Chapter 11 Flashcards
1
Q
What term describes a spillage of mucin into the soft tissues due to rupture of a salivary gland duct?
A
Mucocele
2
Q
A mucocele is considered what type of salivary gland condition?
A
Non-neoplastic condition
3
Q
What causes mucoceles?
A
Usually trauma such as falling or braces
4
Q
Where are mucoceles most common?
A
In the lower lip (81%). Other sites include the FOM, anterior ventral tongue and buccal mucosa
5
Q
What is the treatment for a mucocele?
A
Surgical excision – make sure to remove the adjacent minor salivary gland and submit to pathology
6
Q
Clinical mucoceles located on the upper lip are more likely to be ____ ____ _____.
A
Salivary gland tumor (salivary gland tumor)
7
Q
Clinical mucoceles of the retromolar region are unusual and are more likely to be __________ ______.
A
Mucoepidermoid carcinoma (salivary gland neoplasm)
8
Q
What term describes a large, lateral mucocele in the FOM?
A
Ranula
9
Q
What salivary gland/duct is usually involved in a ranula?
A
Sublingual gland
10
Q
What is the treatment for a ranula?
A
Refer to an oral surgeon ASAP for the removal of the feeding sublingual gland and/or marsupialization
11
Q
What can occur if a ranula is not treated?
A
It can dissect the mylohyloid muscle and block off the airway, called a plunging ranula (Refer to OMFS immediately)
12
Q
What term describes a epithelium lined cavity that arises from salivary gland tissue?
A
Salivary duct cyst
13
Q
What is another name for a salivary duct cyst?
A
Mucus retention cyst
14
Q
In what age population are salivary duct cysts more common?
A
They occur mostly in adults
15
Q
In what glands do salivary duct cysts occur?
A
In both major and minor glands, and can have multiple, so swellings can be noticed in the parotid gland, FOM, buccal mucosa, lips
16
Q
What is the clinical presentation of a salivary duct cyst?
A
Bluish, soft fluctuant swelling
17
Q
What term describes a calcification developed in a salivary duct?
A
Sialolith, sialolithiasis
18
Q
Where do sialoliths often occur?
A
In submandibular glands, upper lip, buccal mucosa
19
Q
Why do sialoliths often occur in submandibular glands?
A
Because the submandibular glands have long, tortuous ducts with thick secretions
20
Q
What are some signs of a sialolith?
A
Pain or swelling, especially at meal times
21
Q
How can sialolith diagnosis be confirmed?
A
Through radiographs, sialography, ultrasounds, CT, palpation
22
Q
How is a sialolith treated?
A
Gentle massage, increase fluid intake, moist heat, sialogogue, surgery – suck on candies to “wash out”
23
Q
What are some causes of sialoliths?
A
Anything that slows or inhibits salivary flow thru the duct system – mucous plug, bacterial colonies, chronic duct blockage phenomena, normal duct anatomy, xerostomia – NOT associated with elevated calcium serum levels
24
Q
What is the term for salivary gland inflammation?
A
Sialadenitis
25
What can cause sialadenitis?
Viral, bacterial infections, sjogren syndrome, sarcoidosis, radiation, recent surgery, allergic reaction, obstruction of the salivary duct
26
What viral infection has been associated with sialadenitis?
Mumps (epidemic parotitis)
27
What virus causes mumps?
Paramyxovirus
28
What term describes non-inflammatory, asymptomatic salivary gland enlargement?
Sialadenosis
29
Where does sialadenosis usually occur?
In the parotid gland (hypertrophy of the acini)
30
What are some underlying endocrine disorders that are associated with sialadenosis?
Diabetes mellitus, hypothyroidism, pregnancy
31
What are some underlying malnutrtion disorders that are associated with sialadenosis?
General malnutrition, alcoholism, anorexia nervosa, bulimia
32
What is another underlying condition that is associated with sialadenosis?
Drugs (antihypertensive and psychotropic drugs)
33
What is the clinical presentation of sialadenosis?
Parotid swelling, slowly evolving, bilateral, and with or without pain
34
What term describes a localized, sessile painless swelling/mass that mimics a neoplasm?
Adenomatoid hyperplasia of the minor salivary glands
35
Where does adenomatoid hyperplasia of the minor salivary glands usually occur?
In minor glands (DUH), but on the hard or soft palate
36
What is the cause of adenomatoid hyperplasia of the minor salivary glands?
Unknown, possible trauma
37
How is adenomatoid hyperplasia treated?
Through biopsy to rule out neoplasm
38
What term describes a localized destructive inflammatory condition of the salivary glands?
Necrotizing sialometaplasia
39
What is believed to be the cause of necrotizing sialometaplasia?
Ischemia (either injecting too fast or the epinephrine)
40
What are some predisposing factors of necrotizing sialometaplasia?
Traumatic injuries, dental injections, ill fitting dentures, upper respiratory infections, adjacent tumors, previous surgery
41
What does necrotizing sialometaplasia usually occur?
On the palate, unilateral
42
What does necrotizing sialometaplasia clinically present as?
Non-ulcerated swelling, with pain and paresthesia
43
How long does it take for necrotizing sialometaplasia take to heal?
5-6 weeks
44
What does necrotizing sialometaplasia mimic?
Mimic malignancy clinically (except too acute onset) and histologically
45
How is necrotizing sialometaplasia treated?
It will heal on its own, but biopsy to rule out possible malignancy
46
What term describes swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands?
Cheilitis glandularis
47
What is the cause of cheilitis glandularis?
Unknown, but possibly due to sun damage, tobacco, syphilis, poor hygiene, hereditary
48
What is the clinical presentation of cheilitis glandularis?
Swelling, pain, eversion, red dots indicating duct orifices, weeping secretions
49
In what population is cheilitis glandularis more common?
Middle aged to older males
50
What is the treatment for cheilitis glandularis?
Usually nothing... however obtain biopsy if due to sun damage
51
What term describes excessive salivation?
Sialorrhea
52
What can cause sialorrhea?
Local irritiations, GERD, Rabies, heavy metal poisoning, medications, idiopathic, down syndrome, neurological disorders (ex cerebral palsy), teething
53
What is the treatment for sialorrhea?
Treat the underlying cause! Possibly use of anticholinergic medications (ex: scopolamine transdermal patch -- not for children) or surgery to relocate the salivary ducts to tonsillar fossa
54
What term describes dry mouth?
Xerostomia
55
How common is xerostomia?
About 25% of older adults have xerostomia
56
What are some complications from xerostomia?
Xerostomia changes the oral microflora so candidiasis, cervical and root caries, alteration of taste, fissured tongue
57
What are the common causes for xerostomia?
Medications, caffeine/alcohol, smoking, radiation therapy, sjogrens syndrome, diabetes mellitus, sarcoidosis, surgery of salivary glands
58
How can xerostomia be managed?
Elimination of alcohol, smoking, caffeine consumption; drug modification; sugarless candies or gum; oral lubricants; prescription sialogogues
59
What is a side effect of prescription sialogogues?
Restlessness, profuse sweating and tremors for the first couple days
60
How can xerostomia be tested/confirmed? How much saliva production is normal?
Normal salivary flow is 1 ml/min so test how much saliva is produced in 3 min. If it is 3 ml or less = xerostomia
THere are also pH tests, or simply noticing the patients mucosa sticks to dry gloves
61
What are some over the counter mouthwashes, toothpaste and gum for patients with xerostomia?
Biotene
Xerostom
Mighteaflow
62
What is sjogren's syndrome?
A chronic, systemic autoimmune disease that mainly affects salivary and lacrimal glands (dry mouth and dry eyes)
63
In what population is sjogrens syndrome more common?
80-90% female
64
What is sicca syndrome?
The clinical presentation of dry mouth and dry eyes -- keratoconjunctivitis sicca is the effect on the eyes
65
What is primary sjogrens syndrome?
When SS is not associated with any autoimmune diseases
66
What is secondary sjogrens syndrome?
When SS is associated with other autoimmune diseases
67
What is the most common autoimmune disease that sjogrens syndrome is associated with?
Rheumatoid arthritis
68
What are the diagnostic criteria for diagnosing primary sjogrens syndrome?
Patient has to present with 2 out of the 3:
1. Positive serological studies (antibodies)
2. Ocular staining score >/= 3
3. Presence of focal lymphocytic sialadenitis (focus score >1 in 4 mm2 of salivary gland)
69
What are the exclusion criteria for xerostomia diagnosis?
Past head and neck radiation tx, hepatitis C infection, AIDS, preexisting lymphoma, sarcoidosis, GVHD, use of anticholinergic drugs
70
What are some prescription sialogogues for treating xerostomia?
Pilocarpine (Salagen), Cevimeline (Evoxac)
71
What must be monitored for in paitents with xerostomia?
Monitor for lymphoma! Increased risk for lymphoma (40x)
72
What are the 2 most common forms of salivary gland neoplasms?
Smooth surfaced, dome shaped nodule
| Ulcerated mass lesion
73
Where can salivary gland neoplasma occur?
In major or minor salivary glands
74
What is the most common site for salivary gland neoplasms?
Parotid gland (70% of all cases) > minor glands (25%) . submandibular and sublingual (less tahn 1%)
75
Where is the most common site of a salivary gland neoplasm in MINOR salivary glands?
The palate
76
What is the % of benign and malignant salivary gland neoplasms in the major salivary glands?
All sites= 66B to 34M
Parotid = 70B : 30M
Submd= 60B : 40M
Subling= 30B ; 70M
77
What is the % of benign and malignant salivary gland neoplasms in minor salivary glands altogether?
Minor glands = 50B: 50M
78
What is the % of benign and malignant salivary gland neoplasms in the upper lip?
upper lip 80B - 20M
79
What is the % of benign and malignant salivary gland neoplasms in the lower lip?
lower lip 40B - 60 M
In the lower lip it is more likely to be a mucocele, but if it is a salivary glandneoplasm it is more likely to be malignant
80
What is the % of benign and malignant salivary gland neoplasms in the palate?
palate 50/50
81
What is the % of benign and malignant salivary gland neoplasms in the tongue?
tongue 15B - 85M
82
What is the % of benign and malignant salivary gland neoplasms in the cheek?
cheek 50/50
83
What is the % of benign and malignant salivary gland neoplasms in the retromolar pad?
Retromolar pad 10B-90M
Mostly malignant
84
What is the most common salivary gland neoplasm? What is the most common malignant neoplasm?
Pleomorphic adenoma
Mucoepidermoid carcinoma
85
What are the most common benign salivary gland neoplasms?
Canalicular adenoma, pleomorphic adenoma, warthin tumor, oncocytoma
86
What is another name for warthin tumor?
Papillary cystadenoma lymphomatosum
87
What the clinical presentation of canalicular adenoma?
Slow growing, painless mass, blue or normal color, may be multifocal
88
Where does canalicular adenoma usually occur?
The upper lip (75%) or buccal mucosa but it is EXCLUSIVELY IN MINOR SALIVARY GLANDS
89
How does age affect the diagnosis of canalicular adenoma (in the upper lip?) ?
Pleomorphic adenoma is found more commonly in the upper lip in patients who are younger than 50. >60= canalicular adenoma
90
What are the names of the 2 ocular tests to confirm Sjogrens syndrome?
Schirmer and Rosebangle tests
91
What is the most common salivary gland neoplasm?
Pleomorphic adenoma
92
What is another name for pleomorphic adenoma?
Benign mixed tumor
93
Where is the most common site of pleomorphic adenoma? What is the most common site in minor glands?
In parotid glands, then submandibular glands
For minor glands, the most common site is the palate, then the upper lip and buccal mucosa
94
What is the definition of a pleomorphic adenoma?
Mixture of ductal and myoepithelial cells
95
What are 2 characteristic features associated with pleomorphic adenoma?
Can grow to grotesque proportions, and the tumor is often encapsulated with a fibrous layer
96
What term describes a benign salivary gland tumor composed of large epithelial cells known as oncocytes?
Oncocytoma
97
What is another name for oncotyoma?
Oxyphilic adenoma
98
What is the second most common benign parotid tumor?
Warthin's tumor (Papillary cystadenoma lymphomatosum)
99
In what population is Warthin's tumor most prevalent?
60-70 males, who smoke!
100
What are the common malignant salivary neoplasms?
Mucoepidermoid carcinoma, acinic cell adenocarnicoma, adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, malignant mixed tumor
101
What is the most common malignant salivary gland neoplasm?
Mucoepidermoid carcinoma (in both adults and children)
102
Which gland is most commonly affected by mucoepidermoid carcinoma? What is the most common site for minor salivary glands?
The parotid gland, then minor glands.
The palate is the most common site for minor glands?
103
Treatment of mucoepidermoid carcinoma depends on what 3 things?
Location, histopathologic grade, and clinical stage
104
What is the expected survival in low grade mucoepidermoid carcinoma?
90-95% survival
105
What is the expected survival in high grade mucoepidermoid carcinoma?
30-54% survival
106
What salivary gland is associated with a poorer prognosis in mucoepidermoid carcinoma than the parotid gland?
The submandibular gland is associated with a poorer prognosis than in the parotid gland
107
What term describes ectopic salivary gland tissue that was developmentally entrapped within the bone of the jaw, and undergoes metaplasia into mucus cells?
Intraosseous (central) mucoepidermoid carcinoma
108
In what population is intraosseous mucoepidermoid carcinoma most common?
Middle aged adults
109
Where does intraosseous mucoepidermoid carcinoma usually occur?
Mandibular > maxilla, and in the molar ramus region
110
What is the prognosis for intraosseous mucoepidermoid carcinoma?
90% survival
111
What is the treatment of intraosseous mucoepidermoid carcinoma?
Surgical resection of bone
112
What are some other intaosseous salivary tumors?
Adenoid cystic carcinoma, benign and malignant mixed tumors, acinic cell adenocarcinoma, monomorphic adenoma
113
True of False: The tooth is usually devitalized in intraosseous mucoepidermoid carcinoma
False. the toot is usually vital and the patient may or may not have pain
114
What is the second most common malignant salivary gland neoplasm?
Acinic cell adenocarcinoma (in both adults and children)
115
What cells show differences in acinic cell adenocarcinoma?
Serous acinar differentation, so there is few ducts seen in the histology
116
What is the most common site of acinic cell adenocarcinoma?
Parotid > minor glands > submandibular gland
117
What is the prognosis and survival associated with acinic cell adenocarcinoma?
Good prognosis, 80-94% survival
118
What term describes a slow growing, widely infiltrative tumor that can cause pain and facial nerve paralysis?
Adenoid cystic carcinoma
119
What is the most common site of adenoid cystic carcinoma?
Minor glands of the palate, then parotid and submandibular glands
120
What is the most common malignant salivary gland tumor of the submandibular gland?
Adenoid cystic carcinoma
121
Why is adenoid cystic carcinoma associated with pain and facial nerve paralysis?
Grows around nerve! (perineural and intraneural growth)
122
What carcinoma
| has multiple cell types and can mimic the growth pattern of adenoid cystic carcinoma?
Polymorphous low grade adenocarcinoma
123
What is another name for polymorphous low grade adenocarcinoma?
Terminal duct carcinoma
124
Where does polymorphous low grade adenocarcinoma usually occur?
Almost exclusively in minor glands! So palate > upper lip and buccal mucosa
125
What are the 3 malignant mixed tumors?
Carcinoma ex pleomorphic adenoma, carcinosarcoma, metastasizing mized tumor
126
What is carcinoma ex pleomorphic adenoma?
Malignant transformation of the epithelial cells in a mass that has been present for many years
127
What is carcinosarcoma?
Tumor of bone and soft tissue (?)
128
What is a metastasizing mixed tumor?
Histologically benign pleomorphic adenoma in bone, lung, or lymph node (metastatic sites)
