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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
Complications of Xerostomia
Candidiasis -- angular cheilitis Prone to cervical and root caries Alterations of taste (metallic)
26
Common cuases of xerostomia (8)
Medications Caffeine/alcohol Smoking Radiation therapy Sjogren's syndrome Sarcoidosis Surgery Diabetes Mellitus
27
Management of Xerostomia
Drug modification surgless candy and gum Oral lubricants **Pilocarpine (Salagen)** -- prescription
28
Pilocarpine
Prescription for xerostomia
29
Sjogren's Syndrom
SICCA SYNDROME -- **Dry mouth, Dry eyes** Inflammation in exocrine glands -- destroys glands
30
Primary Sjogren's Syndrome Diagnosis
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
Sjogren's Syndrome Treatment
Xerostomia Treatments
32
Salivary neoplasms
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
Sublingual neoplasms
Not a common site But 70-90% are **MALIGNANT**
34
Minory salivary gland neoplasms
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
Most comon sites for Salivary neoplasms
**Parotid gland** (60-80%) **Minor glands** ( 9-23%) --\> PALATE (posterior lateral hard or soft) **Submandibular** **Sublingual** (\<1%) --\> most MALIGNANT
36
Minor Salivary glands: Benign vs malignant
50% 50%
37
Minor Salivary glands Upper lip Benign vs Malignant
Benign - 80% Malignant - 20%
38
Minor Salivary Glands Lower Lip Benign vs Malignant
Benign: 40% Malignant: 60%
39
Minor Salivary Glands Palate Benign vs Malignant
Benign: 50% Malignant: 50%
40
Minor Salivary Glands Tongue Benign vs Malignant
Benign: 15% Malignant: 85%
41
Minor Salivary Gland Cheek Benign vs Malignant
Benign: 50% Malignant: 50%
42
Minor Salivary Glands Retromolar Pad Benign vs Malignant
Benign: 10% Malignant: 90%
43
Upper lip salivary neoplasms --\> mostly \_\_\_\_\_\_
benign
44
Lower lip salivary neoplasms ---\> mostly \_\_\_\_
Malignant
45
Salivary gland neoplams in retromolar area are most likely \_\_\_\_\_
malignant
46
What is the most common benign salivary neoplasm?
**Pleomorphic adenoma**
47
What is the 2nd most common benign salivary neoplasms in ADULTS?
Warthins Tumor | (Papillary Cystadenoma Lymphomatosum)
48
What is the most common _malignant_ salivary neoplasm?
Mucoepidermoid Carcinoma
49
What is the 2nd most common _malignant_ salivary neoplasm in CHILDREN?
Acinic Cell Adenocarcinoma
50
Benign Salivary Gland Neoplasms (4)
Canalicular Adenoma Pleomorphic adenoma Warthin Tumor Oncocytoma
51
**Canalicular Adenoma**
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
Pleomorphic Adenoma
*_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
Oncocytoma | (Oxyphillic Adenoma)
**Benign salivary gland tumor -** epithelial cells: oncocytes Mostly parotid Excessive accumulation of ***_MITOCHONDRIA_***
54
Adenoma -\>
Benign tumor
55
Patient is a smoker
**Warthin's Tumor** (Papillary Cystadenoma Lymphomatosum) _Exclusively parotid_ ***Second most common benign neoplasm*** Bilateral **_*SMOKERS --* 8x increase in risk_**
56
Malignant Salivary Neoplasms (6)
Mucoepidermoid Carcinoma Acinic Cell Adenocarcinoma Adenoid Cystic Carcinoma Polymorphous low-grade adenocarcinoma (terminal duct adenocarcinoma) Malignant Mixed Tumor Intraosseous mucoepidermoid carcinoma
57
Most common MALIGNANT salivary neoplasm
**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
Intraosseous mucoepidermoid carcinoma
**Ectopic salivary gland tissue that was developmentally entrapped within the jaw** Mandibular (molar, ramus) \> Maxillary Prognosis - 90% survival
59
Acinic Cell Adenocarcinoma
**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
Adenoid Cystic Carcinoma
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
Polymorphous Low-grade Adenocarcinoma | (Terminal Duct carcinoma)
**MINOR glands --\> _Hard and soft palate (65%)_**, upper lip, buccal mucosa
62
Malignant Mixed Tumor
Most common in -- **MAJOR gland** _Malignant transformation of the epithelial cells_ \*Mass present for many years --\> recent _rapid_ growth with pain or ulcerations\*
63
What gland is associated with a RANULA
Sublingual Gland
64
Necrotizing Sialometaplasia
65
Major Salivary Glands ALL sites Benign vs Malignant
Benign -- 66% Malignant -- 34%
66
Major Salivary Gland Neoplasms PAROTID Benign vs Malignant
Benign -- 70% Malignant -- 30%
67
Major Salivary Glands SUBMANDIBULAR Benign vs Malignant
Benign -- 60% Malignant -- 40%
68
Major Salivary Glands SUBLINGUAL Benign vs Malignant
Benign -- 30% Malignant -- 70%
69
Carcinosarcoma
**_Malignant mixed tumor_** Carcinoma --\> Epidermal origin Sarcoma --\> Mesenchymal Cell Origin Tumor of mixed origins - harder to treat
70
Upper lip adenoma
Pleomorphic adenoma \<50 yr Canalicular adenoma \>60yr
71
Cause of nectotizing sialometaplasia
Due to local ischemia

Oral Pathology (17 decks)

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