during acute infection
Treatment
  • Conservative (stones <6mm):
    • Hydration
    • Sialagogues (lemon drops, sour candy)
    • Warm compresses
    • Gland massage
    • NSAIDs
  • Interventional (stones >6mm or failed conservative):
    • Sialendoscopy with stone removal
    • Lithotripsy
    • Surgical excision
Complications
  • Most common: Secondary sialadenitis
  • Abscess formation
  • Chronic sialadenitis

 

 

 

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Sialadenitis

Sialadenitis
Definition
  • Inflammation of the salivary glands; usually submandibular gland
Microbiology
  • Staphylococcus aureus
  • Mumps
Risk factors
  • Obstruction
  • Immune-mediated (Sjogren syndrome)
  • Postoperatively
Clinical presentation
  • Sudden swelling
  • Tenderness
  • Fever
  • Purulent discharge
Diagnosis
  • Gram stain and culture
  • Ultrasound or CT scan if abscess was suspected (stones are made of calcium and are visible on CT scan)
Treatment
  • Hydration, warm compresses, oral hygiene and gland massage
  • Parenteral antibiotics: metronidazole, nafcillin or clindamycin
  • Recurrent (refer to ENT for stone removal)
  • Surgery (if abscess forms or no improvement after 48 hours)

 

 

 

Version 2

Acute Sialadenitis
Definition
  • Acute inflammation of salivary glands
  • Most common: Parotid gland
Types
  • Acute suppurative (bacterial):
    • ★Most common organism: S. aureus (50-60%)
    • Streptococcus viridans (20%)
    • Anaerobes in chronic cases
  • Viral:
    • ★Mumps (most common viral cause)
    • EBV, CMV, HIV
Risk factors
  • Dehydration (most important)
  • Poor oral hygiene
  • Sialolithiasis
  • Medications reducing saliva flow (anticholinergics)
  • Post-operative (especially abdominal surgery)
  • Sjögren syndrome
  • Radiation therapy
Clinical presentation
  • Bacterial:
    • ★Sudden onset unilateral pain and swelling
    • Fever, malaise
    • ★Purulent discharge from duct orifice (pathognomonic)
    • Trismus (difficulty opening mouth)
    • Erythema of overlying skin
  • Viral (Mumps):
    • ★Bilateral parotid swelling (70%)
    • Prodrome: fever, headache, malaise
    • Earache, difficulty chewing
    • Orchitis in post-pubertal males (20-30%)
Diagnosis
  • Clinical diagnosis in most cases
  • Bacterial:
    • Express pus from duct for Gram stain and culture
    • Blood cultures if systemic symptoms
  • Imaging (if abscess suspected):
    • Ultrasound: First-line
    • CT with contrast: If deep neck infection suspected
  • Mumps: Clinical diagnosis, can confirm with IgM antibodies
Treatment
  • Bacterial:
    • Empiric antibiotics:
      • First-line: Nafcillin or cefazolin
      • MRSA coverage: Vancomycin
      • Oral (mild): Amoxicillin-clavulanate or cephalexin
    • Duration: 7-10 days
    • Hydration, sialagogues, warm compresses
    • Surgical drainage if abscess
  • Viral: Supportive care only
Complications
  • Most common: Abscess formation
  • Deep neck space infection
  • Facial nerve palsy (with parotid involvement)
  • Chronic sialadenitis

 

 

💡 CLINICAL PEARLS

  • Pus from Stensen's duct = Acute bacterial parotitis (pathognomonic)
  • Bilateral parotid swelling + orchitis = Mumps until proven otherwise
  • "Chipmunk cheeks" = Classic description for bilateral parotid swelling
  • Stone palpable in floor of mouth = Submandibular sialolithiasis

Chronic Sialadenitis

Definition
  • Chronic inflammation with irreversible damage to gland parenchyma
  • Usually results from recurrent acute episodes
Causes
  • Most common: Recurrent obstruction (stones, strictures)
  • Sjögren syndrome
  • Radiation therapy
  • HIV-associated salivary gland disease
Clinical features
  • Recurrent swelling with meals
  • Firm, enlarged gland
  • Decreased salivary flow
  • Salty taste
Diagnosis
  • Sialography: "Pruned tree" appearance
  • MR sialography: Non-invasive alternative
  • Biopsy if malignancy suspected
Treatment
  • Conservative management initially
  • Antibiotics for acute exacerbations
  • Definitive: Gland excision for severe cases

 

 

سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

CLINICAL PEARLS - Version 2

  • Pus from Stensen's duct = Acute bacterial parotitis (pathognomonic)
  • Bilateral parotid swelling + orchitis = Mumps until proven otherwise
  • "Chipmunk cheeks" = Classic description for bilateral parotid swelling
  • Stone palpable in floor of mouth = Submandibular sialolithiasis
سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

HIGH-YIELD FACTS - Version 2

⭐ HIGH-YIELD FACTS

  • Most common salivary gland disorder overall: Sialolithiasis (80% in submandibular gland)
  • Most common cause of bilateral parotid swelling: Mumps (viral sialadenitis)
  • Most common salivary gland tumor: Pleomorphic adenoma (benign)
  • Pathognomonic sign: Facial nerve palsy = malignant parotid tumor until proven otherwise
  • Classic triad of chronic sialadenitis: Pain + swelling + occurs with meals
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