Salivary glands

SALIVARY GLANDS
SIALADENOSIS - Benign, non-tender, non-inflammatory enlargement of salivary glands - Causes: Commonly in pts with advanced liver disease (e.g. alcoholic and non-alcoholic cirrhosis), also in pts with altered dietary patterns or malnutrition (e.g. diabetes, bulimia) - Associated with abnormal autonomic innervation of the glands, with accumulation of secretory granules in acinar cells. - D/D: sialadenitis (focal tenderness, erythema, fever), salivary gland stones (glandular swelling and pain with meals), and malignancy - No management is needed other than to address any underlying nutritional disorders. PLEOMORPHIC ADENOMA - Benign neoplasm affecting salivary glands - Present as firm nodule
ORAL LEUKOPLAKIA - Reactive precancerous lesion that represent hyperplasia of squamous epithelium - Risk factors: same as those for squamous cell CA, with smokeless tobacco (tobacco chewing) or alcohol use accounting for most cases - C/F: white granular patch or plaque over buccal mucosa, cannot be scraped off. - Natural history depends on degree of dysplasia, with 1-20% lesions progressing to squamous cell CA in 10 years - Most resolve within a few weeks with cessation of tobacco use - The development of areas with induration and/or ulceration should prompt biopsy to rule out malignant transformation of the lesion
ORAL CANDIDIASIS - Risk factors: DM, immunodeficiency, use of antibiotics or inhaled glucocorticoids - C/F: white plaques on oral mucosa, tongue, or oropharynx with underlying erythema can be scraped off with tongue depressor
TEMPOROMANDIBULAR JOINT (TMJ) DYSFUNCTION - Most pts have a h/o nocturnal teeth grinding - Pts usually interpret pain as coming from ear—worsened by chewing - Many have audible clicks or crepitus with jaw movement—not seen in all pts

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  • Radiologic imaging is of limited use - Management:  Initial management: conservative such as nighttime bite guard  Surgical intervention is sometimes necessary
    GLOSSOPHARYNGEAL NEURALGIA - Intermittent, severe, stabbing pain in areas innervated by CN IX and X, which includes ear
    RAMSAY HUNT SYNDROME - Form of herpes zoster infection - Causes Bell’s palsy - Vesicles seen on outer ear