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Neville and Damm > Ch11 Salivary > Flashcards

Ch11 Salivary Flashcards

1
Q

What 3 syndromes can present with salivary gland APLASIA?

A
  1. mandibulofacial dysostosis (Treacher-Collins) 2.hemifacial microsomia 3. lacrimo-auriculo-dento-digital (LADD) syndrome
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2
Q

M:F ratio for salivary aplasia?

A

2M:1F

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3
Q

LADD (Lacrimo-auriculo-dento-digital) syndrome is what inheritance pattern? What gene mutation?

A

AD…FGF10

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4
Q

Superficial mucoceles are assoiciated with what type of disorders? What are three examples?

A

LICHENOID disorders…lichen planus, lichenoid drug eruptions, and GVHD

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5
Q

_______ is a term used for mucoceles that occur in the floor of the mouth, arising from the sublingual gland.

A

Ranula

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6
Q

Which gland forms a ranula again?

A

sublingual

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7
Q

What helps clinically distinguish a ranula from a dermoid cyst?

A

Ranulas are usually lateral to the midline (ducts of rivinus/bartholin) vs MIDLINE dermoid cysts are midline

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8
Q

Which muscle is dissected in a plunging ranula?

A

MYLOHYOID

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9
Q

What is the classic sign of a plunging ranula on CT or MRI?

A

“tail sign” (extension into the sublingual space)

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10
Q

What are the three top sites for salivary duct cysts in the mouth?

A

FOM, Buccal mucosa, lips

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11
Q

Salivary duct cysts on the FOM have what color?

A

amber

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12
Q

What is it called when a salivary duct cyst shows oncocytic metaplasia in the lining? What else can it resemble? If the features develop further, what can these be diagnosed as?

A

ductal ectasia secondary to salivary obstruction. it can resemble a warthin tumor (w/o the lymphoid stroma)..papillary cystadenoma

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13
Q

80% of cases of sialoliths form in which gland?

A

submandibular

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14
Q

If a sialolith forms in a minor salivary gland/duct, what two oral locations are most common?

A

upper lip, buccal mucosa

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15
Q

What age range is most common for salivary stones?

A

young and middle-aged adults

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16
Q

Multiple parotid stones radiographically can mimic calcified parotid lymph nodes, such as might occur in ________

A

TB

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17
Q

What is the characteristic micro appearance for sialoliths?

A

concentric laminations surrounding a nidus of amorphic debris

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18
Q

What is the most common virus to cause sialadenitis?

A

mumps

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19
Q

One of the more common causes of sialadenitis is recent surgery, especially WHAT TYPE?

A

abdominal surgery

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20
Q

After abdominal surgery, an acute parotitis (AKA ______) may arise because the patient has been kept without food or fluids (NPO) and has received ________ (WHAT DRUG?) during the surgical procedure.

A

surgical mumps…ATROPINE

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21
Q

What bacteria is responsible for most acute bacterial sialadenitis cases (both community and hospital acquired)?

A

Staph aureus

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22
Q

What are 4 causes of non-infectous sialadenitis?

A

Sjogrens, sarcoidosis, radiation therapy, allergens

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23
Q

What % of acute bacterial sialadenitis cases are bilateral?

A

10-25%

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24
Q

In chronic parotitis, Stensen duct may show a characteristic sialographic pattern known as “_______,” which reflects a combination of dilatation plus ductal strictures from scar formation.

A

sausaging

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25
Q

What are the two most common inflammatory salivary disorder in kids?

A

mumps and juvenile recurrent parotitis

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26
Q

juvenile recurrent parotitis: age range, treatment

A

3-6 years old, can irrigate during flare ups, but condition resolves around puberty

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27
Q

Subacute necrotizing sialadenitis: age range, location, tx

A

teenagers, young adults…minor salivary glands of the hard or soft palate…self-limiting

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28
Q

Clinical decision making: pts with sialadenitis should first have ______ to look for a possible _______….then more scans can be warrented. If a there is purulence at the duct orifice, then ________ should be done

A

a pano….sialolith…..bacterial culture

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29
Q

Name the condition: sausaging on sialography

A

chronic parotitis

30
Q

Name the condition: 3-6 years old, can irrigate during flare ups, but condition resolves around puberty

A

juvenile recurrent parotitis

31
Q

Name the condition: teenagers, young adults…minor salivary glands of the hard or soft palate…self-limiting

A

Subacute necrotizing sialadenitis

32
Q

Name the condition: After abdominal surgery, an acute parotitis may arise because the patient has been kept without food or fluids

A

surgical mumps

33
Q

Name the condition: inflammation of the minor salivary glands, lower lip vermillion swelling and eversion, caused by actinic damage, tobacco, etc

A

cheilitis glandularis

34
Q

cheilitis glandularis: age, gender

A

middle aged or older men (some cases of women and children)

35
Q

What can develop in albino patients 2/2 sun sensitivity?

A

cheilitis glandularis

36
Q

What are the three types of cheilitis glandularis?

A
  1. simple 2.superficial supperative (Baelz disease) 3.Deep supperative (chelitis glandularis apostematosa)
37
Q

What distiguishes Baelz disease and chelitis glandularis apostematosa from simple cheilitis glandularis?

A

they both involve bacterial infection whereas simple does not

38
Q

What do rabies, heavy-metal poisoning, clozapine, Alzheimers / myasthenia gravis meds have in common?

A

assoc with sialorrhea

39
Q

What is the term for excessive salivation lasting 2 to 5 min with prodrome of nausea or epigastric pain?

A

IPS - idiopathic paroxysmal sialorrhea

40
Q

Lots of tx for sialorrhea, including surgery, but what class of meds can sometimes be used?

A

anticholinergic meds

41
Q

What % of the 200 most rx’d meds in the US have a side effect of xerostomia?

A

63%

42
Q

What are the 3 active ingredients in biotene and oralbalence products?

A

lactoperoxidase, lysozyme, lactoferrin

43
Q

Systemic _______ is a parasympathomimetic agonist that can be used as a sialagogue. At doses of ___-___ mg, ____x daily

A

pilocarpine…5 to 10 mg…3-4x daily

44
Q

Pilocarpine: three side effects

A

excessive sweating, increased HR, increased BP

45
Q

_________ hydrochloride, a cholinergic agonist with affinity for muscarinic M3 receptors

A

Cevimeline

46
Q

BOTH pilocarpine and cevimeline are CONTRAINDICATED in patients with __________.

A

narrow-angle glaucoma

47
Q

What is the old term for IgG4 disease?

A

MI-KUL-ICZ disease

48
Q

What organ was first associated with IgG4 disease? You see IgG4 protein in the serum up to ___x the normal level as well as what type of immune cell?

A

Pancreas..25x (60-80% of the time)..plasma cells

49
Q

IgG4 mean age, gender

A

60 y/o..men slightly more than women (Japan women more than men)

50
Q

What is the most commonly involved salivary gland in IgG4 disease?

A

submandibular

51
Q

Pancreatitis, cholangitis, abdominal aortitis/aneurysm, inflammatory pesudotumors of the kidney, thyroid inflammation (Ridel thyroiditis) and lymphadenopathy are possible effects of what?

A

IgG4

52
Q

What are the 2 main histo findings for IgG4? What is the overall pattern sometimes referred to as?

A

Chronic sclerosing sialadenitis, obliteraitve phelbitis…Kuttner tumor

53
Q

What is the other term for sicca syndrome?

A

kerato-conjunctivitis sicca

54
Q

What is the difference between primary and secondary sjogrens? (may be obsolete)

A

primary = sicca only, secondary = sicca + autoimmune disorder

55
Q

What histocompatability antigen (HLA) is associated with both primary and secondary sjogrens?

A

HLA-DRw52

56
Q

What 2 histocompatability antigens (HLAs) are associated with primary sjogrens?

A

HLA-B8 and HLA-DR3

57
Q

What is the F:M ratio for sjogrens?

A

9:1 F:M

58
Q

What % of patients with RA have SS?

A

15%

59
Q

Secondary Sjogren may develop in 30% of patients with ________

A

SLE

60
Q

Whats the buzz phrase for the sialographic presentation of sjogrens?

A

“fruit-laden, branchless tree”

61
Q

What are the 3 diagnostic qualifiers of sjogrens for the amer col of rheum?

A
  1. positive autoantibodies to Ro(SS-A) and/or La(SS-B) OR positive RF AND ANA >1:320 2.Labial salivary gland bx with focus score of >or equal to 1 3. Keratoconjunctivitis sicca with ocular staining score >3
62
Q

What serum markers are elevated in sjogrens?

A
  1. increased ESR 2.increased Ig 3. increased IgG 4. RF 5. ANA 6. anti-SS-A (anti-Ro) 7. anti-SS-B (anti-La)
63
Q

Terms (2) for a more advanced lesion in Sjogren’s (2 names)

A

benign lymphoepithelial lesion (myoepithelial sialadenitis)

64
Q

Sjogrens histo: In a benign lymphoepithelial lesion (myoepithelial sialadenitis), what structure is destroyed, what tissue persists?

A

acini are destroyed, ductal epithelium persists

65
Q

Sjogren Histo: In a benign lymphoepithelial lesion (myoepithelial sialadenitis) of Sjogrens, the remaining ductal and myoepithelial cells become hyperplastic forming ________

A

epimyoepithelial islands (throughout a lymphoid proliferation) (these are rare in the minor salivary glands)

66
Q

Sjogren Histo: Ideal # of minor glands during bx? What is the # of lymphocytes or plasma cells in an aggregate to qualify for an SS Dx?

A

5…..>50 (adjacent to normal acini and conistently in most glands of the specimen

67
Q

What is the formula for focus score in Sjogrens?

A

Focus score = (# of inflammatory aggregates x 4) / (# of mm^2 of salivary gland parynchema)

68
Q

Interesting - what habit can lower the amount of inflammation in a Sjogrens biopsy?

A

smoking

69
Q

What are the three ‘L’s of supportive medications for Sjogrens?

A

Lactoperoxidase, Lysozyme, Lactoferrin

70
Q

Patients with Sjögren syndrome have a lifetime risk for LYMPHOMA of __ to __%, which is estimated to be about ___ times greater than the general population.

A

5-15%….20x greater

71
Q

If a patient with Sjogrens develops lymphoma, what are the two locations it will likely arise first?

A

salivary glands or lymph nodes

72
Q

What is the most common category of Lymphoma to arise in Sjogren? What 2 types specifically?

A

low-grade non-Hodgkin B-cell lymphomas….MALT or extranodal marginal zone

Neville and Damm (72 decks)

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