11- Salivary gland pathology Flashcards

1
Q

What is the largest salivary gland?

A

The parotid gland (p.4)

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2
Q

What kind of secretions does the parotid gland secrete?

A

Serous (watery) saliva

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3
Q

What CN does the parotid gland run through?

A

CN VII (7) the facial nerve

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4
Q

Where does the parotid gland enter through?

A

The stenson’s duct (near the maxillary second molars)

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5
Q

Where can we find the submandibular gland?

A

In the floor of the mouth (under the mylohyoid muscle) (p.6)

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6
Q

What kind of secretions does the submandibular gland secrete?

A

A mix of serous + mucous saliva

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7
Q

Where does the submandibular gland exit at?

A

It exits at the oral cavity at the Wharton’s duct at the floor of the mouth.

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8
Q

Where is the sublingual gland?

A

In the anterior floor of the mouth above the mylohyoid muscle (p.7) * clusters of small glands

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9
Q

What does the sublingual gland secrete?

A

A mix of serous + mucous saliva

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10
Q

Where does the sublingual gland secrete through?

A

Through the Bartholin’s duct + ducts of Rivinus

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11
Q

Where are the minor salivary glands?

A

They are almost everywhere except gingiva + anterior hard palate.

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12
Q

What are minor salivary glands?

A

They are 100’s of small salivary glands distributed throughout the oral cavity.

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13
Q

What do the minor salivary glands secrete in general?

A

They secrete mucous saliva.

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14
Q

What are some of the functions of saliva (hint: 7 functions)

A

1.) Solvent
2.) Role in taste
3.) Immune response
4.) Buffer & maintains pH
5.) Remineralizes enamel
6.) Lubricates food
7.) Helps keep teeth clean

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15
Q

What are sialadenitis?

A

They are known as a inflammation of the salivary glands

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16
Q

A sialadenitis that clinically shows pus & neutrophils are known as acute/chronic?

A

Acute sialadenitis

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17
Q

A sialadenitis that clinically shows lymphocytes & fibrosis are known as acute/chronic sialdenitis?

A

Chronic sialadenitis

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18
Q

What are the causes of sialadenitis?

A

They are due microbial beings, which can be bacterial or viral & due to obstructions.

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19
Q

Sialadenitis derived from staph aureus & from retrograde movement of bacteria during periods of low salivary flow is due to what microbial being?

A

Due to a bacterial cause.

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20
Q

Sialadenitis derived from mumps & paramyxovirus are due to what microbial being?

A

Due to a viral cause.

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21
Q

What are 3 examples of obstructions leading to sialadenitis?

A

1.) Strictures
2.) Sialolith (stones)
3.) Foreign bodies

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22
Q

Where is an acute sialadenitis more commonly found?

A

In the parotid gland.

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23
Q

What are some of the signs of an acute sialadenitis?

A

1.) Reddened, warm skin
2.) Purulent exudate when gland is massaged

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24
Q

What are treatment options for an acute sialadenitis?

A

1.) Antibiotics

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25
Q

How does a chronic sialadenitis commonly appear as?

A

Appears unilateral, typically in a swelling with mild pain (swelling seen especially after meals)

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26
Q

What occurs to a chronic sialadenitis over time?

A

The gland becomes fibrotic (thickening/scarring of tissue)

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27
Q

What are the treatments for chronic sialadenitis?

A

1.) Secretagogues to stimulate secretions
2.) Antibiotics
3.) Surgeries if gland becomes fibrotic

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28
Q

What is a sialolith?

A

They are salts that precipitate around mucus plug forming a stone.

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29
Q

Where are sialoliths more commonly found? & how do they feel & appear on radiographs?

A

1.) In the submandibular gland
2.) Like a hard bony mass & appear radiopaque on radiographs

30
Q

What is a sialadenosis?

A

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

31
Q

What are the causes of sialadenosis?

A

1.) Endocrine disorders:
- diabetes
-acromegaly - increase in growth hormones
- hypothyroidism

2.) Nutritional conditions:
- alcoholism
- bulimia, anorexia

3.) Neurogenic medications

32
Q

What are the treatments of sialadenosis?

A

1.) Secretagogues to stimulate more saliva
2.) Surgical removal of gland

33
Q

What is Sjogren’s syndrome?

A

It is an autoimmune disease (loss of tolerance in T cells) which presents itself in 2 ways:
1.) Primary (Sicca syndrome)
2.) Secondary

34
Q

How can we differentiate between the primary (Sicca syndrome) & secondary presentation of Sjogren’s syndrome?

A

1.) Primary (Sicca syndrome) only presents with dry eyes & dry mouth
2.) Secondary presents with Primary Sjogrens + another autoimmune disease

*90% seen in females

35
Q

How can we diagnose/identify an individual with Sjogren’s syndrome?

A

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

36
Q

How is Sjogren’s syndrome managed?

A

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

37
Q

What is a necrotizing sialometaplasia?

A

It is a benign, self-limiting ulcer commonly affecting the palate which presents itself as a painless ulcer with surrounding erythema

38
Q

What are the causes of necrotizing sialometaplasia?

A

Due to ischemic necrosis derived from dental injections, ill-fitting dentures.

39
Q

How is necrotizing sialometaplasia treated?

A

1.) Self limiting
2.) Heals over 6-10 weeks

40
Q

What is a mucous extravasation cyst/mucocele?

A

It is a release of mucous in the underlying tissue due to the rupture of a minor salivary gland.

41
Q

Where can we typically find mucous extravasation cysts/mucocele?

A

Found in the lower lip>floor of the mouth & typically more common in females

42
Q

What is a ranula?

A

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.

43
Q

Why is mucous extravasation cyst not a TRUE cyst?

A

Because there is NO EPITHELIAL lining to it.

44
Q

If a lesion is found on the upper lip & looks like a mucocele, what are we assuming?

A

That it is probably a neoplasm (meaning it might be cancerous)

there is no mucocele on the upper lip!
low lip = low risk.

45
Q

What is the difference between unstimulated & stimulated saliva in xerostomia?

A

1.) Unstimulated: is the basal production baseline production of saliva.
2.) Stimulated: during mastication, in digestion

46
Q

Where can we typically find unstimulated saliva?

A

In the minor salivary glands & submandibular glands

47
Q

Where can we typically find stimulated saliva?

A

In the parotid gland

48
Q

What kind of decrease of saliva is hyposalivation?

A

It is an OBJECTIVE DECREASE in saliva, meaning it can be measured by various means.

49
Q

What kind of decrease of saliva is xerostomia?

A

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.

50
Q

What are some causes of xerostomia?

A

1.) Developmental (born w/o salivary glands)
2.)Water/metabolite loss
3.) Systemic diseases
4.) Latrogenic
5.) Local factors

51
Q

What does water/metabolite loss encompass in causes for xerostomia?

A

1.) A decrease in fluid intake
2.) Hemorrhage
3.) Vomiting

52
Q

What encompasses the systemic diseases that may cause xerostomia?

A

1.) Sjogren’s Syndrome
2.) Diabetes
3.) Sacoidosis
4.) HIV
5.) Hepatitis C
6.) Graft- versus host disease

53
Q

What encompasses the latrogenic causes that may lead to xerostomia?

A

1.) Medications
2.) Radiation
3.) Chemotherapy

54
Q

What are some medications that may indicate appearance of xerostomia?

A

1.) Antihistamine medications
2.) decongestant
3.) antidepressants
4.) Antihypertensives
5.) Anticholinergics

55
Q

What are some local factors that may contribute to xerostomia?

A

1.) Decreased mastication
2.) Smoking
3.) Mouth breathing

56
Q

What are some clinical findings of xerostomia?

A

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

57
Q

How do we manage xerostomia?

A

1.) Saliva substitutes
2.) Secretagogues
- local : mints, gums
- systemic: pilocarppines
3.) Fluoride, improved oral hygiene

58
Q

How are salivary gland neoplasms divided?

A

Divided into either a benign or malignant neoplasm.

59
Q

What is said about a size of a salivary gland relative to the incidence rate of the malignancy?

A

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

60
Q

What is commonly found in malignant neoplasms?

A

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

61
Q

What is a pleomorphic adenoma?

A

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.

62
Q

Why is a pleomorphic adenoma considered a benign mixed tumour?

A

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.
63
Q

What is a mucoepidermoid carcinoma?

A

It is the most common malignant salivary gland neoplasm which is common in children & mostly found on the parotid & posterior palate

64
Q

What kind of cells is found in mucoepidermoid carcinoma?

A

1.) Mucous cells & squamous cells (hence why it is called mucoepidermoid)

65
Q

What are the signs & symptoms of mucoepidermoid carcinoma?

A

1.) Rapidly growing mass
2.) Association with pain

66
Q

How is mucoepidermoid carcinoma treated?

A

With aggressive surgical removal (this is to ensure that everything is removed to prevent recurrent cancers)

67
Q

What is adenoid cystic carcinoma?

A

It is a presentation similar to mucoepidermoid carcinoma, though grows relatively slower (but still rapid compared to benign tumours)

68
Q

Where is an adenoid cystic carcinoma typically found?

A

It is typically found in the palate.

69
Q

What are the signs & symptoms of adenoid cystic carcinoma?

A

1.) They are rapidly growing mass
2.) They are associated with pain
3.) They have perineural invasion (meaning the cancer invades the nerves & spreads)

70
Q

What is the treatment of adenoid cystic carcinoma?

A

1.) Aggressive surgical removal
2.) Less aggressive than mucoepidermoid carcinoma
3.) Prone to recurrence (due to perineural invasion)