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Oral surgery > 4th year salivary gland disease > Flashcards

4th year salivary gland disease Flashcards

1
Q

Define mucocele

A

Mucus-filled cysts that affect minor salivary glands

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2
Q

Commonality of mucoceles

A

Common

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3
Q

Aetiology of mucoceles

A

Thought to be caused by trauma

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4
Q

2 epidemiological features of mucoceles

A

More common in young adults/children
More common in males

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5
Q

6 common features of the clinical presentation of mucoceles

A

Single
Fluctuant, dome shaped cyst
Normal or bluish coloration
Non-pulsatile
Normal overlying epithelium
1mm-1cm, can increase and decrease in size

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6
Q

Common location of a mucocele

A

Inner aspect of lower lip

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7
Q

Define superficial mucocele and 4 locations they are commonly found

A

Variant of mucoceles that affect:
Soft palate
Retromolar pad
Posterior buccal mucosa
Lower labial mucosa

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8
Q

3 conditions associated with superficial mucoceles

A

Lichen planus
Lichenoid drug reactions
Graft versus host disease

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9
Q

Give 2 histologically different types of mucus-filled cysts

A

Mucous extravasation cyst
Mucous retention cyst

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10
Q

Most common mucus-filled cysts

A

Mucous extravasation cyst

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11
Q

Describe 3 histological features of mucous extravasation cyst

A

Pool of extravasated mucous
Wall of compressed granulation tissue
Mixed inflammatory cell infiltrate

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12
Q

Describe 5 histological features of mucous retention cyst

A

Duct stricture
Cyst forms lined by ductal epithelium
Pool of mucous in cyst
Minimal inflammatory reaction
Wall of fibrous tissue lined by altered ductal epithelium

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13
Q

4 managements strategies mucoceles

A

Reassurance only
Excision biopsy
Cryosurgery
Sclerotic agents

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14
Q

6 complications of active treatment for mucoceles

A

Bruising
Bleeding
Post-operative pain
Swelling and infection
Possibility of recurrence
Altered sensation

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15
Q

Define ranula

A

Mucocele affecting floor of mouth involving major salivary glands

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16
Q

Commonality of ranulas

A

Uncommon

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17
Q

Aetiology of ranulas

A

Obstruction

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18
Q

4 features of the clinical presentation of ranulas

A

Unilateral
2-3cm in diameter
Soft, fluctuant, blue
Painless but may effect speech

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19
Q

Define plunging ranulas

A

Ranula that extends into sublingual gland beyond the mylohyoid muscle and may cause midline swelling

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20
Q

4 management strategies for ranulas

A

Spontaneous resolution
Aspiration
Marsupialization
Excision of the gland

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21
Q

Define sialosis

A

Swelling of major salivary glands in particular parotid glands

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22
Q

Commonality of sialosis

A

Uncommon

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23
Q

4 aetiological factors linked to sialosis

A

Drugs
Alcohol
Endocrine conditions
Nutritional disorders

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24
Q

4 features of the clinical presentation of sialosis

A

Soft, painless swelling
Gradual onset
Bilateral
Outward deflection of the ear lobe

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25
Q

Common location of sialosis

A

Parotid glands

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26
Q

2 management strategies of sialosis

A

No treatment
Manage systemic cause

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27
Q

Define necrotising sialometaplasia

A

Benign, necrotizing and inflammatory condition affecting the minor salivary glands

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28
Q

Commonality of necrotising sialometaplasia

A

Rare

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29
Q

Common location of necrotising sialometaplasia

A

Posterior palate

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30
Q

Aetiology of necrotising sialometaplasia

A

Trauma leading to necrosis

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31
Q

3 predisposing factors to necrotising sialometaplasia

A

Middle age
Male
Smokers

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32
Q

Epidemiology of necrotising sialometaplasia

A

2M:F

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33
Q

3 features of the clinical presentation of necrotising sialometaplasia

A

Preceded by paraesthesia
Irregular margins
Heaped up appearance

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34
Q

2 management strategies for necrotising sialometaplasia

A

Spontaneous resolution
Symptomatic management: analgesic mouth washes, topical corticosteroid preparations

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35
Q

Define salivary gland hypofunction

A

Condition where unstimulated and stimulated salivary flow is significantly reduced, measured objectively

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36
Q

2 objective measures of salivary gland hypofunction

A

Unstimulated salivary flow < 0.1-0.2mL per minute
Stimulated salivary flow < 0.7mL per minute

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37
Q

Define xerostomia

A

Subjective perception of a dry mouth (function is commonly found to be normal)

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38
Q

Prevalence of xerostomia

A

10-46%

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39
Q

Epidemiology of xerostomia

A

More common in the older population
More common in women

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40
Q

6 functions of saliva

A

Lubrication
Protection
Digestion through hydrolysis of starch (amylase)
Anti microbial and immunological defence
Wound healing
Solvent for taste substances

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41
Q

3 salivary gland disease lubrication associated problems

A

Difficulty speaking
Difficulty eating
Soft and hard tissue abrasion

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42
Q

2 salivary gland disease protection associated problems

A

Mucosal atrophy due to water loss
Demineralisation

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43
Q

1 salivary gland disease digestion associated problem

A

Increased substrate left in the oral cavity for bacteria to digest

44
Q

2 salivary gland disease antimicrobial associated problems

A

Colonisation infection
Adhesion versus deletion

45
Q

1 salivary gland disease wound healing associated problem

A

Prolonged wound repair

46
Q

1 salivary gland disease taste associated problem

A

Loss of taste and associated dietary issues that can lead to caries

47
Q

2 developmental causes of salivary gland disease

A

Agenesis or hypoplasia
Cystic fibrosis

48
Q

2 inflammatory causes of salivary gland disease

A

Primary Sjogrens syndrome
Secondary Sjogrens syndrome

49
Q

1 metabolic cause of salivary gland disease

50
Q

2 iatrogenic causes of salivary gland disease

A

Drug therapy eg. antidepressants
Post irradiation damage

51
Q

6 challacombe scale indicators of xerostomia

A

Lack of saliva
Frothy saliva
Mucositis
Candidal infection
Cervical caries
Red, depapillated, lobulated tongue

52
Q

4 management strategies for saliva gland disease

A

Rectify/improving underlying causes
Avoid contributing factors
Saliva replacement therapies
Enhance salivary function

53
Q

5 contributing factors to xerostomia

A

Dry foods
Alcohol including alcohol containing mouthwashes
Smoking
Diuresis producing drinks e.g. tea/coffee
Dry hot environments

54
Q

3 saliva replacement options

A

Saliva Orthana: non-acidic and contains fluoride
Biotene: lubricates and contains fluoride
Glandosane if edentulous

55
Q

1 salivary gland stimulant to enhance function

A

Pilocarpine derivatives eg. Salagen

56
Q

3 ways to manage increased caries risk for patients with salivary gland disease

A

High fluoride provision
Diet advice
Regular check ups and radiographs

57
Q

Define Sjogren’s syndrome

A

Systemic autoimmune disorder that affects exocrine glands, particularly the lacrimal and salivary glands and is characterised by lymphocytic infiltration

58
Q

Define primary Sjögren’s syndrome

A

Clinical symptoms of Sjögren’s disease occurring in the absence of another systemic autoimmune disease

59
Q

Define secondary Sjögren’s syndrome

A

Clinical symptoms of Sjögren’s disease are associated with another systemic autoimmune disease

60
Q

5 epidemiological features of Sjogren’s syndrome

A

Most common systemic autoimmune disease
0.5-1.56%
9F:1M
60% of patients secondary Sjogrens
Two age peaks

61
Q

Aetiology of Sjogren’s syndrome

A

Unknown, potentially oestrogen/androgen deficiency or virus related

62
Q

6 oral presentations of Sjogren’s syndrome

A

Decreased function of salivary glands
Dry painful mouth
Loss of taste
Dysphagia
Thicker and opaque saliva
Enlarged and painful salivary glands

63
Q

3 methods of diagnosing Sjogren’s syndrome

A

2017 ACR–EULAR Classification Criteria for Primary Sjögren’s Syndrome
Ultrasound
Labial gland biopsy

64
Q

5 indicators of primary Sjögren’s Syndrome as per the 2017 ACR–EULAR Classification Criteria

A

A focus score of ≥1 of minor labial salivary gland obtained on biopsy
Presence of anti-SSA antibodies
SICCA ocular staining score of ≥5
Schirmer test of ≤ 10 mm per 5 min
Unstimulated whole salivary flow of ≤0.1 ml per min

65
Q

3 management strategies for Sjögren’s Syndrome

A

No cure, symptomatic relief only
Regular dental review
Monitor for complications: lymphoma, heart block

66
Q

Define artificial saliva replacements

A

Medicaments that mimic natural saliva, don’t stimulate salivary glands

67
Q

Define salivary stimulants

A

Medicaments that stimulate salivary glands

68
Q

Define salivary gland neoplasms

A

Tumours that form in the tissues of salivary glands

69
Q

4 features that may indicate that a salivary gland tumour is likely to be malignant

A

Located on tongue, floor of the mouth, retromolar pad
History of pain/tenderness
Facial nerve dysfunction
Involvement of skin, fixation or ulceration

70
Q

Common salivary glands affected by neoplasms

A

10x more common in major glands, usually the parotid gland

71
Q

Define pleomorphic salivary adenoma

A

Benign tumour affecting salivary glands characterised by architectural diversity: ducts, sheets, strands of myoepithelium

72
Q

2 histological features of pleomorphic salivary adenoma

A

Myoepithelial cells produce myxoid matrix which may resemble cartilage
Tumour often lined with thin incomplete capsule

73
Q

Epidemiology of pleomorphic salivary adenoma

A

Commonest tumour (60%+), in both major and minor glands
Occurs at all ages, peak 20-40 years

74
Q

Recurrence of pleomorphic salivary adenoma

A

Local recurrence common, especially if ruptured

75
Q

Metastasis of pleomorphic salivary adenoma

A

Very rarely, benign pleomorphic adenoma may metastasise, usually post-op, major glands

76
Q

Define carcinoma ex-pleomorphic adenoma

A

Malignancy of longstanding and/or recurrent pleomorphic salivary adenoma lesions

77
Q

3 features of the clinical presentation of carcinoma ex-pleomorphic adenoma

A

Rapid enlargement of lump
Usually major salivary glands
Peak incidence about 10 years after pleomorphic adenoma

78
Q

2 factors affecting the prognosis of carcinoma ex-pleomorphic adenoma

A

Degree of invasion beyond capsule of the pleomorphic adenoma
Precise subtype(s)

79
Q

Define mucoepidermoid carcinoma

A

Malignant tumour affecting salivary glands, usually minor and parotid glands with 3 histologically distinct elements

80
Q

3 histologically distinct elements of mucoepidermoid carcinoma

A

Mucous cells
Epidermoid cells
Intermediate cells

81
Q

2 histological features of mucoepidermoid carcinoma

A

May be solid, cystic or both
Circumscribed but unencapsulated

82
Q

Epidemiology of mucoepidermoid carcinoma

A

Occurs at all ages, peak 40-50 years

83
Q

Metastasis of mucoepidermoid carcinoma

A

Low-grade tumour, less than 10% metastasise

84
Q

3 features indicative of a high-grade mucoepidermoid carcinoma lesion

A

Solid rather than cystic
Cytologically malignant-looking cells
Infiltrative edge

85
Q

Define adenoid cystic carcinoma

A

Malignant tumour affecting salivary glands, usually minor and parotid glands

86
Q

Epidemiology of adenoid cystic carcinoma

A

Occurs at all ages, peak 40-50 years

87
Q

4 features of the clinical presentation adenoid cystic carcinoma

A

Soft
Unencapsulated
Discoloured mucosa
Nerve-related symptoms

88
Q

Histology of adenoid cystic carcinoma

A

Swiss cheese appearance with deceptively bland cytology

89
Q

3 features of metastasis of adenoid cystic carcinoma

A

Usually low-grade
Widespread local invasion
Haematogenous metastasis common

90
Q

3 management strategies for malignant salivary gland neoplasms

A

Surgery
Radiotherapy: not particularly effective
Chemotherapy: formalin

91
Q

3 opportunistic bacteria associated with salivary gland infections

A

Staphylococcus aureus
Steptococci
Anaerobes

92
Q

2 predisposing factors to bacterial salivary gland infections

A

Reduced salivary gland flow
Reduction in host immunity

93
Q

4 features of the clinical presentation of bacterial salivary gland infections

A

Painful gland swelling, usually unilateral, involving one major gland
Pus expressed from duct
Regional lymphadenopathy
Gradual onset, over days

94
Q

3 management strategies for bacterial salivary gland infections

A

Antibiotic therapy: co-amoxiclav 5 day course
Adequate hydration
Specialist referral if recurrent / signs of spreading infection

95
Q

Salivary duct obstruction

A

Obstruction affecting salivary gland output

96
Q

4 causes of salivary duct obstruction

A

Benign stricture
Mucus plug
Sialolith/stone
Extraductal compression

97
Q

Clinical presentation of salivary duct obstruction

A

Swelling at mealtimes that resolves over the next few hours

98
Q

Define sialoliths

A

Single or multiple calcification(s) of a mucus plug over time

99
Q

Location of sialoliths

A

Usually affecting submandibular gland
May be within salivary gland duct or deep within gland itself

100
Q

5 management strategies for sialoliths

A

Self management with lemon drops, liquid intake
Removal in clinic using probe
Lithotripsy (ultrasound)
Basket retrieval (sialendoscopy)
Excision

101
Q

4 complications of bacterial salivary gland infection

A

Recurrence of infection
Spread of infection
Fistula formation
Compromised gland function

102
Q

Describe sialography

A

Anatomical investigation of major salivary gland structure where radiopaque dye is introduced into the gland via the duct and two radiographs at 90 degrees to each other

103
Q

Give 2 indications for sialography

A

Obstructive symptomatology
Sjogrens syndrome

104
Q

Give 2 contraindications to sialography

A

During acute phase of salivary gland infection
Hypersensitivity to iodine

105
Q

4 viruses commonly infecting salivary glands

A

Paramyxovirus
Influenza virus
Echo viruses
Epstein Barr virus

106
Q

6 clinical features of a paramyxovirus salivary gland infection

A

Affecting parotid gland, bilaterally
Mumps
Pyrexia
Painful swelling
Regional lymphadenopathy
Clear saliva expressed

107
Q

3 systemic complications of paramyxovirus infection

A

Pancreatitis
Orchitis
Oophoritis

Oral surgery (5 decks)

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