11 Salivary Gland Diseases Flashcards
Any bump on the roof of the mouth is automatically considered to be what before exam/biopsy?
Salivary gland tumor
What is a mucocele?
leaking of mucin into soft tissues due to the rupturing of a salivary gland duct
(mostly caused by trauma)
What are common places to see a mucocele?
- Lower lip (81%)
- FOM
- anterior ventral tongue
- buccal mucosa
A clinical mucocele on the upper lip is more likely to be what?
A salivary gland tumor
A mucocele of the retromolar region is unusual and more often proven to be what?
Mucoepidermoid carcinoma
What is this?
Mucocele
How would you treat this?
Surgical excision of the mucocele and adjacent (minor) salivary glands
If left untreated, what can a mucocele eventually become?
A fibroma
What is this?
mucocele
What is this called?
Ranula (mucocele on FOM or sublingual)
What can happen if this is left untreated and it continues to grow in size?
Called a “Plunging Ranula” it will dissect the mylohyoid and continue into the mediastinum to slowly suffocate the patient
Pt says they used to have a big bump under their tongue. What happened?
Plunging Ranula dissected mylohyoid
Upon biopsy it shows an epithelium-lined cavity. What is this soft fluctuant swelling?
Salivary duct cyst (aka mucous retention cyst)
What are common places to see salivary duct cysts?
- Parotid gland
- FOM
- Buccal mucosa
- Lips
Salivary duct cysts occur mostly in ________ whereas mucoceles occur more often in __________.
adults, children
What is a sialolith?
A calicification (stone) in the salivary duct
What are the three most common places to find a sialolith?
- Submandibular gland
- Upper lip
- Buccal mucosa
What is this artifact seen on this CT scan?
A sialolith
Why is the submandibular gland most likely to develop a sialolith?
It has the longest, most tortuous duct for saliva to go through on its way to the mouth
What are some possible causes of sialoliths?
- Mucous plug
- Bacterial colonies
- Chronic duct blockage phenomena
- Normal ductal anatomy (Wharton’s duct)
- Xerostomia
What is that?
Sialolith
What is this? How do you get it out if near the surface?
- Sialolith
- “milk” it out of the duct or surgical excision if too deep
What is the definition of Sialadenitis?
An inflammation of the salivary gland
What is a viral infection that can cause sialadenitis?
Mumps - caused by paramyxovirus
What are some non-infectious causes of sialadenitis?
- Sjögren syndrome
- Sarcoidosis, granulomatous inflammation
- Radiation induced
- Recent surgery
- Allergic reaction
- Obstruction of the salivary duct
What is sialadenosis?
non-inflammatory, asymptomatic enlargement of the salivary glands (usually bilateral)
What are some underlying systemic conditions that can cause sialadenosis?
diabetes mellitus, general malnutrition, bulimia
hypothyroidism, pregnancy, alcoholism, anorexia, anti-hypertensive drugs, psychotropic drugs
Pt is in third trimester. What could this be?
Sialadenosis (salivary gland enlargement)
Upon palpation you find the parotid glands are enlarged but still feel soft. What is this termed?
Sialadenosis
Describe Adenomatoid Hyperplasia of the Minor Salivary Glands.
Localized, sessile, painless swelling of minor salivary glands (usually on hard/soft palate) that mimics a neoplasm. Typically hyperplasia of gland.
What are your first thoughts? (Give a differential diagnosis of two things.)
- Adenomatoid hyperplasia of minor salivary glands
- Salivary gland tumor
There are more cells in this frame than regularly seen in a salivary gland. What pathogenesis does this fall under?
Adenomatoid hyperplasia of minor salivary gland(s)
- hyperplasia is seen in this histo slide
What is necrotizing sialometaplasia?
Locally destructive inflammatory condition of the salivary glands believed to be due from ischemia (other causes)
What could a dentist cause if they inject anesthetic too quickly under the periosteum of the palate?
Necrotizing sialometaplasia
What is this?
necrotizing sialometaplasia
How long does it take Necrotizing Sialometaplasia to resolve/heal?
5-6 weeks
Person has hitory of anorexia. What is this?
Necrotizing sialometaplasia
Give two possible diagnoses for this.
- necrotizing sialometaplasia (will heal in 5-6 weeks)
- malignancy (continues to grow)
Watch for a week. If it gets smaller then it’s #1.
Define Cheilitis glandularis.
Swelling and eversion of the lower lip due to hypertrophy and inflammation of minor salivary glands
What is this? What can give it away?
- Cheilitis Glandularis
- “weeping” of minor salivary glands
What is this salivary gland pathology?
Cheilitis glandularis
Someone with a sialolith will usually complain of what symptom?
Having pain or swelling upon eating
What is excessive salivation called?
Sialorrhea
What are some possible causes of Sialorrhea?
- GERD
- Local irritations
- Cholenergic agonists
- Lithium
- etc
Xerostomia is a common problem in ____% of adults.
25%
What are clinical signs of xerostomia?
- fissured tongue
- dry lips
- mucosal tissue is sticky after wiping dry
What are three complications of xerostomia?
- altered taste
- higher risk of cervical or root caries
- candidiasis
What are some known causes of xerostomia?
medications, radiation therapy, caffeine/alcohol, smoking, Sjögren’s syndrome, diabetes, sarcoidosis
What is an autoimmune disease mainly affecting salivary and lacrimal glands?
Sjögren’s syndrome
What are three common symptoms seen in Sjögren’s syndrome patients?
- xerostomia
- xerophthalmia
- arthralgia
What are three criteria to meet to diagnose Sjögren’s syndrome?
- Positive autoantibodies to Ro(SS-A) and/or La(SS-B) antigens
- Or positive rheumatoid factor and antinuclear antibody titer
- labial salivary gland biopsy showing focal lymphocytic sialadenitis (≥1 focus/4mm2)
- Keratoconjunctivitis sicca w/ ocular staining score ≥3
People with Sjögren’s syndrome have a 40x greater risk of getting ___________.
Lymphoma
What are the most common sites to have a salivary neoplasm?
- Parotid gland (64-80%)
- Minor glands
- Submandibular
- Sublingual
Of the three major salivary glands, which one is more likely to be malignant if it had a salivary neoplasm?
Sublingual (~70%)
Of all minor salivary gland neoplasms, which location in the mouth has the highest rate of malignancy?
Retromolar pad (90% are malignant)
Tongue is close second w/ 85%
Of all minor salivary gland neoplasms, which location is most likely to have a benign neoplasm?
Upper lip (80% are benign)
Are minor salivary gland neoplasms more common in upper lip or lower lip?
Upper lip is more common, but lower lip is more likely to be malignant.
What is the most common benign neoplasm overall?
Pleomorphic adenoma (benign) - most common in parotid
What is the most common malignant neoplasm overall?
Mucoepidermoid carcinoma (parotid most common site)
What are four benign salivary gland neoplasms to know?
- Canalicular adenoma
- Pleomorphic adenoma
- Warthin tumor (papillary cystadenoma lymphomatosum)
- Oncocytoma
Canalicular adenoma occurs exclusively in _______ salivary glands.
Minor
If your patient is >60 yrs old and has a benign salivary gland neoplasm, it is more likely to be what kind?
canalicular adenoma
if your patient is <50 yrs old and has a benign salivary gland neoplasm, it is more likely to be what kind?
pleomorphic adenoma
T or F: Benign salivary gland tumors are typically encapsulated in connective tissue.
True
Pleomorphic adenomas are most commonly seen where overall?
parotid gland
Pleomorphic adenomas are most commonly seen where if in a minor salivary gland?
Palate
Oncocytoma occurs mainly in _______ salivary glands.
Major
Oncocytoma get it’s name from what histologic feature?
Oncocytes: large epithelial cells
What is the second most common benign tumor of the parotid gland?
Warthin’s tumor (papillary cystadenoma lymphomatosum)
Who has an 8-fold higher risk of developing warthin’s tumor?
smokers
Papillary cystadenoma lymphomatosum is almost exclusively seen in the ________ gland.
Parotid
What are the two most common malignant salivary neoplasms?
- Mucoepidermoid carcinoma
- Acinic cell adenocarcinoma
What is malignant ectopic salivary gland tissue that was developmentally entrapped in the jaw?
Intraosseous Mucoepidermoid Carcinoma
What is a common site to see Intraosseous mucoepidermoid carcinoma?
The angle of the mandible
Histologically, this acinic cell adenocarcinoma will show what taking over the salivary gland?
Acinar cells
What is the most common malignant salivary gland tumor of the submandibular gland?
Adenoid cystic carcinoma
Why is the long-term survival rate with adenoid cystic carcinoma so low?
The tumor metastesises in the neurons and spreads out through the nerves, making total removal impossible
Not occurring on the midline and affecting minor salivary glands of the palate, what might this be?
Polymorphous Low-grade Adenocarcinoma
