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Oral Pathology - My deck > Chapter 11 > Flashcards

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

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2
Q

A mucocele is considered what type of salivary gland condition?

A

Non-neoplastic condition

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3
Q

What causes mucoceles?

A

Usually trauma such as falling or braces

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4
Q

Where are mucoceles most common?

A

In the lower lip (81%). Other sites include the FOM, anterior ventral tongue and buccal mucosa

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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

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6
Q

Clinical mucoceles located on the upper lip are more likely to be ____ ____ _____.

A

Salivary gland tumor (salivary gland tumor)

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7
Q

Clinical mucoceles of the retromolar region are unusual and are more likely to be __________ ______.

A

Mucoepidermoid carcinoma (salivary gland neoplasm)

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8
Q

What term describes a large, lateral mucocele in the FOM?

A

Ranula

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9
Q

What salivary gland/duct is usually involved in a ranula?

A

Sublingual gland

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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

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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)

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12
Q

What term describes a epithelium lined cavity that arises from salivary gland tissue?

A

Salivary duct cyst

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13
Q

What is another name for a salivary duct cyst?

A

Mucus retention cyst

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14
Q

In what age population are salivary duct cysts more common?

A

They occur mostly in adults

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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

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16
Q

What is the clinical presentation of a salivary duct cyst?

A

Bluish, soft fluctuant swelling

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17
Q

What term describes a calcification developed in a salivary duct?

A

Sialolith, sialolithiasis

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18
Q

Where do sialoliths often occur?

A

In submandibular glands, upper lip, buccal mucosa

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19
Q

Why do sialoliths often occur in submandibular glands?

A

Because the submandibular glands have long, tortuous ducts with thick secretions

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20
Q

What are some signs of a sialolith?

A

Pain or swelling, especially at meal times

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21
Q

How can sialolith diagnosis be confirmed?

A

Through radiographs, sialography, ultrasounds, CT, palpation

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22
Q

How is a sialolith treated?

A

Gentle massage, increase fluid intake, moist heat, sialogogue, surgery – suck on candies to “wash out”

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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

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24
Q

What is the term for salivary gland inflammation?

A

Sialadenitis

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25
Q

What can cause sialadenitis?

A

Viral, bacterial infections, sjogren syndrome, sarcoidosis, radiation, recent surgery, allergic reaction, obstruction of the salivary duct

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26
Q

What viral infection has been associated with sialadenitis?

A

Mumps (epidemic parotitis)

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27
Q

What virus causes mumps?

A

Paramyxovirus

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28
Q

What term describes non-inflammatory, asymptomatic salivary gland enlargement?

A

Sialadenosis

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29
Q

Where does sialadenosis usually occur?

A

In the parotid gland (hypertrophy of the acini)

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30
Q

What are some underlying endocrine disorders that are associated with sialadenosis?

A

Diabetes mellitus, hypothyroidism, pregnancy

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31
Q

What are some underlying malnutrtion disorders that are associated with sialadenosis?

A

General malnutrition, alcoholism, anorexia nervosa, bulimia

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32
Q

What is another underlying condition that is associated with sialadenosis?

A

Drugs (antihypertensive and psychotropic drugs)

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33
Q

What is the clinical presentation of sialadenosis?

A

Parotid swelling, slowly evolving, bilateral, and with or without pain

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34
Q

What term describes a localized, sessile painless swelling/mass that mimics a neoplasm?

A

Adenomatoid hyperplasia of the minor salivary glands

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35
Q

Where does adenomatoid hyperplasia of the minor salivary glands usually occur?

A

In minor glands (DUH), but on the hard or soft palate

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36
Q

What is the cause of adenomatoid hyperplasia of the minor salivary glands?

A

Unknown, possible trauma

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37
Q

How is adenomatoid hyperplasia treated?

A

Through biopsy to rule out neoplasm

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38
Q

What term describes a localized destructive inflammatory condition of the salivary glands?

A

Necrotizing sialometaplasia

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39
Q

What is believed to be the cause of necrotizing sialometaplasia?

A

Ischemia (either injecting too fast or the epinephrine)

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40
Q

What are some predisposing factors of necrotizing sialometaplasia?

A

Traumatic injuries, dental injections, ill fitting dentures, upper respiratory infections, adjacent tumors, previous surgery

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41
Q

What does necrotizing sialometaplasia usually occur?

A

On the palate, unilateral

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42
Q

What does necrotizing sialometaplasia clinically present as?

A

Non-ulcerated swelling, with pain and paresthesia

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43
Q

How long does it take for necrotizing sialometaplasia take to heal?

A

5-6 weeks

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44
Q

What does necrotizing sialometaplasia mimic?

A

Mimic malignancy clinically (except too acute onset) and histologically

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45
Q

How is necrotizing sialometaplasia treated?

A

It will heal on its own, but biopsy to rule out possible malignancy

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46
Q

What term describes swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands?

A

Cheilitis glandularis

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47
Q

What is the cause of cheilitis glandularis?

A

Unknown, but possibly due to sun damage, tobacco, syphilis, poor hygiene, hereditary

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48
Q

What is the clinical presentation of cheilitis glandularis?

A

Swelling, pain, eversion, red dots indicating duct orifices, weeping secretions

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49
Q

In what population is cheilitis glandularis more common?

A

Middle aged to older males

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50
Q

What is the treatment for cheilitis glandularis?

A

Usually nothing… however obtain biopsy if due to sun damage

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51
Q

What term describes excessive salivation?

A

Sialorrhea

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52
Q

What can cause sialorrhea?

A

Local irritiations, GERD, Rabies, heavy metal poisoning, medications, idiopathic, down syndrome, neurological disorders (ex cerebral palsy), teething

53
Q

What is the treatment for sialorrhea?

A

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
Q

What term describes dry mouth?

A

Xerostomia

55
Q

How common is xerostomia?

A

About 25% of older adults have xerostomia

56
Q

What are some complications from xerostomia?

A

Xerostomia changes the oral microflora so candidiasis, cervical and root caries, alteration of taste, fissured tongue

57
Q

What are the common causes for xerostomia?

A

Medications, caffeine/alcohol, smoking, radiation therapy, sjogrens syndrome, diabetes mellitus, sarcoidosis, surgery of salivary glands

58
Q

How can xerostomia be managed?

A

Elimination of alcohol, smoking, caffeine consumption; drug modification; sugarless candies or gum; oral lubricants; prescription sialogogues

59
Q

What is a side effect of prescription sialogogues?

A

Restlessness, profuse sweating and tremors for the first couple days

60
Q

How can xerostomia be tested/confirmed? How much saliva production is normal?

A

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
Q

What are some over the counter mouthwashes, toothpaste and gum for patients with xerostomia?

A

Biotene
Xerostom
Mighteaflow

62
Q

What is sjogren’s syndrome?

A

A chronic, systemic autoimmune disease that mainly affects salivary and lacrimal glands (dry mouth and dry eyes)

63
Q

In what population is sjogrens syndrome more common?

A

80-90% female

64
Q

What is sicca syndrome?

A

The clinical presentation of dry mouth and dry eyes – keratoconjunctivitis sicca is the effect on the eyes

65
Q

What is primary sjogrens syndrome?

A

When SS is not associated with any autoimmune diseases

66
Q

What is secondary sjogrens syndrome?

A

When SS is associated with other autoimmune diseases

67
Q

What is the most common autoimmune disease that sjogrens syndrome is associated with?

A

Rheumatoid arthritis

68
Q

What are the diagnostic criteria for diagnosing primary sjogrens syndrome?

A

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
Q

What are the exclusion criteria for xerostomia diagnosis?

A

Past head and neck radiation tx, hepatitis C infection, AIDS, preexisting lymphoma, sarcoidosis, GVHD, use of anticholinergic drugs

70
Q

What are some prescription sialogogues for treating xerostomia?

A

Pilocarpine (Salagen), Cevimeline (Evoxac)

71
Q

What must be monitored for in paitents with xerostomia?

A

Monitor for lymphoma! Increased risk for lymphoma (40x)

72
Q

What are the 2 most common forms of salivary gland neoplasms?

A

Smooth surfaced, dome shaped nodule

Ulcerated mass lesion

73
Q

Where can salivary gland neoplasma occur?

A

In major or minor salivary glands

74
Q

What is the most common site for salivary gland neoplasms?

A

Parotid gland (70% of all cases) > minor glands (25%) . submandibular and sublingual (less tahn 1%)

75
Q

Where is the most common site of a salivary gland neoplasm in MINOR salivary glands?

A

The palate

76
Q

What is the % of benign and malignant salivary gland neoplasms in the major salivary glands?

A

All sites= 66B to 34M
Parotid = 70B : 30M
Submd= 60B : 40M
Subling= 30B ; 70M

77
Q

What is the % of benign and malignant salivary gland neoplasms in minor salivary glands altogether?

A

Minor glands = 50B: 50M

78
Q

What is the % of benign and malignant salivary gland neoplasms in the upper lip?

A

upper lip 80B - 20M

79
Q

What is the % of benign and malignant salivary gland neoplasms in the lower lip?

A

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
Q

What is the % of benign and malignant salivary gland neoplasms in the palate?

A

palate 50/50

81
Q

What is the % of benign and malignant salivary gland neoplasms in the tongue?

A

tongue 15B - 85M

82
Q

What is the % of benign and malignant salivary gland neoplasms in the cheek?

A

cheek 50/50

83
Q

What is the % of benign and malignant salivary gland neoplasms in the retromolar pad?

A

Retromolar pad 10B-90M

Mostly malignant

84
Q

What is the most common salivary gland neoplasm? What is the most common malignant neoplasm?

A

Pleomorphic adenoma

Mucoepidermoid carcinoma

85
Q

What are the most common benign salivary gland neoplasms?

A

Canalicular adenoma, pleomorphic adenoma, warthin tumor, oncocytoma

86
Q

What is another name for warthin tumor?

A

Papillary cystadenoma lymphomatosum

87
Q

What the clinical presentation of canalicular adenoma?

A

Slow growing, painless mass, blue or normal color, may be multifocal

88
Q

Where does canalicular adenoma usually occur?

A

The upper lip (75%) or buccal mucosa but it is EXCLUSIVELY IN MINOR SALIVARY GLANDS

89
Q

How does age affect the diagnosis of canalicular adenoma (in the upper lip?) ?

A

Pleomorphic adenoma is found more commonly in the upper lip in patients who are younger than 50. >60= canalicular adenoma

90
Q

What are the names of the 2 ocular tests to confirm Sjogrens syndrome?

A

Schirmer and Rosebangle tests

91
Q

What is the most common salivary gland neoplasm?

A

Pleomorphic adenoma

92
Q

What is another name for pleomorphic adenoma?

A

Benign mixed tumor

93
Q

Where is the most common site of pleomorphic adenoma? What is the most common site in minor glands?

A

In parotid glands, then submandibular glands

For minor glands, the most common site is the palate, then the upper lip and buccal mucosa

94
Q

What is the definition of a pleomorphic adenoma?

A

Mixture of ductal and myoepithelial cells

95
Q

What are 2 characteristic features associated with pleomorphic adenoma?

A

Can grow to grotesque proportions, and the tumor is often encapsulated with a fibrous layer

96
Q

What term describes a benign salivary gland tumor composed of large epithelial cells known as oncocytes?

A

Oncocytoma

97
Q

What is another name for oncotyoma?

A

Oxyphilic adenoma

98
Q

What is the second most common benign parotid tumor?

A

Warthin’s tumor (Papillary cystadenoma lymphomatosum)

99
Q

In what population is Warthin’s tumor most prevalent?

A

60-70 males, who smoke!

100
Q

What are the common malignant salivary neoplasms?

A

Mucoepidermoid carcinoma, acinic cell adenocarnicoma, adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, malignant mixed tumor

101
Q

What is the most common malignant salivary gland neoplasm?

A

Mucoepidermoid carcinoma (in both adults and children)

102
Q

Which gland is most commonly affected by mucoepidermoid carcinoma? What is the most common site for minor salivary glands?

A

The parotid gland, then minor glands.

The palate is the most common site for minor glands?

103
Q

Treatment of mucoepidermoid carcinoma depends on what 3 things?

A

Location, histopathologic grade, and clinical stage

104
Q

What is the expected survival in low grade mucoepidermoid carcinoma?

A

90-95% survival

105
Q

What is the expected survival in high grade mucoepidermoid carcinoma?

A

30-54% survival

106
Q

What salivary gland is associated with a poorer prognosis in mucoepidermoid carcinoma than the parotid gland?

A

The submandibular gland is associated with a poorer prognosis than in the parotid gland

107
Q

What term describes ectopic salivary gland tissue that was developmentally entrapped within the bone of the jaw, and undergoes metaplasia into mucus cells?

A

Intraosseous (central) mucoepidermoid carcinoma

108
Q

In what population is intraosseous mucoepidermoid carcinoma most common?

A

Middle aged adults

109
Q

Where does intraosseous mucoepidermoid carcinoma usually occur?

A

Mandibular > maxilla, and in the molar ramus region

110
Q

What is the prognosis for intraosseous mucoepidermoid carcinoma?

A

90% survival

111
Q

What is the treatment of intraosseous mucoepidermoid carcinoma?

A

Surgical resection of bone

112
Q

What are some other intaosseous salivary tumors?

A

Adenoid cystic carcinoma, benign and malignant mixed tumors, acinic cell adenocarcinoma, monomorphic adenoma

113
Q

True of False: The tooth is usually devitalized in intraosseous mucoepidermoid carcinoma

A

False. the toot is usually vital and the patient may or may not have pain

114
Q

What is the second most common malignant salivary gland neoplasm?

A

Acinic cell adenocarcinoma (in both adults and children)

115
Q

What cells show differences in acinic cell adenocarcinoma?

A

Serous acinar differentation, so there is few ducts seen in the histology

116
Q

What is the most common site of acinic cell adenocarcinoma?

A

Parotid > minor glands > submandibular gland

117
Q

What is the prognosis and survival associated with acinic cell adenocarcinoma?

A

Good prognosis, 80-94% survival

118
Q

What term describes a slow growing, widely infiltrative tumor that can cause pain and facial nerve paralysis?

A

Adenoid cystic carcinoma

119
Q

What is the most common site of adenoid cystic carcinoma?

A

Minor glands of the palate, then parotid and submandibular glands

120
Q

What is the most common malignant salivary gland tumor of the submandibular gland?

A

Adenoid cystic carcinoma

121
Q

Why is adenoid cystic carcinoma associated with pain and facial nerve paralysis?

A

Grows around nerve! (perineural and intraneural growth)

122
Q

What carcinoma

has multiple cell types and can mimic the growth pattern of adenoid cystic carcinoma?

A

Polymorphous low grade adenocarcinoma

123
Q

What is another name for polymorphous low grade adenocarcinoma?

A

Terminal duct carcinoma

124
Q

Where does polymorphous low grade adenocarcinoma usually occur?

A

Almost exclusively in minor glands! So palate > upper lip and buccal mucosa

125
Q

What are the 3 malignant mixed tumors?

A

Carcinoma ex pleomorphic adenoma, carcinosarcoma, metastasizing mized tumor

126
Q

What is carcinoma ex pleomorphic adenoma?

A

Malignant transformation of the epithelial cells in a mass that has been present for many years

127
Q

What is carcinosarcoma?

A

Tumor of bone and soft tissue (?)

128
Q

What is a metastasizing mixed tumor?

A

Histologically benign pleomorphic adenoma in bone, lung, or lymph node (metastatic sites)

Oral Pathology - My deck (22 decks)

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