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Most common submandibular gland malignancy
adenoid cystic carcinoma
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Efferent parasympathetic innervation of the parotid gland
inferior salivatory nucleus -> glossopharyngeal nerve -> lesser petrossal nerve -> otic ganglion -> auricular temporal nerve, branch of V3
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Parasympathetic innervation of submandibular gland and sublingual gland
superior salivatory nucleus -> chorda tympani (on lingual nerve) -> submandibular ganglion -> submandibular and sublingual gland
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Salivary gland most commonly affected by sialolithisis
Submandibular gland (80%)
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What percent of submandibular stones are radioopaque? Parotid?
- 90% of Submandibular gland stones are opaque
- 10% of parotid stones are radioopaque
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Mumps
Is what type of virus?
Is b/l in what percent of pts
Complication to watch out for?
Treatment?
- Is what type of virus? Paramyxovirus
- Is b/l in what percent of pts? 75%
- Complication to watch out for? SNHL, orchitis, encephalitis, pancreatitis
- Treatment? Supportive
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Signs and symptoms of uveoparotid fever (heerfordt's syndrome). This is a manifestation of what disease process?
- Uveitis, parotid enlargement, facial palsy (50%), SNHL
- Extrapulmonary sarcoidosis
- Self limited
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Difference between primary and secondary sjogrens.
- Primary: exocrine gland involvement only
- Secondary: other connective tissue disorder, usu RA
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Sjogrens may be assoc with what lymphoid neoplasm
Nonhodgkins lymphoma
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3 most suggestive symptoms of sjogrens
- Dry eyes (sandy sensation)
- Xerostomia
- Intermittent bl parotid swelling
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MRI reveals multiple BL parotid cysts. FNA is benign. Next test?
HIV
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What is the biocellular theory of origin of salivary neoplasms?
- All neoplasms originate from basal cells of excretory and striated ducts.
- Multicellular theory is more more commonly accepted
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What is the second most common tumor of the salivary gland?
Warthin's - papillary cystadenoma lymphomatosum
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Why does a Warthin's tumor concentrate technetium-99m?
- High mitochondrial content in oncocytes
- The other salivary tumor to concentrate Tc99m is oncocytoma
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Poor prognostic indicators for salivary gland malignancy
- submandibular gland involvement
- parapharyngeal space involvement
- high grade
- larger size
- nerve or skin involvement
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Most common malignancy of submandibular gland?
Adenoid cystic
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Most common salivary malignancy in children and adults?
Mucoepidermoid carcinoma
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Rates of regional mets in mucoepidermoid carcinoma?
30-70%
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Mucoepidermoid Ca stains commonly positive for what two elements?
- Mucin (differentiates from SCC)
- Keratin
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Treatment and prognosis for low grade mucoepidermoid Ca?
- 70% 5-year survival
- Gland excision
- Radical neck for clinically positive nodes only
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Treatment and prognosis for high grade mucoepidermoid Ca
- Aggressive, less than 50% survival
- N0: Elective neck dissection (supraomohyoid)
- N+: radical neck
- Consider adjuvant RT for high grade, close margins, bone or nerve involvement
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In adenoid cystic, two low-grade histologic morphologies
- Tubular, cribriform
- Up to 100% five year survival
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What is the second most common salivary malignancy in children?
Acinic cell
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Management of adenoid cystic ca
- Aggressive resection
- Consider adjuvant RT (possible neutron beam)
- Long term follow up
- Elective neck not usually indicated
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Management of acinic cell Ca
- Resection with wide margins
- Neck for positive nodes only
- RT for advanced disease only
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Management of post-parotidectomy salivary fistula
- Conservative. Usu resolves spontaneously in 2-3 weeks
- Aspiration, pressure dressings
- Surgical closure (possibly tympanic neurectomy) for prolonged drainage
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Radiographic landmark dividing the deep and superficial parotid lobes
Retromandibular vein. Approximates facial nerve depth.
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