Salivary Gland Problems

1
Salivary Gland Problems

• Fergus Donachie

2
Anatomy

• 3 Main salivary glands
• Parotid
• Submandibular
• Sublingual

3
Salivary Stones

• 85 occur in submandibular gland
• More common in men
• Rare in children
• Only 3 are bilateral
• Made of calcium phosphate
• Some association with dehydration, trauma,
  anticholinergics, gout and kidney stones

4
Clinical Features

• Pain and swelling of the affected gland
• Worse on eating
• May present as a painless swelling
• Erythema suggests infection
• Clear saliva should be seen on pressing a
  salivary gland, pus may be seen if infected

5
Examination

• Palpate the gland from posterior to anterior
• Should feel spongy and elastic
• May be tender
• Stones feel rock hard, usually in the duct
• In chronic obstruction gland will feel firm

6
Diagnosis

• Plain X-ray
• Sialogram
• CT
• Ultrasound

7
Management

• No evidence based advice
• Good hydration
• Warm compresses
• Massage gland
• Lemon wedges
• May be able to milk out the stone

8
Management

• Consider stopping anticholinergics
• Antibiotics if infection suspected - cefalexin,
  flucloxacillin
• Refer if doesnt settle within a few days
• If infection doesnt settle needs urgent referral
• Duct dilatation
• Gland excision

9
Differential Diagnosis

• Viral sialadenitis (Mumps) - usually bilateral
• Suppurative sialadenitis - post op, elderly,
  malnourished
• Sjogrens syndrome - gradual swelling of parotid
  or submandibular gland with decreased saliva
• Sarcoid - bilateral painless parotid enlargement

10
Salivary Tumours

• 2/100000 per year incidence
• Commonest in parotid gland - 80
• 20 are malignant
• Smaller glands have greater chance of malignancy
• Usually solitary and slow growing
• Squamous cell carcinoma can metastasize to
  salivary glands
• Facial nerve paralysis almost always means
  malignancy