Salivary Gland Pathologies

Dave PothierSt Michael’s 2004

Anatomy

• 3 pairs of (groups) of glands– Parotid– Submandibular– Sublingual

Anatomy

Parotid

In cheek and behind angle of mandible

Stenson’s duct to inner cheek

Anatomy

Anatomy

Submandibular

Medial to mandible

Wharton’s duct around mylohyoid to either side of frenulum of tongue

Anatomy

Anatomy

• Sublingual glands

Pathologies

• Congenital – Unusual – Atresia– Strictures

• Aquired…

Pathologies - Infective

Parotitis:

bacterial (staph, TB,

actinomycoses)

viral (mumps)

Infective

• Pus at duct opening

• Tender, hot gland

• IV Abx for bacterial infections

• Cons Rx for viral

Neoplastic

It is benign or malignant?

50 / 50 split across all neoplasms

Depends a lot on site…

Neoplastic

Benign Malignant

Parotid 80% 20%

Submandibular 40% 60%

Sublingual 10% 90%

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

Approach to a lump

• Hx

General - eye + other sjogren’ signs

- bulimia

- TB etc

Approach to a lump

• Hx

Specific-

Duration of lesion

Pain

Neural symptoms

• Examination

Look – skin, inside mouth

Feel – mass: palpate, tenderness, bimanual

- duct

- for stones

Neck

Approach to a lump

Approach to a lump

• Ix

FNAB

USS

+/- MRI or CT

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

Conclusions

• Beware of non-parotid salivary swellings more than usual

• Remember VII

• Consent thoroughly for complications