Otorhinolaryngology (ENT)
Diseases of the Oral Cavity, Salivary Glands and Neck
Oral, salivary and neck disease for MBBS ENT: leucoplakia and oral cancer, pleomorphic adenoma and Warthin tumour, salivary stones and neck swellings, mapped to NMC codes EN4.
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Diseases of the Oral Cavity, Salivary Glands and Neck
Oral, salivary and neck disease for MBBS ENT: leucoplakia and oral cancer, pleomorphic adenoma and Warthin tumour, salivary stones and neck swellings, mapped to NMC codes EN4.
This chapter covers the mouth, salivary glands and neck. It deals with premalignant oral lesions and oral cancer, benign and malignant salivary gland tumours and salivary stones, and the common congenital and acquired neck swellings, with emphasis on the features that distinguish benign from malignant disease.
High-yield: Diseases of the Oral Cavity, Salivary Glands and Neck
- Oral leucoplakia is a white patch that cannot be wiped off and is a premalignant lesion, most often linked to tobacco use.
- Erythroplakia is a red velvety patch with a higher risk of malignant change than leucoplakia.
- Oral submucous fibrosis is a premalignant condition of areca (betel) nut chewing that causes progressive trismus and a stiff mouth.
- Squamous cell carcinoma is the commonest oral cancer and is strongly associated with tobacco, areca nut and alcohol.
- A non-healing oral ulcer lasting more than two to three weeks should be biopsied to exclude malignancy.
- The parotid is the commonest site of salivary gland tumours, and most parotid tumours are benign.
- Pleomorphic adenoma is the commonest salivary gland tumour, a benign but recurrence-prone mixed tumour of the parotid.
- Warthin tumour is a benign parotid tumour that is often bilateral and associated with smoking.
- The smaller the salivary gland, the higher the chance that a tumour in it is malignant.
- Sialolithiasis (salivary stones) most often affects the submandibular gland and causes pain and swelling at mealtimes.
- A facial nerve palsy with a parotid mass strongly suggests a malignant parotid tumour.
- Ranula is a mucus retention cyst in the floor of the mouth arising from the sublingual gland.
- A midline neck swelling that moves on swallowing and on protruding the tongue is a thyroglossal cyst.
- A lateral neck swelling in a young adult that transilluminates and lies deep to sternocleidomastoid may be a branchial cyst.
Salivary gland tumours
- **Pleomorphic adenoma:** Commonest salivary tumour. Benign, parotid, prone to recurrence.
- **Warthin tumour:** Benign, parotid, often bilateral, linked to smoking.
- **Malignant risk:** Rises as gland size falls; minor gland tumours are more often malignant.
- **Red flag:** Facial nerve palsy with a parotid mass suggests malignancy.
NMC competencies in this chapter
- **EN4.36:** Diseases and premalignant conditions of the oral cavity
- **EN4.37:** Salivary gland disorders and neck swellings
Frequently Asked Questions
Which oral lesions are premalignant?
Leucoplakia, erythroplakia and oral submucous fibrosis are the important premalignant conditions. Erythroplakia carries the highest risk, and all are linked to tobacco or areca nut use.
What is the commonest salivary gland tumour?
Pleomorphic adenoma, a benign mixed tumour usually of the parotid gland. It is prone to recurrence if not fully removed, so superficial parotidectomy is preferred over simple enucleation.
Why does gland size matter in salivary tumours?
The smaller the gland, the higher the chance a tumour in it is malignant. Parotid tumours are usually benign, while minor salivary gland tumours are more often malignant.
How do I recognise a thyroglossal cyst?
It is a midline neck swelling that moves upward on swallowing and on protrusion of the tongue, because of its attachment to the hyoid and the tract of the thyroglossal duct.
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