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OT30 Otolaryngology
Salivary Glands
Toronto Notes 2019
Bilateralenlargementoftheparotidglands maybeamanifestationofasystemicdisease, such as mumps, HIV, Sjögren’s or an eating disorder (i.e. anorexia, bulimia)
Mumps usually presents with bilateral parotid enlargement ± SNHL ± orchitis
Salivary Glands
Sialadenitis
Definition
• inflammationofsalivaryglands
Etiology
• viralmostcommon(mumps)
• bacterial causes: S. aureus, S. pneumoniae, H. influenzae • obstructivevs.non-obstructive
■ obstructive infection involves salivary stasis and bacterial retrograde flow
Predisposing Factors
• HIV
• anorexia/bulimia
• Sjögren’ssyndrome
• Cushing’s, hypothyroidism, DM
• hepatic/renalfailure
• medsthatincreasestasis:diuretics,tricyclicantidepressants,β-blockers,anticholinergics,antibiotics • sialolithiasis(cancausechronicsialadenitis)
Clinical Features
• acuteonsetofpainandedemaofparotidorsubmandibularglandthatmayleadtomarkedswelling • ±fever
• ±leukocytosis
• ±suppurativedrainagefrompunctumofthegland
Investigations
• U/Simagingtodifferentiateobstructivevs.non-obstructivesialadenitis
Treatment
• bacterial:treatwithcloxacillin±abscessdrainage,sialogogues • viral:notreatment
Sialolithiasis
Definition
• ductalstone(mainlyhydroxyapatiteinadults,sand/sludgeinchildren),leadingtochronicsialadenitis • 80%insubmandibulargland,<20%inparotidgland,~1%insublingualgland
Risk Factors
• anyconditioncausingductstenosisorachangeinsalivarysecretions(e.g.dehydration,diabetes,EtOH, hypercalcemia, psychiatric medications)
Clinical Features
• painandtendernessoverinvolvedgland
• intermittentswellingrelatedtomeals
• digitalpalpationrevealspresenceofcalculus
Investigations
• U/S±sialogram
Treatment
• mayresolvespontaneously
• encouragesalivationtoclearcalculus
• massage,analgesia,antibiotics,sialogogues(e.g.lemonwedges,sourlemoncandies),warmcompresses • removecalculiendoscopically,bydilatingductororifice,orbyexcisionthroughfloorofthemouth
• gland-preservingsurgeryhaslong-termsymptomimprovementandfavourableglandretentionrates
Salivary Gland Neoplasms
Etiology
• anatomicdistribution
■ parotid gland: 70-85%
■ submandibular gland: 8-15%
■ sublingual gland: 1%
■ minor salivary glands, most concentrated in hard palate: 5-8%
