ENT Knowledge Base

Diagnosis

Neck

Salivary gland

Salivary gland infection

It can be bacterial or viral in origin. Mumps virus it the most common cause of viral salivary gland infection. It causes acute, nonsuppurative enlargement of both parotid glands with low grade fever, malaise and anorexia. Its course is usually mild.

Salivary ductal stone (Sialolithiasis)

It refers to the stones present in the salivary gland or duct. Sialolithiasis is associated with sudden pain or swelling with eating, relieved by a sudden gush of fluid into the mouth. Sialolithiasis may predispose the patient to repeated episodes of bacterial sialadenitis.

Salivary gland tumor

Cancer of the salivary glands usually occurs in the major salivary glands, with 80% occurring in the parotids, and almost 20% occurring in the submandibular glands.

Main symptoms indicating malignancy

  1. Rapid growth or episodes of growth (exception is adenoid cystic carcinoma which grows very slowly)

  2. Pain

  3. Firm infiltration, occasionally ulceration of skin or mucosa, poor mobility of tumor

  4. Facial paralysis in parotid gland

Thyroid gland

The thyroid gland is located just below the cricoid cartilage in the anterior part of the neck. The arterial blood supply is from the superior thyroid artery, which is the 1st branch off the external carotid artery, and the inferior thyroid artery, which is a branch of the thyrocervical trunk. There is a superior, inferior and a middle thyroid vein of each side. The recurrent laryngeal nerve courses just deep and lateral to the thyroid gland. As you know, it supplies the only muscles that open the vocal cords, so these nerves need to be identified and preserved in thyroid surgery

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Sialogram

Thyroid nodule

It refers to any abnormal growth that forms a lump in the thyroid gland. Although the majority of thyroid nodules are benign (not cancerous), about 10% of nodules do contain cancer. Therefore, the primary purpose for evaluating a thyroid nodule is to determine whether cancer is present.

Most thyroid nodules don't cause signs or symptoms. Occasionally some may become so large that you can feel or even see the swelling at the base of your neck, especially when you're shaving or putting on makeup. Men sometimes become aware of a nodule when their shirt collars suddenly feel too tight. Some nodules produce too much thyroxine, a hormone secreted by your thyroid gland. The extra thyroxine can cause signs and symptoms such as:

  1. Sudden, unexplained weight loss

  2. Nervousness

  3. Rapid or irregular heartbeat

Although thyroid nodules are seldom cancerous, a nodule is more likely to be malignant if it:

  1. Grows quickly or feels hard

  2. Causes you to become hoarse or to have trouble swallowing or breathing

  3. Causes enlarged lymph nodes under your jaw or in your neck

Just why normal thyroid tissue develops into nodules isn't clear. What is known is that several types of nodules can develop in the thyroid gland:

Colloid nodule. Most thyroid nodules are colloid nodules - benign overgrowths of normal thyroid tissue. You may have just one colloid nodule or many. Although these nodules may grow larger, they don't spread beyond the thyroid gland. 

Follicular adenoma. This type of nodule also is benign. 

Thyroid cyst. These fluid-filled areas of the thyroid can range in size from less than 1/3-inch in diameter to 1 inch or more. Many thyroid cysts are entirely filled with fluid, but some cysts, called complex cysts, also have solid components. Fluid-filled cysts are usually benign, but complex cysts are sometimes malignant. 

Inflammatory nodule. This occasionally develops as a result of chronic inflammation of the thyroid gland (thyroiditis). One rare type of thyroiditis — subacute thyroiditis — causes severe pain in the thyroid gland. Other types are painless and sometimes occur after pregnancy (postpartum thyroiditis).

Thyroid cancer. Although the chances that a nodule is malignant are small, you're at higher risk if you have a family history of thyroid or other endocrine cancers, are younger than 20 or older than 60, are a man, or have a history of head or neck radiation. Malignant nodules are usually large and hard and may cause neck discomfort or pain. 

Multinodular goiter. "Goiter" is a term used to describe any enlargement of the thyroid gland. Several factors can lead to a goiter, including the presence of a number of thyroid nodules. This condition, called multinodular goiter, can cause a tight feeling in your throat and difficulty breathing or swallowing.

Hyperfunctioning thyroid nodule (toxic adenoma, toxic multinodular goiter, Plummer's disease). These nodules grow and produce thyroid hormones independent of the influence of thyroid-stimulating hormone (TSH), a substance released by the pituitary gland, which normally regulates the production of thyroid hormones. Hyperfunctioning thyroid nodules cause high blood levels of thyroxine along with low or nonexistent levels of TSH. A genetic defect of the TSH receptors may play a role in the overactivity of these nodules.

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Thyroid nodule

Lateral neck

Salivary gland general information:

The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular, and sublingual glands. They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth. Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay. As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.

Salivary gland infection

Infection of the salivary glands may be either viral or bacterial in origin. Viral sialadenitis may be caused by coxsackie virus, echo virus, cmv or mumps virus. Mumps virus it the most common cause of viral salivary gland infection. It causes acute, nonsuppurative enlargement of both parotid glands with low grade fever, malaise and anorexia. Its course is usually mild. This is in contrast to bacterial sialadenitis, also known as suppurative sialadenitis or surgical parotitis. It occurs in dehydrated, debilitated patients. There is a rapid onset of swelling and fever, with erythema and warmth over the affected gland. You can sometimes see pus coming from the duct. Staph. Aureus is the most common organism. Treatment is IV fluids, augmented penicillins and sialagogues, and possibly surgical drainage.

Salivary ductal stone (Sialolithiasis)

Sialolithiasis is stones in the salivary gland or duct. 90% of salivary stones occur in the submandibular gland, and 10% occur in the parotid gland. 70 - 90% of all stones are radiopaque; that is, they are white on plain films. However, only 10% of parotid stones are radiopaque. Sialolithiasis is associated with sudden pain or swelling with eating, relieved by a sudden gush of fluid into the mouth. Sialolithiasis may predispose the patient to repeated episodes of bacterial sialadenitis.

Salivary gland tumor

Neoplasms of the salivary glands usually occur in the major salivary glands, with 80% occurring in the parotids, and almost 20% occurring in the submandibular glands. Parotid tumors are benign 80% of the time, and malignant 20%. One-half of submandibular tumors are malignant. 80% of minor salivary gland tumors are malignant. Minor salivary glands are located in the lips, buccal mucosa and palate. The most common site of minor salivary glands is the hard palate.

Benign epithelial neoplasms include pleomorphic adenoma, which is also known as mixed tumor. It is the most common benign salivary gland tumor. Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is common in elderly men, and can be bilateral. Monomorphic adenoma is another benign neoplasm of the salivary glands. These tumors present as discrete painless, slowly enlarging masses, usually in the superficial lobe of the parotid gland. There is no facial nerve weakness. Treatment is superficial parotidectomy.

Main symptoms indicating malignancy

  • Rapid growth or episodes of growth (exception is adenoid cystic carcinoma which grows very slowly)

  • Pain

  • Firm infiltration, occasionally ulceration of skin or mucosa, poor mobility of tumor

  • Facial paralysis in parotid gland

 

 

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Salivary glands: Parotid gland, submandibular gland and sublingual gland

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Left parotid mass