09/10 - Salivary Gland Disease

Question 1

What is a common cause of oral mucosal swelling in children and young adults?

Answer 1

mucocele/ranula

Question 2

Where is a mucocele/ranula most often located?

Answer 2

• lower lip (75%)
• buccal mucosa
• ventral tongue
• floor of the mouth

Question 3

Describe a mucocele/ranula.

Answer 3

non-tender, soft swelling, translucent to blue to normal color depending on the depth of mucus spillage

Question 4

What is the difference between a mucocele or ranula?

Answer 4

a ranula can be found on the floor of the mouth

Question 5

What does a mucocele/ranula look like histologically?

Answer 5

extravasated mucin, granulation tissue, and variable numbers of inflammatory cells

Question 6

What is the recommended treatment for a mucocele/ranula?

Answer 6

• excision of the mucous deposit together with involved gland
• unroofing procedure with ranula
• may recur (warn the patient)

Question 7

True or false: A mucocele will resolve on its own.

Answer 7

FALSE

Question 8

Why may a mucocele recur?

Answer 8

• because widened salivary gland duct

- because damage to adjacent salivary gland during excision

Question 9

What glands are most often affected by sialolithiasis?

Answer 9

submandibular gland most often but may be parotid and minor glands as well

Question 10

True or false: Sialolithiasis is always symptomatic.

Answer 10

FALSE. It may or may not be symptomatic

*if it is, patient will complain of swelling of involved gland prior to or during meals

Question 11

What are the clinical and radiographic findings of sialolithiasis?

Answer 11

• hard submucosal mass in soft tissue

- soft tissue film will show an opaque, lamellated structure

Question 12

What is the recommended treatment for sialolithiasis?

Answer 12

• surgical excision (ligate before incision otherwise stone may retreat)
• if submandibular gland is involved, evaluate function to determine if gland should be removed

Question 13

What is acute sialadentitis?

Answer 13

bacterial, often penicillinase-producing staph move into the gland and infect the gland

Question 14

What is acute sialadentitis associated with?

Answer 14

severe xerostomia or may follow general anesthesia (called “surgical mumps”)

Question 15

What is the clinical presentation of acute sialadentitis?

Answer 15

• diffuse, painful and tender, unilateral swelling
• usually a parotid gland
• purulent exudate expressed from the parotid papilla

Question 16

What is the recommended treatment for acute sialadentitis?

Answer 16

• culture and test sensitivity of bacteria
• penicillinase-resistant penicillin initially
• adjust antibiotic depending on culture and sensitivity results

Question 17

What is chronic sialadentitis associated with?

Answer 17

• may follow acute sialadentitis due to ductal damage

- often associated with sialolithiasis

Question 18

What gland is usually affected by chronic sialadentitis?

Answer 18

submandibular gland

Question 19

What does the sialography imaging look like for chronic sialadentitis?

Answer 19

“sausage-link” appearance of ductal system

Question 20

Describe the appearance of chronic sialadentitis histologically.

Answer 20

the acini are gone and replaced by scar tissue (called chronic sclerosing sialadentitis; has been under inflammation and infection over time)

Question 21

What is the recommended treatment for chronic sialadentitis?

Answer 21

• antibiotic therapy, such as tetracycline
• massage and sialogogues (ex. lemon drops, which get patients to express saliva through)
• ductal ligation or removal of offending gland if problem fails to resolve

Question 22

What is xerostomia? What is it usually associated with?

Answer 22

• subjective symptom of dryness

- associated with glandular hypofunction

Question 23

What is the most common cause of xerostomia in the USA?

Answer 23

medication-related xerostomia

Question 24

What medications cause xerostomia?

Answer 24

• antihistamines
• antidepressants
• sedatives and anxiolytic agents
• antihypertensive agents

Question 25

What are other causes of xerostomia, other than medications?

Answer 25

• radiation therapy with salivary glands in the field
• Sjorgren syndrome
• graft vs. host defense

Question 26

What does xerostomia result in?

Answer 26

• mucosa that is susceptible to injury
• candidiasis
• increased dental caries

Question 27

What is the recommended treatment for xerostomia?

Answer 27

• artificial saliva/lubricants
• sialogogues (sugar free lemon drops, Salagen (pilocarpine), or Evoxac (cevimelie)
• 1% neutral sodium fluoride gel or toothpaste nightly
• antifungal therapy, as needed

Question 28

Describe a benign lymphoepithelial lesion (BLEL).

Answer 28

unilateral or bilateral firm non-tender swelling of the parotid area

Question 29

What other disease is BLEL associated with?

Answer 29

• BLEL may represent an isolated form of Sjogren’s syndrome

- a portion of the infiltrate is monoclonal, maybe a low-grade lymphoma in-situ

Question 30

Who is most at risk for BLEL?

Answer 30

females middle-aged or older

Question 31

How is BLEL visualized via sialography?

Answer 31

“blossoms on a tree” pattern of punctate sialectasis

Question 32

What is the etiology of BLEL?

Answer 32

destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infiltrate

Question 33

What is the histopathology of BLEL?

Answer 33

epimyothelial islands (which probably represent residual ductal structures; can also be seen in lymphoma)

Question 34

What is the recommended treatment for BLEL?

Answer 34

varies from doing nothing to low-dose radiation or corticosteroid therapy (steroids especially for IgG4 patients)

Question 35

What is the prognosis of BLEL?

Answer 35

good but malignant transformation of both the lymphoid component or the epithelial component has been reported