Salivary Gland disease

Andrew McCombe

Anatomy

• Major– Parotid– Sub-mandibular– Sub-lingual

• Minor– Oral cavity– Palate– Uvula

Physiology

• Autonomic nerve supply– Parasympathetic– Sympathetic

• Production of saliva– Major – mealtimes– Minor – all the time!

Physiology – salivary function

• Lubrication - mucins• Protection – antibacterial/antifungal functions• Lavage/cleansing• Buffering• Mineralisation – calcium, phosphate• Digestion – amylase• Taste

Function

Hypofunction

• Anxiety – sympathetic drive• Depression• Radiotherapy• Drugs (Age?)– Atropine etc/

tricyclics/MAOIs/Phenothiazines/antihistamines• Disease (Sjogren’s)• Dehydration

Hypofunction- consequences/symptoms

• Dry mouth• Altered taste• Dysarthria/Dysphagia• Dental problems• Candidiasis• Salivary gland swelling

Hypofunction - treatment

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

Hyperfunction

• Very rare – more likely an inability to manage normal salivary quantities - neurological

Sialorrhoea - treatment

• Anticholinergics – scopolomine/benztropine patches

• Intra-glandular botox• Low dose radiotherapy• Surgery – Duct relocation– Sub-lingual gland removal

Infective problems

• Mumps• Acute suppurative sialadenitis• Chronic sialadenitis– Infective– Inflammatory– Stone disease

Infections - management

• Maintain hydration• Analgesia• Antibiotics• Treat underlying pathology

Sialolithiasis

• Sub-mandibular gland - 80%• Various causes– Salivary composition– Dehydration– Reduced flow - anatomy

• Obstructive symptoms

Sialolithiasis - investigation

• Plain X-ray• Sialogram

Sialolithiasis - treatment

• Observation• Stone removal– Locally intra-oral– Lithotripsy (Smaller stones – 7mm)– Basket removal (Sialadenoscopy)

• Surgical gland removal

Form

General salivary gland swelling

• Drugs• Disease– Mumps etc– Sjogren’s– Sarcoidosis, Diabetes,….etc

Mangment is that of underlying condition

Localised swelling - tumours

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

Tumours - investigation

• Clinical assessment

Tumours - investigation

• Clinical assessment• FNA• Ultrasound

Fine Needle Aspiration Cytology

Cytology – Royal Surrey

Tumour - investigation

• MRI• CT

Tumours - management

• Observation• Surgery– Balance of risk/benefit

• +/- Radiotherapy (MDT)

• Risks – local nerve damage– Facial– Lingual/hypoglossal– Marginal mandibular

Summary

• Parotid gland – tumours (benign) / Infections

• Submandibular gland – Stones

• Minor glands - function

Thank you!