General Surgery
Salivary Glands
MBBS surgery notes on salivary glands: anatomy, sialadenitis, stones and benign and malignant tumours, mapped to NMC codes SU21.1 and SU21.2.
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Salivary Glands
MBBS surgery notes on salivary glands: anatomy, sialadenitis, stones and benign and malignant tumours, mapped to NMC codes SU21.1 and SU21.2.
This chapter covers the anatomy and surgical diseases of the salivary glands. It spans inflammation, stones and the benign and malignant tumours, with emphasis on the facial nerve relationship and the significance of facial weakness.
High-yield: Salivary Glands
- The major salivary glands are the parotid, submandibular and sublingual glands.
- The parotid gland is divided into superficial and deep lobes by the facial nerve, which is at risk in parotid surgery.
- The parotid duct, Stensen duct, opens opposite the upper second molar tooth.
- The submandibular duct, Wharton duct, opens at the floor of the mouth beside the frenulum.
- Most salivary stones form in the submandibular gland because its secretion is mucus rich and its duct runs uphill.
- Sialadenitis is inflammation of a salivary gland, and acute bacterial parotitis classically affects dehydrated elderly patients.
- Mumps is the commonest cause of viral parotitis and gives bilateral painful parotid swelling.
- The commonest salivary gland tumour is the pleomorphic adenoma, most often in the parotid, benign but prone to recurrence if incompletely excised.
- Warthin tumour is a benign parotid tumour that is more common in older men and smokers and may be bilateral.
- The commonest malignant salivary tumour overall is mucoepidermoid carcinoma.
- Adenoid cystic carcinoma is notable for perineural spread and a tendency to late recurrence.
- The smaller the salivary gland, the higher the proportion of its tumours that are malignant.
- Facial nerve weakness with a parotid swelling strongly suggests a malignant tumour.
- Superficial parotidectomy is the usual operation for a benign parotid tumour, preserving the facial nerve.
- Frey syndrome, gustatory sweating over the cheek, is a recognised complication after parotid surgery.
Salivary gland tumours
- **Pleomorphic adenoma:** Commonest salivary tumour; usually parotid; benign but recurs if incompletely excised.
- **Warthin tumour:** Benign parotid tumour; older men and smokers; may be bilateral.
- **Mucoepidermoid carcinoma:** Commonest salivary malignancy overall.
- **Adenoid cystic carcinoma:** Perineural spread and late recurrence; poor long-term prognosis.
NMC competencies in this chapter
- **SU21.1:** Anatomy and inflammatory and calculous disease of salivary glands
- **SU21.2:** Salivary gland tumours: benign and malignant
Frequently Asked Questions
Why do most salivary stones form in the submandibular gland?
Its saliva is more mucus rich and its duct runs uphill against gravity, both of which favour stasis and stone formation compared with the parotid gland.
What is the commonest salivary gland tumour?
The pleomorphic adenoma, most often in the parotid. It is benign but has a tendency to recur if it is not completely excised, so adequate surgery is important.
What does facial nerve weakness with a parotid lump suggest?
Facial nerve involvement strongly suggests a malignant parotid tumour, since benign tumours usually displace but do not invade the nerve.
What is Frey syndrome?
Gustatory sweating and flushing over the cheek during eating, caused by aberrant reinnervation of sweat glands after parotid surgery.
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