耳鼻喉科Otolaryngology topic four: salivary gland disease

Salivary gland disease

1. Development:

-- earliest start+ last completion: parotid gland

-- before lymphoid tissue development: submandibular, sublingual gland
   (Contain lymphoid tissue --> inflammation or malig., but few malig. at submandibular gland )

2. Parotid gland
-- serous gland, excreted via  Stensen duct 
-- mixed gland at accessory gland
-- connection: forehead, lateral temporal, frontal, periorbital --> intra-parotid lymph-->parotid gland

-- nerve passing: CN7 , 86.7% divided into two branches(tempofacial, cervicofacial), then finally divided into five terminals(temporal, zygomatic, buccal, marginal, cervical), among which buccal is the most variable

-- innervation: CN5-3; sym. n. traveling at external carotid a./ para. n, CN5-3, join CN9

3. Submandibular gland
-- mixed gland (more serous), excreted via  Wharton duct 
-- cross CN7 marginal mandibular nerve
-- related surgery: Hayes martin maneuver

-- innervation:  sym. n. traveling at lingual a./ para. n, CN5-3


4. Sublingual gland
-- mucus gland , excreted via  ducts of rivinus,  Bartholin duct

5. Others
-- minor salivary glands: trachea, oral cavity, nasal cavity, ...
-- histology: acinus cell secreting amylase(serous), mucin(mucus)
-- components: mostly water(99.5%), secreting K+, reabsorb Na+
-- amount:  1-1.5L per day( mostly from stimulation), too much--> hypersalivation, ptyalism
-- innervation: sym. for viscus (norepinepherine);
                        para. for watery part (acetylcholine)

6. Frey syndrome
-- CN5-3 for parotid gland--> change pathway to direct sweat glands
-- after parotidectomy-->80%

7. Acute suppurative sialadenitis
-- retrograde infection
-- more common in parotid gland, post-op pts
-- symptom: diffuse swelling
-- microbiology: 90% S. aureus

8. Mumps
-- symptoms:  fever, malaise, myalgia, anorexia,  orchitis、aseptic meningitis、pancreatitis、myocarditis
-- diagnosis tools:  anti-mumps S antigen and V antigen antibody, urine culture, PCR

9. HIV-related
-- more common in parotid gland (lymph related)
-- presented with xerostomia

10. Granulomatous infection
-- disseminated TB: submandibular gland

11. Cat-scratch disease
-- microbiology: Bartonella henselae

12. Sarcoidosis
-- more common in parotid gland

13. Sjogren’s syndrome
-- 40~60 y/o female
-- prone to have lymphoma

14. Chronic sialadenitis
-- due to sialolithiasis(80% submandibular, unilateral) or duct stricture
-- presented with xerostomia
-- tool for diagnosis: sialography(=x-ray+contrast at salivary glands)

15. Juvenile recurrent parotitis
-- only happens to the "juvenile" group (XDDD I won't get this!)

16. Cystic lesions
-- most common at parotid gland ,second pair
-- mucous extravasation phenomenon(mucoceles at lips, called ranula if from sublingual)
-- ranula: needs transoral resection

17. Radiation injury (including iodine-induced sialadenitis)
-- parotid, >20-30 Gy or I-131(dose depedent) 
-- needs F/U neoplasms

18. Trauma: CN7
-- posterior to the border line from lateral canthus to mental foramen: end to end repair