salivary gland disease andrew mccombe. anatomy major – parotid – sub-mandibular – sub-lingual...
Post on 24-Dec-2015
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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
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
Sialolithiasis
• Sub-mandibular gland - 80%• Various causes– Salivary composition– Dehydration– Reduced flow - anatomy
• Obstructive symptoms
Sialolithiasis - treatment
• Observation• Stone removal– Locally intra-oral– Lithotripsy (Smaller stones – 7mm)– Basket removal (Sialadenoscopy)
• Surgical gland removal
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 - 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
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