09/10 - Salivary Gland Disease Flashcards
What is a common cause of oral mucosal swelling in children and young adults?
mucocele/ranula
Where is a mucocele/ranula most often located?
- lower lip (75%)
- buccal mucosa
- ventral tongue
- floor of the mouth
Describe a mucocele/ranula.
non-tender, soft swelling, translucent to blue to normal color depending on the depth of mucus spillage
What is the difference between a mucocele or ranula?
a ranula can be found on the floor of the mouth
What does a mucocele/ranula look like histologically?
extravasated mucin, granulation tissue, and variable numbers of inflammatory cells
What is the recommended treatment for a mucocele/ranula?
- excision of the mucous deposit together with involved gland
- unroofing procedure with ranula
- may recur (warn the patient)
True or false: A mucocele will resolve on its own.
FALSE
Why may a mucocele recur?
- because widened salivary gland duct
- because damage to adjacent salivary gland during excision
What glands are most often affected by sialolithiasis?
submandibular gland most often but may be parotid and minor glands as well
True or false: Sialolithiasis is always symptomatic.
FALSE. It may or may not be symptomatic
*if it is, patient will complain of swelling of involved gland prior to or during meals
What are the clinical and radiographic findings of sialolithiasis?
- hard submucosal mass in soft tissue
- soft tissue film will show an opaque, lamellated structure
What is the recommended treatment for sialolithiasis?
- surgical excision (ligate before incision otherwise stone may retreat)
- if submandibular gland is involved, evaluate function to determine if gland should be removed
What is acute sialadentitis?
bacterial, often penicillinase-producing staph move into the gland and infect the gland
What is acute sialadentitis associated with?
severe xerostomia or may follow general anesthesia (called “surgical mumps”)
What is the clinical presentation of acute sialadentitis?
- diffuse, painful and tender, unilateral swelling
- usually a parotid gland
- purulent exudate expressed from the parotid papilla
What is the recommended treatment for acute sialadentitis?
- culture and test sensitivity of bacteria
- penicillinase-resistant penicillin initially
- adjust antibiotic depending on culture and sensitivity results
What is chronic sialadentitis associated with?
- may follow acute sialadentitis due to ductal damage
- often associated with sialolithiasis
What gland is usually affected by chronic sialadentitis?
submandibular gland
What does the sialography imaging look like for chronic sialadentitis?
“sausage-link” appearance of ductal system
Describe the appearance of chronic sialadentitis histologically.
the acini are gone and replaced by scar tissue (called chronic sclerosing sialadentitis; has been under inflammation and infection over time)
What is the recommended treatment for chronic sialadentitis?
- 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
What is xerostomia? What is it usually associated with?
- subjective symptom of dryness
- associated with glandular hypofunction
What is the most common cause of xerostomia in the USA?
medication-related xerostomia
What medications cause xerostomia?
- antihistamines
- antidepressants
- sedatives and anxiolytic agents
- antihypertensive agents
