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Oral Pathology > Chapter 11 > Flashcards

Chapter 11 Flashcards

1
Q
A

Mucocele

Mucus Extravasation Phenomenon

Spillage of mucin into the soft tissue due to rupture of a salivary gland duct, usually caused by trauma.

May fill with fibrotic tissue and develop into a fibroma

More superficial –> clear

may rupture and pts may think they are recurring “blisters”

More deep –> Mucosal colored, purple due to blood

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2
Q

Most common locations for mucocele

A

Lower lip (81%)

FOM

Anterior ventral tongue

Buccal Mucosa

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3
Q

Mucocele Treatment

A

Surgical excision

Remove with the adjacent minor salivary gland

Submit to pathology to ensure it is not cancerous

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4
Q

Mucocele’s of the upper lip are more likely to be a

A

Salivary gland tumor

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5
Q

Mucoceles of the retromolar region are distinctly unusual…. most are

A

Mucoepidermoid carcinoma

Malignant Salivary Neoplasm

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6
Q
A

Ranula

Mucoceles in the floor of the mouth – usually lateral to the midline

Sublingual gland duct

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7
Q

Treatment of a Ranula

A

Removal of the feeding sublingual gland and/or marsupialization (Removal of the roof of the intraoral lesion)

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8
Q

What may an untreated Ranula become?

A

Plunging Ranula

Dissects through the mylohyoid muscle

May cause death –> closes of esophagus and airway

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9
Q
A

Salivary Duct Cyst

Epithelium-lined cavity that arises from the salivary gland tissue – SIMPLE CUBOIDAL

(Looks similar to mucocele – just lined with epithelium)

Moslty in adults

Major and minor salivary glands

Bluish (or mucosal colored), soft fluctuant swelling

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10
Q

Where is a salivary duct cyts most often found?

A

Parotid gland

FOM

Buccal mucosa

Lips

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11
Q

What is the treatment for a salivary duct cyst?

A

Surgical excision

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12
Q
A

Sialolith (Sialolithiasis)

Calcifications developed in salivary duct

** SUBMANDIBULAR gland – long duct **

Upper lip, buccal mucosa

Pain or swelling especially at meal time

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13
Q

Treatment for Sialolith

A

Gentle massage

Increase fluid intake

Moist heat

Silogogue surgery

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14
Q

Sialadentitis

A

Inflammation of the salivary gland

Infection –> Viral (MUMPS)

Noninfection –> Sjrogrens, Sarcoidosis

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15
Q

Mumps

A

Epidemic Parotitis

Paramyxovirus

Epididymoorchitis, mastistis (breasts), oophoritis

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16
Q

Anesthesia Mumps

A

Rare complication after general anesthesia

Swelling of parotid or submandibular glands after surgery

Spontaneously resolve

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17
Q

Sialadenosis (Sialosis)

A

Non-inflammatory asymptomatic salivary gland enlargment

Hypertrophy of acini –> PAROTID GLAND

Underlying systemic conditions:

Endocrine disorders –> diabetes mellitus, hypthyroidism, prganancy

Malnutrition –> alcoholism, anorexia, bulimia

Drugs –> Anti-hypertensive drugs, psychotropic drugs

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18
Q

Causes for Sialadenosis

A

Diabetes Mellitus, hypothyroidism, pregnancy

Malnutrition, alcoholism, anorexia, bulimia

Anti-hypertensive drugs, psychotropic drugs

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19
Q

Adenomatoid Hyperplasia

A

Hyperplasia and/or hypertrophy of minor salivary glands

Localized

Sessile painless swelling that mimics a neoplasm

Biopsy –> rule out neoplasm

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20
Q

Necrotizing Sialometaplasia

A

Locally destructive inflammatory condition of the salivary glands (trauma)

Traumatic Injuries

Dental injections - tear the periosteum; kills the underlying tissue

Due to ischemia - leads to local infarction

Frequently PALATAL - unilateral

Non-ulcerated swelling, pain and paresthesia –> necrotic tissue sloughs off, ulcer –> heals in 5-6 weeks

Mimics malignancy - but too acute, histology

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21
Q
A

Cheilitis Glandularis

Swelling and eversion of lower lip

Hypertrophy and inflammation of minor salivary glands

Cause: Sun damage, tobacco, syphillis, poor hygiene

Clinical Presentation:

Swelling and pain

Eversion

Red dots – duct orifices

Weeping mucopurulent secretions

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22
Q

Sialorrhea

A

Excessive salivation

“DROOLING”

Causes:

Local irritants (ulcers)

GERD

Rabies

Medications

Down syndrome, Cerebral palsy

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23
Q

Treatment for Sialorrhea

A

Treate underlying cause

Anticholinergeic medications

Surgery - relocate salivary ducts

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24
Q

Xerostomia

A

DRY MOUTH

Complications:

Candidiasis - angular cheilitis

Prone to cervical and root caries

Alteration of taste (metallic)

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25
Q

Complications of Xerostomia

A

Candidiasis – angular cheilitis

Prone to cervical and root caries

Alterations of taste (metallic)

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26
Q

Common cuases of xerostomia (8)

A

Medications

Caffeine/alcohol

Smoking

Radiation therapy

Sjogren’s syndrome

Sarcoidosis

Surgery

Diabetes Mellitus

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27
Q

Management of Xerostomia

A

Drug modification

surgless candy and gum

Oral lubricants

Pilocarpine (Salagen) – prescription

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28
Q

Pilocarpine

A

Prescription for xerostomia

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29
Q

Sjogren’s Syndrom

A

SICCA SYNDROME – Dry mouth, Dry eyes

Inflammation in exocrine glands – destroys glands

30
Q

Primary Sjogren’s Syndrome Diagnosis

A

2 out of 3

  1. Positive serum anti-SSA and or anti- SSB (positive RF and ANA)
  2. Ocular staining score of >3
  3. Presence of focal lymphocytic siladenitis with a focus score of >1 from labial salivary gland biopsy
31
Q

Sjogren’s Syndrome Treatment

A

Xerostomia Treatments

32
Q

Salivary neoplasms

A

Smooth surface domed shaped nodule

An ulcerated mass lesion (trauma)

1-6.5 cases per 100,000

More common on upper lip than lower lip

(lower lip –mucocele)

33
Q

Sublingual neoplasms

A

Not a common site

But 70-90% are MALIGNANT

34
Q

Minory salivary gland neoplasms

A

Smooth surface domed shape nodule

May be ulcerated

1-6.5 cases for every 100,000 people

Any large nodules on palate, gingiva, etc

35
Q

Most comon sites for Salivary neoplasms

A

Parotid gland (60-80%)

Minor glands ( 9-23%) –> PALATE (posterior lateral hard or soft)

Submandibular

Sublingual (<1%) –> most MALIGNANT

36
Q

Minor Salivary glands:

Benign vs malignant

37
Q

Minor Salivary glands

Upper lip

Benign vs Malignant

A

Benign - 80%

Malignant - 20%

38
Q

Minor Salivary Glands

Lower Lip

Benign vs Malignant

A

Benign: 40%

Malignant: 60%

39
Q

Minor Salivary Glands

Palate

Benign vs Malignant

A

Benign: 50%

Malignant: 50%

40
Q

Minor Salivary Glands

Tongue

Benign vs Malignant

A

Benign: 15%

Malignant: 85%

41
Q

Minor Salivary Gland

Cheek

Benign vs Malignant

A

Benign: 50%

Malignant: 50%

42
Q

Minor Salivary Glands

Retromolar Pad

Benign vs Malignant

A

Benign: 10%

Malignant: 90%

43
Q

Upper lip salivary neoplasms –> mostly ______

44
Q

Lower lip salivary neoplasms —> mostly ____

45
Q

Salivary gland neoplams in retromolar area are most likely _____

46
Q

What is the most common benign salivary neoplasm?

A

Pleomorphic adenoma

47
Q

What is the 2nd most common benign salivary neoplasms in ADULTS?

A

Warthins Tumor

(Papillary Cystadenoma Lymphomatosum)

48
Q

What is the most common malignant salivary neoplasm?

A

Mucoepidermoid Carcinoma

49
Q

What is the 2nd most common malignant salivary neoplasm in CHILDREN?

A

Acinic Cell Adenocarcinoma

50
Q

Benign Salivary Gland Neoplasms (4)

A

Canalicular Adenoma

Pleomorphic adenoma

Warthin Tumor

Oncocytoma

51
Q

Canalicular Adenoma

A

Slow growing

Painless mass

Blue or normal color

May be multifocal

Minor salivary glands exclusively

Upper lip (75%)

Buccal mucosa

Older patients

Histology –> tubular

52
Q

Pleomorphic Adenoma

A

Benign mixed tumor

MOST COMMON benign SALIVARY NEOPLASM

Major glands:

Parotid (50-75%) –> superficial lobe

Submandibular

Minor glands:

Palate

upper lip

buccan mucosa

Lesion can grow to grotesque proportions

Histology –> multople structures

53
Q

Oncocytoma

(Oxyphillic Adenoma)

A

Benign salivary gland tumor - epithelial cells: oncocytes

Mostly parotid

Excessive accumulation of MITOCHONDRIA

54
Q

Adenoma ->

A

Benign tumor

55
Q

Patient is a smoker

A

Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)

Exclusively parotid

Second most common benign neoplasm

Bilateral

SMOKERS – 8x increase in risk

56
Q

Malignant Salivary Neoplasms (6)

A

Mucoepidermoid Carcinoma

Acinic Cell Adenocarcinoma

Adenoid Cystic Carcinoma

Polymorphous low-grade adenocarcinoma (terminal duct adenocarcinoma)

Malignant Mixed Tumor

Intraosseous mucoepidermoid carcinoma

57
Q

Most common MALIGNANT salivary neoplasm

A

Mucoepidermoid Carcinoma

Major glands –> Parotid (most often)

*Submandibular gland tumors – POORER prognosis than parotid*

Minor glands –>Palate

prognosis depends on the grade and stage

58
Q

Intraosseous mucoepidermoid carcinoma

A

Ectopic salivary gland tissue that was developmentally entrapped within the jaw

Mandibular (molar, ramus) > Maxillary

Prognosis - 90% survival

59
Q

Acinic Cell Adenocarcinoma

A

Second most common MALIGNANT neoplasm in children

Low grade malignant neoplasm

Slow growing mas

+ - pain

Good prognosis - high survival rate

Common locations

Parotid ( 85%)

Minor glands

Submandibular

60
Q

Adenoid Cystic Carcinoma

A

Minor gland (50% of cases) – PALATE

Parotid

Submandibular

Most common malignant salivary gland tumor of submandibular gland

Histology: Swiss Cheese

Slow growing

Widely infiltrate

Grow down and around NERVES

Pain and facial nerve paralysis

61
Q

Polymorphous Low-grade Adenocarcinoma

(Terminal Duct carcinoma)

A

MINOR glands –> Hard and soft palate (65%), upper lip, buccal mucosa

62
Q

Malignant Mixed Tumor

A

Most common in – MAJOR gland

Malignant transformation of the epithelial cells

*Mass present for many years –> recent rapid growth with pain or ulcerations*

63
Q

What gland is associated with a RANULA

A

Sublingual Gland

64
Q
A

Necrotizing Sialometaplasia

65
Q

Major Salivary Glands

ALL sites

Benign vs Malignant

A

Benign – 66%

Malignant – 34%

66
Q

Major Salivary Gland Neoplasms

PAROTID

Benign vs Malignant

A

Benign – 70%

Malignant – 30%

67
Q

Major Salivary Glands

SUBMANDIBULAR

Benign vs Malignant

A

Benign – 60%

Malignant – 40%

68
Q

Major Salivary Glands

SUBLINGUAL

Benign vs Malignant

A

Benign – 30%

Malignant – 70%

69
Q

Carcinosarcoma

A

Malignant mixed tumor

Carcinoma –> Epidermal origin

Sarcoma –> Mesenchymal Cell Origin

Tumor of mixed origins - harder to treat

70
Q

Upper lip adenoma

A

Pleomorphic adenoma <50 yr

Canalicular adenoma >60yr

71
Q

Cause of nectotizing sialometaplasia

A

Due to local ischemia

Oral Pathology (17 decks)

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