Salivary glands

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Parotid Innervation

salivary nucleus -> CN 9 AND Jacobsen's nerve-> otic ganglion -> auriculotemporal nerve -> parotid

Submand/lingual innervations

salivary nucleus -> CN 7 AND chorda tympani -> petrotympanic fissure w/ lingual nerve -> SM ganglion -> SM and SL glands

SG Histopathology

originate as ectodermal oral epith....acini units...serous/mucous.....intercalated-striated-extretory ducts.......Parotid-serous(stimulated flow)...SM- Serous mucus(main flow)......SL- Mucus.....PS system controls

Hemangioma & Arteriovenus malformation

H- overlying skin color change...........AVM- "thrill" changes w/ valsalva and posture. .......Tx: Conservative (mostly spont. Resolution) Refractory (steroids) Last resort (surgery)

Infections

Sialoadenitis/Parotitis...elderly, diabetics, staph.......Mumps, HIV.......TB, Cat-scratch, NonTB myobacterial disease

Mumps

myxovirus...2-3wk incuation.......PRODROME (FMH), parotid swelling, possible SNHL, encephalitis, orchitis, oophoritis, pancreatitis...pain increases w/ sour liquids.......

Tx: supportive/sxmatic

...

Sialothiliasis

salivary stone-> ductal damage & gland infection

Mucocele

*Most common Trauma effect. Trauma to excretory -> mucus into surrounding connective tissue.......Painess, smooth, blue lesions.... Lower lip > cheek > ventral tongue > FOM.......Tx observation and surgery

Ranula

"frog like"....blocked SL gland ducts, mucus extravasation, unilateral, bluish ... Plunging herniates mylohyoid muscle, appears in neck....

Sjogren's

most common autoimmune. "dry disease" ... xerophthalmia (eyes), xerosomia (mouth) ... *4/6 critera...at least 2 objective........ R/O lymphoma, Hep C, AIDS, Sarc, GVHD, XRT>3mos....lip biopsy, no salv flow, Abnl sialography/scintigraphy...anti-SSA or Anti SSB autoantibodies.........secondary to RA and SLE

Sarcoidosis

parotid most common site ***elevated ACE. Autoimmune.

Kimura's disease

autoimmune. Gland enlargement +/- lymphadenopathy....angiolymphoid hyperplasia **eosinophilia

Metabolic

DM & HLD....fatty infiltration, decreased salivary flow.......Pellagra (niacin), Kwashiorkor (protein), Beriberi (thiamine), Alcoholism (protein), Vitamin A def.

Idiopathic Xerostomia

RT, HTN meds, Anti-histamine, Anti-depressants, Muscle relaxants

Pleomorphic Adenoma

Most common benign tumor. Along w/ warthins and benign cyst.

Mucoepidermoid

Most common malignant. Along w/ adenoid cystic and adenocarcinoma.

Frey's syndrome

Aberrant neural pattern—sweat glands innervated by parotid PS fibers. Sweating on cheek area—gustatory sweating. Stop w/ botox, deodorant...

First Bite Syndrome

Cramping pain w/ 1st bite of food...cause: sympathectomy.... Seen w / Horner's.... Treat w/ botox, gabapentin

Branchial Cleft Cyst

residual embryonic pouch of endoderm, lined w/ digestive tract epithelium, swells with infection,infancy or late adulthood, complete surgical excision

Chronic Sialorrhea

increase in salivary flow...spills over lower lip...due to swallowing probs, poor lip closure synchronization....therapy, botox of salivary glands, duct ligation, gland excision, duct re-routing

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