Head And Neck: Salivary Glands

Front 1

1. What is the etiology of bilateral salivary gland calcifications?
2. Calcifications in which salivary glands are uncommon?
3. Which is more common: parotid or submandibular gland sialolithiasis?

Back 1

1.
- Sarcoidosis
- Sjogren's disease
- Hyperparathyroidism
Note: A strictured duct may lead to stone formation, and stones may lead to strictures—a vicious cycle.
2. Sublingual and minor salivary gland calculi are distinctly uncommon. One should exclude calcifications in lymph nodes, tonsils, and vessels before suggesting calculi in these glands.
3. Submandibular gland sialolithiasis is more common as the secretions from the submandibular gland are more viscous, basic, and the course of the submandibular duct is more vertical (goes up to the floor of the mouth).

Front 2

Unilateral parotid mass

Back 2

PLEOMORPHIC ADENOMA:
- note: benign parotid masses account for >80% of parotid lesions.
- MC benign parotid tumor
- Middle aged pt w/ asymptomatic mass
- Circumscribed, heterogeneous, lobulated masses.
- May be located in the deep or superificial lobe of the parotid.
- **T2 hyperintense with delayed enhancement.
WARTHIN TUMOR:
- 2nd MC benign parotid tumor
- Middle aged men.
- May be mutiflocal and bilateral
- Circumscribed with mixed cystic and solid components.
PAROTID CARCINOMA:
- Note: malignant neoplasms are more common in salivary glands other than the parotid gland.
- Mucoepidermoid: MC malignant parotid tumor.
- Adenoid cystic CA: 2nd MC malignant parotid tumor. Usually as aggressive, infilrative appearance with perineural spread leading to facial nerve neuropathy.
LYMPHADENOPATHY:
- may be inflammatory, infectious, or neoplastic.
- may be bilateral and multiple.
- Neoplastic = lymphoma or mets (H/N SCC or skin CA)
- Lymphoma can also cause diffuse enlargement of the parotid gland.
- Type 1 branchial cleft cyst: typically asymptomatic unless superinfected.

Front 3

Bilateral parotid masses

Back 3

LYMPHOEPITHELIAL LESIONS:
- benign lymphoepithelial lesions occur in pts with AIDS.
- bilateral parotid gland enlargement due to lymphocytic infiltration of the gland.
- Bilateral cystic and solid parotid lesions with diffuse gland enlargement.
- Associated LAD within neck is common.
SJOGREN SYNDROME:
- results in lymphocytic infiltration of the gland.
- parotid gland enlargment + dry eyes + dry mouth
- heterogeneous glandular enlargement with scattered enhancing nodules and fluid pockets.
WARTHIN TUMOR:
- mixed cystic and solid masses
LYMPHADENOPATHY:
SARCOIDOSIS:
- granulomatous infiltration of glandular tissue, often involving parotid and lacrimal glands.
- heterogeneous glandular enlargement that is bilateral and symmetric.
- panda sign on gallium imaging.

Front 4

What are the most common tumors of the parotid gland?

Back 4

- Pleomorphic adenoma (MC benign)
- Warthin’s tumor (2nd MC benign, MC bilateral)
- Lymphoepithelial cyst
- Mucoepidermoid tumor (MC malignant)
- Malignant degeneration of Warthin’s Tumor
- Malignant mixed tumor
- Squamous cell carcinoma
- Adenocarcinoma
- Lymphoma

Front 5

What are some characteristics of Warthin tumor of the parotid gland?

Back 5

- Represents the 2nd most common parotid mass.
- MC parotid mass to be b/l.
- Look for bilateral heterogeneous parotid masses with solid and cystic components.
- Bright on T2 like pleomorphic adenoma.
- Increased risk with smokers, age > 50 years