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Salivary Gland Pathologies Dave Pothier St Michael’s 2004.

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Presentation on theme: "Salivary Gland Pathologies Dave Pothier St Michael’s 2004."— Presentation transcript:

1 Salivary Gland Pathologies Dave Pothier St Michael’s 2004

2 Anatomy 3 pairs of (groups) of glands –Parotid –Submandibular –Sublingual

3 Anatomy Parotid In cheek and behind angle of mandible Stenson’s duct to inner cheek

4 Anatomy

5 Submandibular Medial to mandible Wharton’s duct around mylohyoid to either side of frenulum of tongue

6 Anatomy

7 Sublingual glands

8 Pathologies Congenital –Unusual –Atresia –Strictures Aquired…

9 Pathologies - Infective Parotitis: bacterial (staph, TB, actinomycoses) viral (mumps)

10 Infective Pus at duct opening Tender, hot gland IV Abx for bacterial infections Cons Rx for viral

11 Neoplastic It is benign or malignant? 50 / 50 split across all neoplasms Depends a lot on site…

12 Neoplastic BenignMalignant Parotid80%20% Submandibular40%60% Sublingual10%90%

13 Parotid Rule of 80’s 80% of parotid tumors are benign 80% of parotid tumors are pleomorphic adenomas 80% of salivary gland pleomorphic adenomas occur in parotid 80% of parotid pleomorphic adenomas occur in the superficial lobe 80% of untreated pleomorphic adenomas remain benign

14 Types Over 40 different types & grades! Common Benign –Pleomorphic adenoma –Warthin’s tumour –Benign cyst Common Malignant –Mucoepidermoid carcinoma –Adenocarcinoma –Acinic cell

15 Approach to a lump Hx General- eye + other sjogren’ signs - bulimia - TB etc

16 Approach to a lump Hx Specific- Duration of lesion Pain Neural symptoms

17 Examination Look – skin, inside mouth Feel – mass: palpate, tenderness, bimanual - duct - for stones Neck Approach to a lump

18 Ix FNAB USS +/- MRI or CT

19 Surgery Benign disease: superficial parotidectomy Malignant disease spectrum of surgery: Lesion + cuff radical parotidectomy + neck dissetion

20 Complications Scar, infection, bleeding, haematoma VII nerve Frey’s syndrome Salivary fistula

21 Sialolithiasis Calculi in ducts Recurrent swellings Not infected Tender, not hot No pus at duct Rx – cons/surgical

22 Conclusions Beware of non-parotid salivary swellings more than usual Remember VII Consent thoroughly for complications


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