Salivary Gland Pathologies Dave Pothier St Michael’s 2004.
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Transcript of Salivary Gland Pathologies Dave Pothier St Michael’s 2004.
Anatomy
Submandibular
Medial to mandible
Wharton’s duct around mylohyoid to either side of frenulum of tongue
Infective
• Pus at duct opening
• Tender, hot gland
• IV Abx for bacterial infections
• Cons Rx for viral
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
Types
• Over 40 different types & grades!• Common Benign
– Pleomorphic adenoma– Warthin’s tumour– Benign cyst
• Common Malignant– Mucoepidermoid carcinoma– Adenocarcinoma– Acinic cell
• Examination
Look – skin, inside mouth
Feel – mass: palpate, tenderness, bimanual
- duct
- for stones
Neck
Approach to a lump
Surgery
• Benign disease:superficial parotidectomy
• Malignant disease spectrum of surgery:
Lesion + cuff
radical parotidectomy + neck dissetion
Complications
• Scar, infection, bleeding, haematoma
• VII nerve
• Frey’s syndrome
• Salivary fistula
Sialolithiasis
• Calculi in ducts• Recurrent swellings• Not infected• Tender, not hot• No pus at duct
• Rx – cons/surgical