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ENT: Salivary Glands
ENT: Salivary Glands
95
Anatomy
Graduate
10/22/2011

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Term
Salivary glands are __ glands stimulated by the ___ and inhibited by the __.
Definition
- exocrine
- stimulated by the PNS
- inhibited by the SNS
Term
What type of drugs cause dry mouth?
Definition
- Anticholinergics (Atropine)
Term
The PNS causes __ __ secretion, while the SNS causes __ __ secretion.
Definition
- thin watery
- thick viscous
Term
The submandibular gland is aka the ___ gland.
Definition
- submaxillary gland
Term
3 major salivary glands:
Definition
- Parotid
- Sublingual
- Submandibular
Term
Wharton's ducts are associated with the __ __.
Definition
submandibular glands
Term
Stenson's ducts are associated with the __ __.
Definition
parotid gland
Term
Saliva composition:
Definition
1. 97-99% water with a pH of 6.7-7
2. Electrolytes mainly Na+, K+, Cl-, PO4- , HCO3-
3. Salivary amylase
4. Mucin
5. IgA antibodies
6. lysozymes
Term
70% of saliva comes from the __ __ at a resting state.
Definition
submandibular glands

ingestion of food causes submandibular glands to secrete more
Term
The parotid glands secrete __ __ saliva rich in __ and __ __ __. They are associated with __ ducts.
Definition
- watery serous saliva
- amylase and proline-rich proteins
- stensons ducts
Term
The submandibular secretes more __ saliva and is associated with __ ducts.
Definition
- mucinous
- Wharton's
Term
The sublingual gland secretes __ saliva and is associated with __ __ __ and the _ __ ___.
Definition
- viscous
- ducts of Rivinus
- duct of Bartholin
Term
The submandibular and sublingual glands are innervated by the __ __ via __ __, which comes from the __ __ __ in the dorsal brainstem and lower medulla.
Definition
- CN VII (facial) via chorda tympani
- superior salivary nucleus
Term
The parotid gland is innervated by __ __ which is from the __ __ __.
Definition
- CN IX (glossopharyngeal)
- inferior salivatory nucleus
Term
The second largest salivary gland:
Definition
Submandibular Salivary Gland
Term
The submandibular gland is the second largest salivary gland. It is recessed immediately below the __. The __ and __ nerves OVERLY the gland. It is connected to __ __ which opens adjacent to the lingual frenulum.
Definition
- mandible
- hypoglossal and lingual
- Wharton's ducts
Term
The sublingual glands open into the mouth along the top of the __ __ located on the floor of the mouth under the tongue.
Definition
transverse ridge
Term
The largest salivary gland:
Definition
Parotid Salivary Gland
Term
Gland most prone to bacterial sialadenitis:
Definition
Parotid Gland
Term
3 types of bacterial sialadenitis:
Definition
1. Neonatal sialadenitis
2. Acute bacterial sialadenitis
3. Chronic sialadenitis
Term
What nerve bisects the Parotid gland?
Definition
- facial nerve
Term
The parotid gland lies over the __ __.
Definition
maxillary bone
Term
Stensen's ducts are aka __ __ that open out adjacent to to the maxillary __ __. Milking the parotid will expel drop at duct.
Definition
- Parotid Papilla
- second molar
Term
Minor salivary glands are involved in symptoms of __, __, and __ __.
Definition
- xerostomia
- stomatodynia
- denture intolerance
Term
Minor salivary glands aka __ __ are crucial to retain __ __ __.
Definition
- Palastine glands
- maxillary full dentures

There are no connections between secretory rates of major and minor salivary glands.
Term
Anticipatory response:
Definition
smell food> mouth starts watering
Term
The PNS controls the salivary glands. Both __ and __ receptors are used to stimulate the __ __ in the __. Action potentials return to the __ __ __ via cranial nerves __ and __. The saliva released is __ and contains __ __.
Definition
- pressure and chemoreceptors
- salivatory nuclei in the medulla
- extrinsic salivary glands via CN VII and IX
- serous and contains salivary amylase
Term
7 main functions of saliva:
Definition
- Protection
- Buffering
- Digestion
- Antimicrobial
- Maintenance of tooth integrity
- Tissue repair
- Taste
Term
Saliva protection explained:
Definition
lubricant (glycoprotein)
barrier against noxious stimuli; microbial toxins and minor traumas
washing non-adherent and acellular debris
formation of salivary pellicle
calcium-binding proteins: tooth protection; plaque
Term
Saliva buffering explained:
Definition
Buffering (phosphate ions and bicarbonate)
bacteria require specific pH conditions
plaque microorganisms produce acids from sugars
Term
Saliva Digestion explained:
Definition
neutralizes esophageal contents
dilutes gastric chyme
forms food bolus
brakes starch
Term
Saliva Antimicrobial explained
Definition
lysozyme hydrolyzes cell walls of some bacteria
lactoferrin binds free iron and deprives bacteria of this essential element
IgA agglutinates microorganisms
Term
Saliva Maintenance of tooth integrity
calcium and phosphate ions
ionic exchange with tooth surface
Definition
Term
Saliva Tissue repair
bleeding time of oral tissues shorter than other tissues
Definition
Term
Saliva tasteTaste
solubilizing of food substances that can be sensed by receptors
trophic effect on receptors
Definition
Term
Sialadenitis is __ of the __ __.
Definition
- inflammation of the salivary glands
Term
Possible causes of Sialadenitis:
Definition
- Infection: viral/bacterial
- Systemic disease: Sjogren'sy, sarcoidosis
- Stones in the salivary duct
Term
Common causes of Parotiditis:
Definition
- Mumps
- Sjogren's Syndrome
- Bacterial infection (usually Staph. aureus)
- Blocked salivary duct
- Stone in salivary duct
Term
Acute bacterial parotiditis symptoms:
Definition
- PROGRESSIVE PAINFUL SWELLING
- CHEWING AGGRAVATES PAIN
Term
Acute viral parotiditis aka __ symptoms.
Definition
- Mumps
- pain and swelling lasts 5-9 days
- Moderate malaise
- anorexia
- fever
- usually bilateral
Term
HIV parotitis is when there is ___ swelling of the gland and the patient is otherwise ___.
Definition
- nonpainful
- asymptomatic
Term
Sjogren's syndrome is a type of parotitis. Symptoms include:
Definition
- recurrent/chronic swelling of one or both parotid glands
- dry eyes
- dry mouth
- no apparent cause
- frequently associated with autoimmune diseases
- discomfort is modest in most cases
Term
Sarcoidosis is a type of parotitis in which there is __ __ swelling of the parotid glands.
Definition
- chronic nontender
Term
Acute parotitis symptoms:
Definition
- Antibiotics
- Rehydration stimulating salivary flow
- Possible IND
Term
Sialolithiasis aka __ __ __ are most common in the __ __ b/c __ __ is longer and more tortuous than other ducts. There is pain and swelling associated with __ usually from duct obstruction.
Definition
- salivary gland stones
- Submandibular gland
- Wharton's duct
- eating
Term
Sialolithiasis management:
Definition
- milk the duct and look at saliva for infection
- palpate duct, may be able to feel and possibly express stone
- maintain hydration
Term
Most common organsim causing infection with sialolithiasis is :
Definition
Staph aureus
Term
Best image for sialolithiasis:
Definition
CT
Term
Mumps is a danish word that means mumbling, which results from the __ __ and __.
Definition
- glandular inflammation
- trismus
Term
Mumps is caused by __ __, which is an __ __. It is rapidly inactivated by __ _, __, and __ __. It is transmitted by __ __. It can also cause __.
Definition
- Paramyxovirus, RNA virus
- chemical agents, heat, and ultraviolet light
- respiratory droplets
- orchitis
Term
The diagnosis of mumps is based on __ of __, and parotid __ and __.
Definition
- history of exposure
- parotid swelling and tenderness
Term
acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause
Definition
Mumps
Term
Reservoir Human, Asymptomatic infections may be transmitted
Transmission Respiratory drop nuclei
Temporal pattern Peak in late winter and spring
Communicability Three to four days after onset of active disease
Definition
Term
Common complications of mumps:
Definition
Parotitis (after puberty, 30-70%)
Orchitis (after puberty, 20-50%, Mumps orchitis follows the development of parotitis by 4-7 days, 70% unilateral.)
Mastitis (after puberty, 20-30%)
Aseptic meningitis (<10%)
CSF pleocytosis
Term
Rare complications of mumps:
Definition
Orchitis  sterility
Encephalitis (~0.01%-0.02%)
Thyroiditis, pancreatitis (4%)
Pancreatitis (2-5%)
Deafness (0.005%, 1/20,000)
Spontaneous abortion, 1st trimester infection (~25%)
Term
Mumps treatment:
Definition
Maintain hydration
Soft food
Non-acidic foods/bevarages
Analgesics and antipyretics are given to control pain and fever - acetominophen
Bed rest
Term
How does saliva play a role in dental health:
Definition
- remineralizes enamel
- buffers cariogenic acids
- removes food residue
- inhibits bacterial growth
Term
Xerstomia:
Definition
Definition
Decreased saliva production
Physiology: Saliva plays vital role in dental health
Re-mineralizes enamel
Buffers cariogenic acids
Removes food residue
Inhibits bacterial growth
Term
Effects of Xerostomia:
Definition
- sensation of dry mouth
- oral burning/soreness
- sensation of loss/altered taste
- erythematous pebbled or cobblestoned or fissured tongue
- atrophy of filliform papillae
- white curd like patches on mucosa?
Term
Causes of Xerostomia:
Definition
- Sjogren's syndrome
- Radiation to head/neck
- HIV
- Post salivary gland surgery
- Amyloidosis
- Diabets Mellitus
- Chronic active hepatitis
- Granulomatous disease: Sarcoidosis, Tuberculosis, Leprosy
Term
Medications that cause Xerostomia:
Definition
- TCAs
- Antispasmodics
- SSRIs
- Neuroleptics
- Antiparkinsons drugs
- Lithium
- Central adrenergic agonists (Clonidine)
- Diuretics
- Antihistamine
- Bronchodilators (muscarinic antagonists)
Term
Xerostomia treatment:
Definition
- fluoride supplement
- avoid sugar
- frequently sip fluids
- avoid caffeine, alcohol, smoking
- drink while eating
- sugar free saliva stimulants (xylitol)
- alcohol free mouth rinses
- salivary secretagogues
Term
__ is a salivary secretagoge approved for Sjogrens and postradiation of the head/neck.
Definition
Pilocarpine
Term
___ is also approved for treatment of Sjogrens syndrome.
Definition
Cevimaline
Term
Salivary secretagogues are _____.
Definition
- anticholinesterases (Pilocarpine, Cevimaline)
Term
Most common immunological disease of the salivary glands:
Definition
Sjogrens Syndrome
Term
Sjogren's Syndrome is an __ __ __ disorder, most frequent in __ in their __.
Definition
- autoimmune connective tissue
- women in their 50s
Term
With Sjogren's Syndrome their is __ __ leading to difficulty __ and __. Secondary __ __ occur, __ __, and __ in the salivary ducts. __ and __ may be diminished.
Definition
- decreased saliva leading to difficulty chewing and swallowing
- Secondary candida infections
- tooth decay
- calculi
- taste and smell
Term
Sjogren Syndrome is autoimmune d/o characterized by __ and __. If these two are combined with exocrine gland dysfunction, the triad is known as __ __.
Definition
- xerostomia
- xeropthalmia
- sicca complex
Term
Sicca complex:
Definition
- xeropthalmia + xerostomia + exocrine gland dysfunction
Term
Keratoconjuctivitis sicca is when there is atrophy of the __ __ of the __ __ causing dessication of the __ and ___. Diminished _ __ is caused by __ ___ __ of the lacrimal gland parenchyma.
Definition
- epithelium of the lacrimal glands
- dessication of the cornea and conjunctiva
- tear production
- lymphocytic cell replacement
Term
Acute causes of drooling:
Definition
- epiglottitis
- neoplasm
- abscess
Term
Chronic causes of drooling:
Definition
- neurologic (cerebral palsy), most common, usually related to head control
Term
Ptyalism:
Definition
excess saliva
Term
Mechanism of Ptyalism:
Definition
- decreased swallowing and saliva clearance
- excess saliva production
- neuromuscular disease
- anatomic abnormalities
Term
Causes of excess saliva production:
Definition
- Pregnancy = Ptyalism Gravidarum
- Excessive starch intake
- GI causes: Gastric distention or irritation, GERD
- Neuromuscular disorders
Cerebral Palsy
Bilateral Facial Nerve Palsy
Cerebrovascular Accident
Myasthenia Gravis
Rabies
- Miscellaneous Causes
Radiation therapy
Macroglossia
Dental malocclusion
Term
Drugs that cause excess saliva production:
Definition
- Clozapine
- Pilocarpine
- Mercury poisoning
- Arsenic poisoning
- Antimony (treats parasitic infections)
- Iodide
- Bromide
Term
Causes of difficulty swallowing:
Definition
- Infections: tonisilits, peritonsillar abscess, epiglottitis, mumps
- Bone lesions: jaw fracture or dislocation
Term
Management of excess salivation:
Definition
Treat specific causes as below
General measures to reduce Saliva
Tooth brushing and mouthwash has drying effect
Reduce starch intake from diet
Anticholinergic Medications (if refractory to above)
Glycopyrrolate
Adults: 0.5 to 2 mg PO qd to tid prn
Children: 0.04 mg/kg PO qd to tid prn
Scopolamine patch 1.5 mg applied every 72 hours prn
Term
What class of drugs could be used to control excess saliva production? Give an example.
Definition
Anticholinergics- Glycopyrrolate
Term
Excess salivation management:
Definition
Treat cause, ie
Nausea with Antiemetics
Treat Gastroesophageal Reflux
Neuromuscular causes
Speech pathology (e.g. swallowing mechanism)
Occupational therapy (e.g. head-back wheelchair)
Oral diseases including dental malocclusion
Dentist or orthodontist
Macroglossia or Tonsillar Hypertrophy
Otolaryngology
Term
salivary gland tumor:
Definition
Rare
Location – parotid gland, sublingual gland, submandibular gland, and some minor salivary glands
Slow growing
Found on palpation
Check facial nerve – wrinkle brow, squeeze eyes shut, puff cheeks
Types
Benign or malignant – surgical
Term
Benign salivary neoplasms are usually ___.
Definition
asymptomatic
Term
Symptoms of a malignant salivary neoplasm:
Definition
- pain
- rapid growth
- CN VII symptoms
- skin fixation
Term
The __ gland is most likely to get a salivary gland tumor, usually benign.
Definition
parotid
Term
The smaller salivary glands are more likely to get __ tumors.
Definition
malignant
Term
Most common tumor of parotid gland:
Definition
- Benign Mixed Tumor aka Pleomorphic Adenoma
Term
Tumor that occurs most frequently in the tail of the parotid gland of white middle aged males.
Definition
Warthin's Tumor aka Papillary Cystadenoma Lymphomatosum
Term
Any solid assymetric mass is __ until proven otherwise.
Definition
cancer

12% of asymptomatic neck masses are cancer- 80% of those are squamous cell carcinoma
Term
The salivary gland tumor usually presents as an enlarging mass __ and/or __ angle of the __ or within the __ __.
Definition
- anterior and/or inferior angle of the mandible
- submandibular triangle
Term
Benign salivary gland tumors are often __.
Definition
asymptomatic
Term
characteristics of salivary gland tumor suggesting malignancy:
Definition
- rapid growth
- skin fixation
- CN palsies (VII or XII)
Term
First line diagnostic test for salivary gland tumors:
Definition
Fine needle aspiration biopsy
Term
Often asymptomatic, but may show rapid tumor enlargement, pain, trismus, or facial nerve palsy

FNA has 95% sensitivity in salivary gland neoplasms. Any patient with a salivary gland mass should undergo FNA
Incisional biopsy is contraindicated due to tumor seeding
Definition
Term
__ __ is contranindicataed with salivary gland tumors due to tumor seeding.
Definition
Incisional biopsy
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