DMS 211 Salivary Glands

Chronic Sialadenitis

is mainly caused by infection secondary to sialolithiasis. With recurrent infection the gland atrophies and is replaced by fibrotic tissue. Sonographically the gland appears atrophic and diffusely hypoechoic with irregular margins, the ultrasound appearances often simulating a "cirrhotic" liver. Biopsy or excision is often needed to confirm the diagnosis. Sonographically these lesions can mimic tumors appearing as a focal, hypoechoic lesion.

thought, smell, taste or visual

The flow of saliva is stimulated by the ___, ___, ___, or ___ sensations of food

amylase

The glands secrete ___ , an enzyme that breaks down starch into maltose and dextrose (sugars).

Sialolithiasis (Salivary Gland Stones)

he development of tiny calcium deposits or stones within a salivary gland is called sialolithiasis. The majority of the stones affect the submandibular glands (60-90%) and are located at the floor of the mouth that block the flow of saliva into the mouth. Symptoms typically occur while eating. Saliva starts to flow with eating but cannot exit the gland and thus leads to pain and swelling of the involved gland. Both the main duct and intraglandular ductules can be affected. The condition does also, however, occasionally affect the parotid glands, located on the sides of the face or the sublingual glands, which are under the tongue. More men are affected greater than women (2:1) and many people with the condition have multiple stones. The main sonographic feature of a calculus is an echogenic rim with complete posterior acoustic shadowing. A stone impacted at the ductal ostium (30%) may not be well depicted on sonography, but many cases (65%) have associated main duct dilatation. These calculi are often palpable clinically. The swollen gland due to intraglandular calculi can become heterogeneously hypoechoic and can show intraglandular ductal dilation.

Sublingual, parotid, and submandibular glands

3 paired glands

hygroma

A cystic ___ is a growth that often occurs in the head, neck and chest areas. They are fluid-filled sacs that result from a blockage in the lymphatic system.

chromosomal

Cystic hygromas can be single or a series of cysts found in the neck region. A cystic hygroma can be present as a birth defect (congenital) or develop at any time during a person's life. When found in utero, it may have a greater than 50% association with ___abnormalities (such as Trisomy 13, 18, 21 and Turners syndrome). Isolated cystic hygroma can be inherited as an autosomal recessive disorder for which parents are "silent" carriers or it can occur from an unknown cause.

800-1000

Keep in mind that there are ___minor salivary glands located throughout the oral cavity within the submucosa of the mouth along the hard palate and tongue areas!

neoplasms benign malignant lymph nodes

Eighty percent (80%) of salivary gland ___ arise in the parotid glands, 10-15% in the submandibular glands and the remainder in the sublingual and minor salivary glands. About 80% of parotid neoplasms are ___but the relative proportion of malignancy increases in smaller glands. About 50% of submandibular gland neoplasms and most sublingual and minor salivary gland tumors are ___. Normal parotid ___are frequently observed during ultrasound examination. These nodes appear elliptical and hypoechoic with a hyperechoic, fatty, central hilum.

regulating pH levels

Saliva contains chemicals and enzymes that ward off illnesses by ___and neutralizing bacteria.

medially

Sublingual-Wharton's duct of the submandibular gland runs ___ to each gland and is usually not visualized unless obstructed

1 to 1.5

The average human secretes between ___ liters of saliva in a 24 hours period

Oncocytoma (Oxyphilic Adenoma)

The salivary gland oncocytoma is a well-circumscribed, benign neoplastic growth. These rare tumors comprising only 1% of parotid neoplasms. They arise from oncocytes derived from striated duct cells. They present as firm, painless, slow growing masses of < 4 cm. usually in the superficial lobe. Salivary gland oncocytomas are most common in females ages 70-80 and may be bilateral.

exocrine

The salivary glands in human beings are ___ glands (glands with ducts).

production of saliva

Their primary function is the ___, a highly important link in the digestive chain.

Acute Sialadenitis

There is painful swelling and the gland appears enlarged and hypoechoic on ultrasound. There may be adjacent regional lymphadenopathy. Ultrasound is useful in severe cases of bacterial infection, especially if abscess formation is suspected. Abscesses are seen as ill-defined hypoechoic foci with intraglandular ducts passing through the lesion as opposed to ductal displacement which would favor tumor. Ultrasound can also be used to guide drainage of suspected abscess.

Warthin's Tumor (Cystadenolymphoma)

These are the second most common benign tumors of the parotid gland and arise from heterotopic parotid tissue within parotid lymph nodes. They are most common in elderly males and tend to occur in the superficial lobe near the angle of the mandible. They commonly demonstrate a lobulated appearance with internal cystic elements and hyperechoic septations.

digestive

They are considered to be accessory ___ glands.

Sialadenitis (Salivary Gland Infection)

This is the most common condition to affect the major salivary glands. It can be sub-divided into acute and chronic sialadenitis. The parotid gland is involved 85% of the time.

• Cervical Ranula

___ (also known as Plunging ranula) are cysts that occur in the floor of the mouth and extend (plunge) into the neck. usually present as a painless swelling in the neck.

• Sialocele

___ are cysts of major salivary gland origin, are painless swellings of a major salivary gland and may present secondary to inflammation, stones or tumors.

Salivary gland cysts

___ occur as the result of trauma or obstruction to the salivary gland excretory duct and spillage of saliva into the surrounding soft tissue. The blocked duct does not allow the saliva to exit into the mouth. The saliva therefore, gets backed up in the gland and results in the enlargement and ballooning of the gland. can be classified as Sialocele, Mucocele, Oral Ranula and Cervical Ranula.

• Oral Ranula

___are painless cysts that occur in the floor of the mouth and usually involve the major salivary glands. They do not extend beyond the mouth. Usually present with swelling in the floor of the mouth that is painless. On occasion, they can interfere with speech or chewing.

Pleomorphic Adenoma

a benign, ovoid, homogeneous and hypoechoic tumor. It is usually well circumscribed with distal acoustic enhancement and well vascularized. The majority are found in the parotids (60 -80%) and less commonly in the submandibular gland (10-30%). These tumors typically present as lobulated, slow growing, painless masses in middle-aged patients. Long-standing, may develop cysts and/or internal calcification.

Cervical lymph nodes

are composed of lymphoid tissue and are located along the lymphatic vessels in the neck. They are responsible for draining lymphatic fluid from different areas of the head and neck. There are approximately 800 lymph nodes in the body and 300 of them are located in the neck. They are embedded in the soft tissues of the neck and are either partly or completely surrounded by fat

• Mucocele

are cysts of minor Salivary Gland origin, are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size.

Mucoepidermoid Carcinoma

is the most common primary parotid malignancy accounting for over 50% of cases. Commonly seen in 30-50 years of age. It is a usually a solitary, hard, fixed, rapidly-growing tumor possibly causing facial nerve paralysis. Hypervascularity and increased tumoral resistance on color Doppler ultrasound examination is indicative of malignancy. Surgical excision and radiotherapy is the treatment of choice.

Adenoid Cystic Carcinoma

is the second most common primary parotid malignancy and has a tendency to spread along nerves pathways, often presenting with pain and evidence of facial nerve involvement. characterized by its unpredictable behavior and although it can be highly invasive it may also remain quiet for long periods of time. a very slow growing tumor; however, it also has a tendency to recur after removal. It rarely spreads to the lymph nodes or metastasizes to other parts of the body. These tumors when small, as with mucoepidemoid carcinoma often appear circumscribed but develop more overtly malignant ultrasound features as they enlarge. There is no way of telling what the tumor is by just looking at it and a diagnostic biopsy must always be performed.

parotid gland

it is the only gland to have intraparenchymal lymph nodes

Lipoma

these are compressible, oval or elliptical fatty masses with regular margins and a typical striped or feathered internal echotexture. usually hypoechoic with no flow detected with color Doppler examination.

the parotid gland

• Largest of the 3 paired major glands - 6-7 cm (L) x 3.5 cm (W) x 3.5 cm (H)

Stenson's duct

• Parotid-The excretory duct is also known as ___(located in the mid-section of the gland)

Submandibular gland

• Second largest paired salivary gland - 3.5 cm +/- 0.5 cm in length

25

•Parotid- Produces __% of total saliva output

serous

•Parotid- Secretes ___ type saliva

8-20 5

•Sublingual- Contains ___ excretory ducts • Produce less than ___% of total saliva output

sympathetic

•Sublingual- Little or no ___ influence

tongue

•Sublingual- Located beneath the muscles of the ___ near the chin region with the mylohyoid muscles on the lateral side adjacent to the mandible

mucous

•Sublingual- Mixed secretion - mostly ___

Smallest

•Sublingual- ___ of the paired major glands - 2.0 - 2.5 cm

Innervated

•Sublingual- ____by parasympathetic fibers

triangular

•Submandibular gland- Is ___ in shape and may have glandular processes connected to the parotid and sublingual glands

mucous serous

•Submandibular- Mixed secretions - ___ and serous but mostly ___

65-70

•Submandibular- Produces ____% of total saliva output

Wharton's floor

•Submandibular- The excretory duct is called ____ duct • Wharton's duct exits on the ___of the mouth opposing the lingual surface of the tongue

lingual mandible mylohyoid

•submandibular- Located in a depression on the ___ side of the mandibular body, bordered by the ___ laterally and the ___ muscle superiorly and medially