Salivary Gland disease Andrew McCombe

Anatomy Major – Parotid – Sub-mandibular – Sub-lingual Minor – Oral cavity – Palate – Uvula

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

Function

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

Infections - management Maintain hydration Analgesia Antibiotics Treat underlying pathology

Sialolithiasis Sub-mandibular gland - 80% Various causes – Salivary composition – Dehydration – Reduced flow - anatomy Obstructive symptoms

Sialolithiasis - investigation Plain X-ray Sialogram

Sialolithiasis - treatment Observation Stone removal – Locally intra-oral – Lithotripsy (Smaller stones – 7mm) – Basket removal (Sialadenoscopy) Surgical gland removal

Form

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 - investigation Clinical assessment

Tumours - investigation Clinical assessment FNA Ultrasound

Fine Needle Aspiration Cytology

Cytology – Royal Surrey

Tumour - investigation MRI CT

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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