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Sublingual gland The sublingual glands contribute around 5% of saliva produc - tion and are the smallest of the major salivary glands. They - lie above the mylohyoid muscle and below the floor of mouth mucosa and are bordered by the mandible laterally and by...

Submandibular gland The submandibular glands originate from the junctional tissue between ectoderm and endoderm from the floor of the mouth. They grow from the 18th to the 25th embryonic week and acquire connective capsules. They lie in the submandibular space...

TREATMENT OF SALIVARY GLAND MALIGNANCIES The treatment guidelines are based on retrospective studies, with very little randomised evidence to guide treatment deci - sions. Surgery forms the mainstay of treatment with a goal to extirpate the tumour with micros...

Trauma Trauma to the salivary glands or ducts is uncommon and is usually associated with polytrauma due to penetrating injuries, blasts or vehicular accidents. This can result in injury to the salivary glandular tissue, the duct and the surrounding nerves, Ald...

Xerostomia Normal salivary flow decreases with age. Typical complaints are of a dry mouth, di ffi culty swallowing and speaking, intol erance to spicy , acidic and crunchy food, a loss of taste and denture-wearing issues. Xerostomia is more common among postmen...

Benign tumours Follicular adenomas present as clinically solitary nodules us ( Figure 55.21 ) and the distinction between a follicular - carcinoma and an adenoma can only be made by histological examination; in the adenoma there is no invasion of the capsule ...

Calcitonin The parafollicular C cells of the thyroid are of neuroendocrine origin and arrive in the thyroid via the ultimobranchial body ( Figure 55.1 ). They produce calcitonin. Sir James Berry , 1860–1946, surgeon, Royal Free Hospital, London, UK. Oliver H...

Clinical features of thyroid cancers The annual incidence is about 0.8 per million of the popula tion and the sex ratio is three females to one male. However, the incidence of PTC is increasing rapidly across the world. This Karl Hürthle , 1866–1945, histopa...

Clinically discrete swellings Discrete thyroid swellings (thyroid nodules) are common and are palpable in 3–4% of the adult population in the UK and USA. They are three to four times more frequent in women than in men. Diagnosis A discrete swelling in an othe...

Diagnosis of thyroid neoplasms Clinical history and examination continue to be the cornerstone of diagnosis of thyroid neoplasms. As previously mentioned, radiation exposure and family history should be discussed. Examination of the central neck and regiona...

EMBRYOLOGY The embryology of the thyroid and parathyroid glands underlies the anatomical position, anatomical variations and congenital conditions of these structures; it is therefore vital for surgery ( Figure 55.1 ). The thyroglossal duct develops from the...

FURTHER READING Bible KC, Kebebew E, Brierly J et al . 2021 American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 2021; 31 : 337–86. Chadwick D, Kinsman R, Walton P . The British Association of Endocrine a...

Follicular carcinoma Follicular carcinoma can normally only be di ff erentiated from follicular adenoma by the architecture on histology . For this reason, follicular lesions on FNA are unable to be diagnosed as malignant in the absence of clinical features su...

Granulomatous thyroiditis (subacute thyroiditis, de Quervain’s thyroiditis) This may follow a viral infection. In a typical subacute presen tation, there is pain in the neck, fever, malaise and a firm, irregular enlargement of one or both thyroid lobes. There a...

Granulomatous thyroiditis (subacute thyroiditis, de Quervain’s thyroiditis) This may follow a viral infection. In a typical subacute presen tation, there is pain in the neck, fever, malaise and a firm, irregular enlargement of one or both thyroid lobes. There a...

HYPERTHYROIDISM Thyrotoxicosis The term thyrotoxicosis is retained because hyperthyroidism, i.e. symptoms due to a raised level of circulating thyroid hormones, is not responsible for all manifestations of the disease. Clinical types are: /uni25CF di ff use t...

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Isotope scanning The uptake by the thyroid of a low dose of either radiolabelled 123 99m I) or the cheaper technetium ( Tc) will demonstrate iodine ( the distribution of activity in the whole gland. Routine isotope scanning is unnecessary and inappropriate ...