Ch11 Salivary Flashcards by Austin Shackelford

What 3 syndromes can present with salivary gland APLASIA?

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

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M:F ratio for salivary aplasia?

2M:1F

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

AD…FGF10

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

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

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

Ranula

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Which gland forms a ranula again?

sublingual

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What helps clinically distinguish a ranula from a dermoid cyst?

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

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Which muscle is dissected in a plunging ranula?

MYLOHYOID

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

“tail sign” (extension into the sublingual space)

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

FOM, Buccal mucosa, lips

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Salivary duct cysts on the FOM have what color?

amber

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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?

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

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80% of cases of sialoliths form in which gland?

submandibular

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

upper lip, buccal mucosa

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What age range is most common for salivary stones?

young and middle-aged adults

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

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What is the characteristic micro appearance for sialoliths?

concentric laminations surrounding a nidus of amorphic debris

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What is the most common virus to cause sialadenitis?

mumps

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

abdominal surgery

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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.

surgical mumps…ATROPINE

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

Staph aureus

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What are 4 causes of non-infectous sialadenitis?

Sjogrens, sarcoidosis, radiation therapy, allergens

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What % of acute bacterial sialadenitis cases are bilateral?

10-25%

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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.

sausaging

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

mumps and juvenile recurrent parotitis

juvenile recurrent parotitis: age range, treatment

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

Subacute necrotizing sialadenitis: age range, location, tx

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

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 pano....sialolith.....bacterial culture

Name the condition: sausaging on sialography

chronic parotitis

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

juvenile recurrent parotitis

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

Subacute necrotizing sialadenitis

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

surgical mumps

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

cheilitis glandularis

cheilitis glandularis: age, gender

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

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

cheilitis glandularis

What are the three types of cheilitis glandularis?

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

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

they both involve bacterial infection whereas simple does not

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

assoc with sialorrhea

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

IPS - idiopathic paroxysmal sialorrhea

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

anticholinergic meds

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

63%

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

lactoperoxidase, lysozyme, lactoferrin

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

pilocarpine...5 to 10 mg...3-4x daily

Pilocarpine: three side effects

excessive sweating, increased HR, increased BP

\_\_\_\_\_\_\_\_\_ hydrochloride, a cholinergic agonist with affinity for muscarinic M3 receptors

Cevimeline

BOTH pilocarpine and cevimeline are CONTRAINDICATED in patients with \_\_\_\_\_\_\_\_\_\_.

narrow-angle glaucoma

What is the old term for IgG4 disease?

MI-KUL-ICZ disease

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?

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

IgG4 mean age, gender

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

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

submandibular

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

IgG4

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

Chronic sclerosing sialadenitis, obliteraitve phelbitis...Kuttner tumor

What is the other term for sicca syndrome?

kerato-conjunctivitis sicca

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

primary = sicca only, secondary = sicca + autoimmune disorder

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

HLA-DRw52

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

HLA-B8 and HLA-DR3

What is the F:M ratio for sjogrens?

9:1 F:M

What % of patients with RA have SS?

15%

Secondary Sjogren may develop in 30% of patients with \_\_\_\_\_\_\_\_

SLE

Whats the buzz phrase for the sialographic presentation of sjogrens?

"fruit-laden, branchless tree"

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

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

What serum markers are elevated in sjogrens?

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)

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

benign lymphoepithelial lesion (myoepithelial sialadenitis)

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

acini are destroyed, ductal epithelium persists

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

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

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?

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

What is the formula for focus score in Sjogrens?

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

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

smoking

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

Lactoperoxidase, Lysozyme, Lactoferrin

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

5-15%....20x greater

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

salivary glands or lymph nodes

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

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