Salivary Gland

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Author:
jvirbalas
ID:
197429
Filename:
Salivary Gland
Updated:
2013-08-18 19:27:08
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Head Neck
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Salivary Gland
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  1. Most common submandibular gland malignancy
    adenoid cystic carcinoma
  2. Efferent parasympathetic innervation of the parotid gland
    inferior salivatory nucleus -> glossopharyngeal nerve -> lesser petrossal nerve -> otic ganglion -> auricular temporal nerve, branch of V3
  3. Parasympathetic innervation of submandibular gland and sublingual gland
    superior salivatory nucleus -> chorda tympani (on lingual nerve) -> submandibular ganglion -> submandibular and sublingual gland
  4. Salivary gland most commonly affected by sialolithisis
    Submandibular gland (80%)
  5. What percent of submandibular stones are radioopaque? Parotid?
    • 90% of Submandibular gland stones are opaque
    • 10% of parotid stones are radioopaque
  6. Mumps
    Is what type of virus?
    Is b/l in what percent of pts
    Complication to watch out for?
    Treatment?
    • 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
  7. 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
  8. Difference between primary and secondary sjogrens.
    • Primary: exocrine gland involvement only
    • Secondary: other connective tissue disorder, usu RA
  9. Sjogrens may be assoc with what lymphoid neoplasm
    Nonhodgkins lymphoma
  10. 3 most suggestive symptoms of sjogrens
    • Dry eyes (sandy sensation)
    • Xerostomia
    • Intermittent bl parotid swelling
  11. MRI reveals multiple BL parotid cysts. FNA is benign. Next test?
    HIV
  12. 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
  13. What is the second most common tumor of the salivary gland?
    Warthin's - papillary cystadenoma lymphomatosum
  14. Why does a Warthin's tumor concentrate technetium-99m?
    • High mitochondrial content in oncocytes
    • The other salivary tumor to concentrate Tc99m is oncocytoma
  15. Poor prognostic indicators for salivary gland malignancy
    • submandibular gland involvement
    • parapharyngeal space involvement
    • high grade
    • larger size
    • nerve or skin involvement
  16. Most common malignancy of submandibular gland?
    Adenoid cystic
  17. Most common salivary malignancy in children and adults?
    Mucoepidermoid carcinoma
  18. Rates of regional mets in mucoepidermoid carcinoma?
    30-70%
  19. Mucoepidermoid Ca stains commonly positive for what two elements?
    • Mucin (differentiates from SCC)
    • Keratin
  20. Treatment and prognosis for low grade mucoepidermoid Ca?
    • 70% 5-year survival
    • Gland excision
    • Radical neck for clinically positive nodes only
  21. 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
  22. In adenoid cystic, two low-grade histologic morphologies
    • Tubular, cribriform
    • Up to 100% five year survival
  23. What is the second most common salivary malignancy in children?
    Acinic cell
  24. Management of adenoid cystic ca
    • Aggressive resection
    • Consider adjuvant RT (possible neutron beam)
    • Long term follow up
    • Elective neck not usually indicated
  25. Management of acinic cell Ca
    • Resection with wide margins
    • Neck for positive nodes only
    • RT for advanced disease only
  26. 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
  27. Radiographic landmark dividing the deep and superficial parotid lobes
    Retromandibular vein. Approximates facial nerve depth.

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