Gastrointestinal tract and salivary glands
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
There are three pairs of salivary glands: the parotid glands, the submandibular glands and the sublingual glands. They are situated adjacent to the oral cavity and secrete saliva, which contains a digestive enzyme called ptyalase, to aid digestion (Fig. 5.1). The parotid glands are the largest of the salivary glands and lie just below the zygomatic arch in front of, and below, the ear. The parotid duct (Stenson’s duct) is about 5 cm in length and runs forwards over the masseter muscle opening on the surface of a small papilla on the inner surface of the cheek, opposite the second upper molar tooth. The submandibular glands are paired and lie on either side of the neck, forming part of the soft tissues on the medial margin of the mandible, between the body of the mandible and the hyoid bone. The submandibular duct (Wharton’s duct) is about 5 cm in length and runs forward, medially and upwards, beneath the mucous membrane of the floor of the mouth and opens at a small papilla at the base of the frenulum of the tongue. The two sublingual glands are the smallest of the salivary glands and lie on the anterior part of the floor of the mouth, on the surface of the mylohyoid muscle. The glands secrete directly into the oral cavity through multiple ducts (ducts of Rivinus), which may open adjacent to the frenulum of the tongue or may join to form a single duct (Bartholin’s duct) that empties into the submandibular duct.
The neck
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Position The parotid gland lies in front of and below the lower half of the ear. It is wrapped around the vertical ramus of the mandible, with its deep portion in between this bone and the mastoid process (Fig. 12.39). In acute parotitis, the whole gland is swollen, so the whole of the face in front of the lower half of the ear bulges outwards. Colour and temperature The skin over the swelling is discoloured a reddish-brown, feels hot and is smooth and shiny. Tenderness The swelling is very tender. Shape The mass has the shape of the normal parotid gland: a semi-circular anterior edge, a vertical edge just in front of the ear, and a bulge running into the gap between the mandible and the mastoid process. Size The swollen gland may be three or four times larger than a normal gland. Surface Its surface is smooth but difficult to define because of the oedema, inflammation and tenderness. Composition The texture of the swelling is often described as brawny. This means that it has a firm consistency but is indentable. It is dull to percussion, not fluctuant and not compressible.
Facial pain
Anne Stephenson, Martin Mueller, John Grabinar, Janice Rymer in 100 Cases in General Practice, 2017
Left-sided jaw pain in a middle-aged patient might suggest angina though the character, time-scale and triggers of this pain argue against this. Painful locking of the jaw might raise the spectre of ‘lockjaw’ (tetany, though true tetanus seems most improbable). Temporal giant-cell arteritis is possible but there is no local arterial tenderness. A parotid gland tumour, benign or malignant, is possible. Dental disease is another possibility. Depression can cause or worsen, pain problems. Her erythrocyte sedimentation rate (ESR), calcium, cholesterol and electrocardiogram (ECG) are all normal. Her dentist reports no disease. She becomes disheartened by the lack of progress and is pleased when you suggest seeking a second opinion from a hospital specialist about her atypical facial pain. The neurologist confirms the original diagnosis. She is offered microvascular decompression which is successful, much to her and her husband's and your relief.
Sex Hormones in Papillary Carcinoma of Thyroid Gland and Pleomorphic Adenoma of Parotid Gland
Published in Acta Oto-Laryngologica, 1994
This is a histologic study using the peroxidase-antiperoxidase (PAP) method for demonstration of estradiol, testosterone, dihydrotestosterone and progesterone in the normal thyroid gland and papillary carcinoma of the thyroid gland as well as in the normal parotid gland and pleomorphic adenomas. The results show that the normal follicular epithelia of the thyroid gland and the intercalated, striated ducts in the parotid gland stained for sex hormones. Estradiol was positive in both thyroid and parotid gland tissue in females and males. In females, testosterone and dihydrotestosterone were not recognized in the thyroid gland tissue and were only weakly present or negative in parotid gland tissue. In males, both testosterone and dihydrotestosterone were positive. Papillary carcinoma of the thyroid gland and pleomorphic adenoma of the parotid gland were positive for estradiol but not for testosterone or dihydrotestosterone. This suggests that there is a sex difference in the influence of sex hormones on the normal thyroid and parotid glands, and that estradiol exerts an influence on papillary carcinoma of the thyroid gland and pleomorphic adenoma of the parotid gland.
Extracapsular dissection for Warthin tumor in the tail of parotid gland
Published in Acta Oto-Laryngologica, 2017
Dong Hoon Lee, Tae Mi Yoon, Joon Kyoo Lee, Sang Chul Lim
Conclusions: Extracapsular dissection conferred the advantage of reduced operation time and morbidity without any recurrence, and it could be considered as the treatment of choice for Warthin tumors in the tail of the parotid gland. Objective: The purpose of this study is to confirm the appropriate surgical procedure for Warthin tumor in the tail of the parotid gland, by comparing the results of extracapsular dissection and superficial parotidectomy. Materials and methods: The medical records of 72 patients with Warthin tumor in the tail of the parotid gland who underwent surgery between January 2006 and December 2016 were retrospectively reviewed. Results: In the extracapsular dissection group, a total of 44 parotid gland operations were performed in 40 patients. In the superficial parotidectomy group, a total of 34 parotid gland operations were performed in 32 patients. The operation time was significantly shorter in the extracapsular dissection group than in the superficial parotidectomy group (p
New Strategy for the Diagnosis of Parotid Gland Lesions Utilizing Three-Dimensional Sialography
Published in Computer Aided Surgery, 2000
Three-dimensional (3D) imaging for parotid gland lesions was performed using 3D sialography. This method provided a detailed surface structure of the parotid gland, and made it possible to overcome the disadvantages of X-ray sialography, planar CT, and MRI. Immediately after the conventional sialography via an oral route, CT scanning was performed with a slice-thickness of 3 mm using a helical CT scanner. CT data were analyzed on a workstation to reconstruct 3D images. 3D sialography was found to have the following advantages: (1) The structure of the acinar surface is visualized in detail; (2) The 3D structure of the entire parotid system from Stensen's duct to the gland is shown in one image; (3) The parotid gland can be assessed in the context of the bony architecture of facial bones; (4) The surface structure of the parotid gland can be understood very easily, like a scanning electron micrograph. We conclude that 3D sialography is a useful imaging technique for parotid gland lesions.