11- Salivary gland pathology Flashcards
What is the largest salivary gland?
The parotid gland (p.4)
What kind of secretions does the parotid gland secrete?
Serous (watery) saliva
What CN does the parotid gland run through?
CN VII (7) the facial nerve
Where does the parotid gland enter through?
The stenson’s duct (near the maxillary second molars)
Where can we find the submandibular gland?
In the floor of the mouth (under the mylohyoid muscle) (p.6)
What kind of secretions does the submandibular gland secrete?
A mix of serous + mucous saliva
Where does the submandibular gland exit at?
It exits at the oral cavity at the Wharton’s duct at the floor of the mouth.
Where is the sublingual gland?
In the anterior floor of the mouth above the mylohyoid muscle (p.7) * clusters of small glands
What does the sublingual gland secrete?
A mix of serous + mucous saliva
Where does the sublingual gland secrete through?
Through the Bartholin’s duct + ducts of Rivinus
Where are the minor salivary glands?
They are almost everywhere except gingiva + anterior hard palate.
What are minor salivary glands?
They are 100’s of small salivary glands distributed throughout the oral cavity.
What do the minor salivary glands secrete in general?
They secrete mucous saliva.
What are some of the functions of saliva (hint: 7 functions)
1.) Solvent
2.) Role in taste
3.) Immune response
4.) Buffer & maintains pH
5.) Remineralizes enamel
6.) Lubricates food
7.) Helps keep teeth clean
What are sialadenitis?
They are known as a inflammation of the salivary glands
A sialadenitis that clinically shows pus & neutrophils are known as acute/chronic?
Acute sialadenitis
A sialadenitis that clinically shows lymphocytes & fibrosis are known as acute/chronic sialdenitis?
Chronic sialadenitis
What are the causes of sialadenitis?
They are due microbial beings, which can be bacterial or viral & due to obstructions.
Sialadenitis derived from staph aureus & from retrograde movement of bacteria during periods of low salivary flow is due to what microbial being?
Due to a bacterial cause.
Sialadenitis derived from mumps & paramyxovirus are due to what microbial being?
Due to a viral cause.
What are 3 examples of obstructions leading to sialadenitis?
1.) Strictures
2.) Sialolith (stones)
3.) Foreign bodies
Where is an acute sialadenitis more commonly found?
In the parotid gland.
What are some of the signs of an acute sialadenitis?
1.) Reddened, warm skin
2.) Purulent exudate when gland is massaged
What are treatment options for an acute sialadenitis?
1.) Antibiotics
How does a chronic sialadenitis commonly appear as?
Appears unilateral, typically in a swelling with mild pain (swelling seen especially after meals)
What occurs to a chronic sialadenitis over time?
The gland becomes fibrotic (thickening/scarring of tissue)
What are the treatments for chronic sialadenitis?
1.) Secretagogues to stimulate secretions
2.) Antibiotics
3.) Surgeries if gland becomes fibrotic
What is a sialolith?
They are salts that precipitate around mucus plug forming a stone.
Where are sialoliths more commonly found? & how do they feel & appear on radiographs?
1.) In the submandibular gland
2.) Like a hard bony mass & appear radiopaque on radiographs
What is a sialadenosis?
It is an uncommon, benign, non-inflammatory enlargement of a salivary gland which is usually bilateral & causes enlargement of the parotid gland.
*Hypertrophy of the acinar cells
What are the causes of sialadenosis?
1.) Endocrine disorders:
- diabetes
-acromegaly - increase in growth hormones
- hypothyroidism
2.) Nutritional conditions:
- alcoholism
- bulimia, anorexia
3.) Neurogenic medications
What are the treatments of sialadenosis?
1.) Secretagogues to stimulate more saliva
2.) Surgical removal of gland
What is Sjogren’s syndrome?
It is an autoimmune disease (loss of tolerance in T cells) which presents itself in 2 ways:
1.) Primary (Sicca syndrome)
2.) Secondary
How can we differentiate between the primary (Sicca syndrome) & secondary presentation of Sjogren’s syndrome?
1.) Primary (Sicca syndrome) only presents with dry eyes & dry mouth
2.) Secondary presents with Primary Sjogrens + another autoimmune disease
*90% seen in females
How can we diagnose/identify an individual with Sjogren’s syndrome?
1.) If they have a minor salivary gland biopsy
2.) Serology (blood work)
3.) Decreased salivary flow
4.) Decreased tear flow
5.) Sialography: salivary gland imaging
How is Sjogren’s syndrome managed?
1.) Address dry mouth & dry eyes
2.) Monitor as there is a 40x increase in the risk of non-Hodgkin lymphoma (cancer involving the lymphatic system)
3.) symptomatic treatment
What is a necrotizing sialometaplasia?
It is a benign, self-limiting ulcer commonly affecting the palate which presents itself as a painless ulcer with surrounding erythema
What are the causes of necrotizing sialometaplasia?
Due to ischemic necrosis derived from dental injections, ill-fitting dentures.
How is necrotizing sialometaplasia treated?
1.) Self limiting
2.) Heals over 6-10 weeks
What is a mucous extravasation cyst/mucocele?
It is a release of mucous in the underlying tissue due to the rupture of a minor salivary gland.
Where can we typically find mucous extravasation cysts/mucocele?
Found in the lower lip>floor of the mouth & typically more common in females
What is a ranula?
It is a mucous extravasation cyst (mucocele) involving the floor of the mouth due to the fluid being swelled up as it has no where to go.
Why is mucous extravasation cyst not a TRUE cyst?
Because there is NO EPITHELIAL lining to it.
If a lesion is found on the upper lip & looks like a mucocele, what are we assuming?
That it is probably a neoplasm (meaning it might be cancerous)
there is no mucocele on the upper lip!
low lip = low risk.
What is the difference between unstimulated & stimulated saliva in xerostomia?
1.) Unstimulated: is the basal production baseline production of saliva.
2.) Stimulated: during mastication, in digestion
Where can we typically find unstimulated saliva?
In the minor salivary glands & submandibular glands
Where can we typically find stimulated saliva?
In the parotid gland
What kind of decrease of saliva is hyposalivation?
It is an OBJECTIVE DECREASE in saliva, meaning it can be measured by various means.
What kind of decrease of saliva is xerostomia?
It is a SUBJECTIVE DECREASE in saliva, meaning the patient may “feel” dry, though their actual saliva production is does not account for the same thing.
What are some causes of xerostomia?
1.) Developmental (born w/o salivary glands)
2.)Water/metabolite loss
3.) Systemic diseases
4.) Latrogenic
5.) Local factors
What does water/metabolite loss encompass in causes for xerostomia?
1.) A decrease in fluid intake
2.) Hemorrhage
3.) Vomiting
What encompasses the systemic diseases that may cause xerostomia?
1.) Sjogren’s Syndrome
2.) Diabetes
3.) Sacoidosis
4.) HIV
5.) Hepatitis C
6.) Graft- versus host disease
What encompasses the latrogenic causes that may lead to xerostomia?
1.) Medications
2.) Radiation
3.) Chemotherapy
What are some medications that may indicate appearance of xerostomia?
1.) Antihistamine medications
2.) decongestant
3.) antidepressants
4.) Antihypertensives
5.) Anticholinergics
What are some local factors that may contribute to xerostomia?
1.) Decreased mastication
2.) Smoking
3.) Mouth breathing
What are some clinical findings of xerostomia?
1.) Thick, ropey saliva
2.) Dry mucosa. Mirror often sticks to buccal mucosa
3.) Fissured & atrophic tongue
4.) Increased dental caries
5.) Coated tongue
6.) Abnormal taste
How do we manage xerostomia?
1.) Saliva substitutes
2.) Secretagogues
- local : mints, gums
- systemic: pilocarppines
3.) Fluoride, improved oral hygiene
How are salivary gland neoplasms divided?
Divided into either a benign or malignant neoplasm.
What is said about a size of a salivary gland relative to the incidence rate of the malignancy?
That SMALLER the gland is, the HIGHER the incidence of malignancy it is.
e.g: Parotid has an 80% incidence of tumor, but only 20% malignant
Where as a sublingual & minor salivary gland incidence of tumour is 5%, but 70% malignant
What is commonly found in malignant neoplasms?
1.) They are growing
2.) They have spontaneous ulcerations
3.) They have fixations (meaning they have tumours invading the underlying tissue & remains stuck.
4.) Has pain or facial paralysis
What is a pleomorphic adenoma?
It is a benign mixed tumor that encompasses 90% of all benign salivary gland tumors. It involves the parotid gland & presents as a slow-growing mass.
Why is a pleomorphic adenoma considered a benign mixed tumour?
Because it is a combination of both the myoepithelial cells (which reduce saliva & muscle to push it) & ductal cells.
- possibility it may undergo a malignant transformation.
What is a mucoepidermoid carcinoma?
It is the most common malignant salivary gland neoplasm which is common in children & mostly found on the parotid & posterior palate
What kind of cells is found in mucoepidermoid carcinoma?
1.) Mucous cells & squamous cells (hence why it is called mucoepidermoid)
What are the signs & symptoms of mucoepidermoid carcinoma?
1.) Rapidly growing mass
2.) Association with pain
How is mucoepidermoid carcinoma treated?
With aggressive surgical removal (this is to ensure that everything is removed to prevent recurrent cancers)
What is adenoid cystic carcinoma?
It is a presentation similar to mucoepidermoid carcinoma, though grows relatively slower (but still rapid compared to benign tumours)
Where is an adenoid cystic carcinoma typically found?
It is typically found in the palate.
What are the signs & symptoms of adenoid cystic carcinoma?
1.) They are rapidly growing mass
2.) They are associated with pain
3.) They have perineural invasion (meaning the cancer invades the nerves & spreads)
What is the treatment of adenoid cystic carcinoma?
1.) Aggressive surgical removal
2.) Less aggressive than mucoepidermoid carcinoma
3.) Prone to recurrence (due to perineural invasion)
