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Most common submandibular gland malignancy
adenoid cystic carcinoma
Efferent parasympathetic innervation of the parotid gland
inferior salivatory nucleus -> glossopharyngeal nerve -> lesser petrossal nerve -> otic ganglion -> auricular temporal nerve, branch of V3
Parasympathetic innervation of submandibular gland and sublingual gland
superior salivatory nucleus -> chorda tympani (on lingual nerve) -> submandibular ganglion -> submandibular and sublingual gland
Salivary gland most commonly affected by sialolithisis
Submandibular gland (80%)
What percent of submandibular stones are radioopaque? Parotid?
- 90% of Submandibular gland stones are opaque
- 10% of parotid stones are radioopaque
Is what type of virus?
Is b/l in what percent of pts
Complication to watch out for?
- Is what type of virus? Paramyxovirus
- Is b/l in what percent of pts? 75%
- Complication to watch out for? SNHL, orchitis, encephalitis, pancreatitis
- Treatment? Supportive
Signs and symptoms of uveoparotid fever (heerfordt's syndrome). This is a manifestation of what disease process?
- Uveitis, parotid enlargement, facial palsy (50%), SNHL
- Extrapulmonary sarcoidosis
- Self limited
Difference between primary and secondary sjogrens.
- Primary: exocrine gland involvement only
- Secondary: other connective tissue disorder, usu RA
Sjogrens may be assoc with what lymphoid neoplasm
3 most suggestive symptoms of sjogrens
- Dry eyes (sandy sensation)
- Intermittent bl parotid swelling
MRI reveals multiple BL parotid cysts. FNA is benign. Next test?
What is the biocellular theory of origin of salivary neoplasms?
- All neoplasms originate from basal cells of excretory and striated ducts.
- Multicellular theory is more more commonly accepted
What is the second most common tumor of the salivary gland?
Warthin's - papillary cystadenoma lymphomatosum
Why does a Warthin's tumor concentrate technetium-99m?
- High mitochondrial content in oncocytes
- The other salivary tumor to concentrate Tc99m is oncocytoma
Poor prognostic indicators for salivary gland malignancy
- submandibular gland involvement
- parapharyngeal space involvement
- high grade
- larger size
- nerve or skin involvement
Most common malignancy of submandibular gland?
Most common salivary malignancy in children and adults?
Rates of regional mets in mucoepidermoid carcinoma?
Mucoepidermoid Ca stains commonly positive for what two elements?
- Mucin (differentiates from SCC)
Treatment and prognosis for low grade mucoepidermoid Ca?
- 70% 5-year survival
- Gland excision
- Radical neck for clinically positive nodes only
Treatment and prognosis for high grade mucoepidermoid Ca
- Aggressive, less than 50% survival
- N0: Elective neck dissection (supraomohyoid)
- N+: radical neck
- Consider adjuvant RT for high grade, close margins, bone or nerve involvement
In adenoid cystic, two low-grade histologic morphologies
- Tubular, cribriform
- Up to 100% five year survival
What is the second most common salivary malignancy in children?
Management of adenoid cystic ca
- Aggressive resection
- Consider adjuvant RT (possible neutron beam)
- Long term follow up
- Elective neck not usually indicated
Management of acinic cell Ca
- Resection with wide margins
- Neck for positive nodes only
- RT for advanced disease only
Management of post-parotidectomy salivary fistula
- Conservative. Usu resolves spontaneously in 2-3 weeks
- Aspiration, pressure dressings
- Surgical closure (possibly tympanic neurectomy) for prolonged drainage
Radiographic landmark dividing the deep and superficial parotid lobes
Retromandibular vein. Approximates facial nerve depth.
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