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ENT
Salivary Glands
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
10 sections · 106 slides
Overview
- What this deck will teach you
Meet the Salivary Glands
Three big glands, hundreds of small ones, and the ducts that drain them
- The cast of glands
- The three major salivary glands and their ducts
- Where the minor salivary glands live
- How the glands are born (embryology)
- Inside a salivary secretory cell
- The parotid gland - the big one by the ear
- The parotid's duct and the nerve running through it
- Topography of the parotid, neck and throat
- How the brain switches the parotid on
- The submandibular gland - under the jaw
- The sublingual gland and the minor glands
Saliva Itself
How much is made, what is in it, and the jobs it does
- How much, and made in two steps
- Which gland makes how much, and what type
- The many jobs of saliva
- When saliva flow goes wrong
Working Out What Is Wrong
History, palpation, ultrasound first, then imaging and biopsy
- Why diagnosis here is hard
- Reading the clinical signs
- Feeling the glands with two hands
- Clues from age and a common trap
- Imaging - start simple, escalate as needed
- Ultrasound patterns of salivary disease
- Sialography - a contrast picture of the plumbing
- Sialogram patterns from normal to cancer
- Function tests and the decisive biopsy
- Scintigraphy showing a lazy gland
Inflammatory Diseases
Infections (acute and chronic) and the systemic diseases that inflame glands
- The map of salivary diseases
- Acute bacterial infection - the gland turns hot
- Acute bacterial parotitis
- Treating acute bacterial parotitis
- Mumps - the classic viral parotitis
- Confirming mumps, and a hearing warning
- Two more viral causes: CMV and coxsackievirus
- Chronic sclerosing sialadenitis (Kuttner tumour)
- Chronic recurrent parotitis
- Apple-tree-in-bloom sialogram
- Sjogren syndrome (myoepithelial sialadenitis)
- Sjogren syndrome - gland, joints and biopsy
- Diagnosing and treating Sjogren
- Lymphoma arising in long-standing Sjogren
- Mikulicz syndrome - a label, not a disease
- Sarcoidosis of the parotid glands
- Parotid and lacrimal sarcoidosis
- Heerfordt and Melkersson-Rosenthal syndromes
- Tuberculosis and radiation sialadenitis
Sialolithiasis - Salivary Stones
Why stones form, where, and how they are removed
- Salivary colic - pain that comes with meals
- Salivary stones by the numbers
- Why the submandibular gland is the stone-former
- Pulling out a stone by sialoendoscopy
- Instruments for sialoendoscopy
- Removing the stone - least invasive first
Cysts, Sialadenosis and Trauma
Fluid-filled sacs, soft metabolic swelling, and injury
- Cysts - four kinds to separate from tumours
- Lymphoepithelial cyst of the parotid
- Sialadenosis - soft, painless, both sides
- Sialadenosis causing facial asymmetry
- The secretory cycle behind sialadenosis
- Trauma - nerves, ducts and fistulas
- Frey syndrome - sweating instead of salivating
Salivary Tumours
A rule of thumb, the benign lumps, and the cancers
- The single most useful tumour rule
- Tumour risk by gland - smaller means nastier
- The benign adenomas
- Pleomorphic adenoma - the classic benign lump
- Typical pleomorphic adenoma
- An iceberg (dumbbell) pleomorphic adenoma
- Treating pleomorphic adenoma
- Warthin tumour (cystadenolymphoma)
- Warthin tumour on MRI
- Haemangioma - the vascular tumour of childhood
- Parotid haemangioma in a child
- Lymphangioma (lymphatic malformation)
- Facial lymphangioma
- Lymphangioma of the floor of the mouth
- Malignant tumours - the warning signs
- How parotid cancers spread
- Facial paralysis at presentation - a malignancy marker
- Acinic cell and mucoepidermoid carcinomas
- Adenoid cystic carcinoma - the slow killer
- Adenoid cystic carcinoma resection and nerve graft
- Adenocarcinoma, squamous carcinoma, malignant change
- Carcinoma ex pleomorphic adenoma
- TNM T-stage for major salivary gland carcinoma
- Principles of treating salivary tumours
- Systemic therapy and a modern twist
- House-Brackmann facial paralysis scale
- Staging and follow-up in practice
The Operations
Finding and protecting the facial nerve is the whole game
- Superficial parotidectomy for benign tumours
- Landmarks to find the facial nerve trunk
- Dissecting the facial nerve within the gland
- Radical parotidectomy for malignant tumours
- Removing the submandibular gland
- Anatomy of submandibular gland removal
Pulling It Together
The handful of ideas that organise the whole topic
- Three ideas to carry away
- The clinical red flags never to miss
- Why must the surgeon usually resect the facial nerve in adenoid cystic carcinoma even when the face still moves normally?
- Named sources and references cited in the text
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery