1. Salivary Gland disease Andrew McCombe

2. Anatomy Major – Parotid – Sub-mandibular – Sub-lingual Minor – Oral cavity – Palate – Uvula

3. Physiology Autonomic nerve supply – Parasympathetic – Sympathetic Production of saliva – Major – mealtimes – Minor – all the time!

4. Physiology – salivary function Lubrication - mucins Protection – antibacterial/antifungal functions Lavage/cleansing Buffering Mineralisation – calcium, phosphate Digestion – amylase Taste

5. Function

6. Hypofunction Anxiety – sympathetic drive Depression Radiotherapy Drugs (Age?) – Atropine etc/ tricyclics/MAOIs/Phenothiazines/antihistamines Disease (Sjogren’s) Dehydration

7. Hypofunction- consequences/symptoms Dry mouth Altered taste Dysarthria/Dysphagia Dental problems Candidiasis Salivary gland swelling

8. Hypofunction - treatment Fluids Sweets/chewing gum Salivary substitutes Drugs – Pilocarpine (5mg QID) – Cevimeline/Bethanechol…. – Alpha Interferon (Sjogrens)

9. Hyperfunction Very rare – more likely an inability to manage normal salivary quantities - neurological

10. Sialorrhoea - treatment Anticholinergics – scopolomine/benztropine patches Intra-glandular botox Low dose radiotherapy Surgery – Duct relocation – Sub-lingual gland removal

11. Infective problems Mumps Acute suppurative sialadenitis Chronic sialadenitis – Infective – Inflammatory – Stone disease

12. Infections - management Maintain hydration Analgesia Antibiotics Treat underlying pathology

13. Sialolithiasis Sub-mandibular gland - 80% Various causes – Salivary composition – Dehydration – Reduced flow - anatomy Obstructive symptoms

14. Sialolithiasis - investigation Plain X-ray Sialogram

15. Sialolithiasis - treatment Observation Stone removal – Locally intra-oral – Lithotripsy (Smaller stones – 7mm) – Basket removal (Sialadenoscopy) Surgical gland removal

16. Form

17. General salivary gland swelling Drugs Disease – Mumps etc – Sjogren’s – Sarcoidosis, Diabetes,….etc Mangment is that of underlying condition

18. Localised swelling - tumours Majority benign – Parotid -> Minor Very many histological types – Mucocele – Pleomorphic adenoma/Warthins – Muco-epidermoids – Adenocarcinoma/adenoidcystic – Lymphoma (MALT)

19. Tumours - investigation Clinical assessment

20. Tumours - investigation Clinical assessment FNA Ultrasound

21. Fine Needle Aspiration Cytology

22. Cytology – Royal Surrey

23. Tumour - investigation MRI CT

24. Tumours - management Observation Surgery – Balance of risk/benefit +/- Radiotherapy (MDT) Risks – local nerve damage – Facial – Lingual/hypoglossal – Marginal mandibular

25. Summary Parotid gland – tumours (benign) / Infections Submandibular gland – Stones Minor glands - function

26. Thank you!