Chapter 11 Flashcards
Describe the saliva composition of the submandibular, sublingual, and parotid glands
Sublingual - mucous
Submandibular - mostly serous with some mucous
Parotid - serous
Which salivary gland is more likely to have a mass (benign)? Why?
Parotid gland because it is a large gland with lymph nodes embedded in it.
Where in the oral cavity are minor salivary glands found? Where are they not found?
Found in hard palate, soft palate, labial and buccal mucosa, ventral tongue
Not found in anterior hard palate (rugae), attached gingiva, dorsal tongue
What is the definition of a neoplasm?
New growth with unlimited growing potential. Tumors and neoplasms aren’t necessarily the same things
What is a mucocele?
Spillage of mucin/saliva into the soft tissues due to rupture of a salivary gland duct, usually caused by trauma
What population are mucoceles most common in? Why?
Children and young adults because they are more prone to injury
What is the most common location for mucoceles?
Lower lip (83%)
Other common locations are the FOM, anterior ventral tongue, and buccal mucosa
Why is it important to remove the adjacent minor salivary gland when treating a mucocele?
So that the mucocele doesn’t reoccur
Clinical mucoceles of the upper lip are more likely to be a ___ than an actual mucocele.
Salivary gland tumor
Mucoceles of the retromolar region are distinctly unusual. Most clinical mucoceles in this region will prove to be _____
Mucoepidermoid carcinoma
What is a mucocele in the FOM called?
A ranula
Where are ranulas found? They are associate with the rupture of the ____ duct.
FOM
Lateral to midline
Sublingual gland duct
You can treat ranulas by surgical excision or marsupialization. What is marsupialization?
Removal of the roof of the intraoral lesion
Why are ranulas a serious medical concern?
They can get big enough that it could go through the mylohyoid muscle and elevate the tongue and obstruct the airway
What is a mucus extravasation phenomenon called?
A mucocele
What is another name for a salivary duct cyst?
Mucus retention cyst
True or false… salivary duct cysts are most commonly found in children
False. Occurs mostly in adults
What is a salivary duct cyst?
An epithelium-lined cavity that arises from saliavary gland tissue
What is a plunging ranula?
Spilled mucin dissects through the mylohyoid and is dangerous
Where are salivary duct cysts typically found?
Usually in the parotid gland but also common in FOM, buccal mucosa, lips
may be in any major or minor salivary glands
If you find a mass on the hard palate, what should you assume it is?
A mass on the hard palate is considered a neoplasm until proven otherwise
What is the coloring of a salivary duct cyst?
Bluish (may be normal or yellowish)
Soft fluctuatant swelling
What is the treatment of a salivary duct cyst?
Surgical excision
What are sialoliths?
Salivary stones
These are calcifications that develop in salivary ducts
Where is the most common location for sialoliths? Why?
Submandibular gland because it has a long and tortuous duct with thick secretions
May also be found in the upper lip and buccal mucosa
What are the symptoms of a sialolith?
Pain or swelling especially at meal time
You can diagnose it by radiographs, sialography, ultrasound, CT
What is the treatment for a sialolith?
Gentle massage, increase fluid intake, moist heat, sialogogue, surgery
What are some things that slows or inhibits salivary flow through the duct system which may predispose to development of stones?
Mucous plug
Bacterial colonies
Chronic duct blockage phenomena
Normal ductal anatomy (Wharton’s duct (submandibular duct)
Xerostomia (typically are not associated with elevated serum calcium levels)
What is another name for mumps?
Epidemic parotitis
Mumps is caused by a ___ infection primarily affecting the salivary glands. Some complications associated with mumps are ___, ___, and ___.
Paramyxovirus
Epididymoorchitis (swollen testes)
Oophoritis
Mastitis
Diagnosis is based on clinical findings, viral culture, serological tests
What are anesthesia mumps? How long does it take for this to spontaneously resolve?
Rare complication after general anesthesia (due to allergic reaction)
Swelling of parotid or submandiublar glands after surger
Spontaneously resolves in hours to a few days
What is sialadenosis? (Sialosis)
Non inflammatory asymptomatic* salivary gland enlargement
Where does sialadenosis typically occur?
Parotid gland. Hypertrophic of acini
What are some underlying systemic conditions that could lead to sialadenosis?
Endocrine disorders: diabetes*, hypothyroidism, pregnancy
Malnutrition: general malnutrition, alcoholism, anorexia, bulimia
Drugs: anti-hypertensive drugs, psychotropic drugs
What is the clinical presentation of sialenosis?
Parotid swelling
Usually slowly evolving
Usually bilateral
could have pain
What is adenomatoid hyperplasia of the minor salivary glands?
Minor glands, often on hard or soft palate.. localized sessile painless swelling that mimics a neoplasm.
Pathogenesis is unknown but possibly due to trauma
Hyperplasia of normal gland
**remember that you must biopsy to rule out neoplasm because swelling on the hard palate is considered a neoplasm until proven otherwise.
What is necrotizing sialometaplasia? What is it caused by?
Locally destructive inflammatory condition of the salivary glands
Due to ischemia
Some factors that can cause ischemia are traumatic injuries, dental injections (too fast too close to bone), ill-fitting dentures, upper respiratory infections, adjacent tumors, previous surgery
Where does necrotizing sialometaplasia typically occur?
Palate. Unilateral
Necrotizing sialometaplasia is a non-ulcerated swelling, pain and paraesthesia leading to necrotic tissue sloughs out, ulcer heals in __-__ weeks
5-6 weeks
You must biopsy necrotizing sialometaplasia to rule out ___
Malignancy.
It mimics malignancy clinically (except too acute onset) and histologically
What is sialadenitis?
Inflammation of the salivary glands
What are the infectious and non infectious causes of sialadenitis?
Infection: mumps (viral). Bacterial
Non-infectious: sjogren syndrome. Sarcoidosis, radiation induced, recent surgery, allergic reaction, obstruction of the salivary duct.
What is chelitus glandularis?
Swelling and version of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands
Although the cause of chelitus glandularis is unknown, what.are some possible causes?
Sun damage, tobacco, syphilis, poor hygiene, heredity
What is the clinical presentation of cheilitis glandularis
Swelling and pain, typically lower lip
Eversion of the lip
Red dots indicate duct orifices
Weeping mucopurulent secretions often are seen
What population is cheilitis glandularis most commonly found in?
Middle aged to older males
What does the histology of cheilitis glandularis look like?
Chronic sialentitis and ductal dialation
Cheilitis glanduaris can sometimes look like ___. It is important to determine which it is because ___ may be ___.
Actinic chelosis
Actinic chelosis may be premalignant
(Cheilitis glandularis still has a well defined vermillion border)
What is sialorrhea?
Excess salivation
What are some things that can cause sialorrhea?
Local irritations (apthous ulcers, ill fitting dentures)
GERD
Rabies, heavy metal poisoning (hat makers and wood words are prone to metal poisoning)
Medications
Idiopathic paroxysmal sialorrhea
Drooling
What are some things that can cause drooling (leading to sialorrhea), why?
Down syndrome (macroglossia)
Neurological disorder (cerebral palsy)
What is the treatment of sialorrhea?
Treat the underlying cause
Anticholinergic medications, scopolamine transdermal patch (not for children)
Surgery: relocation of the salivary ducts to tonsillar fossa, tympanic neurectomy
How common is xerostomia?
Xerostomia is subjective sensation of a dry mouth common in 25% of older adults
What are 3 complications with xerostomia?
Candidiasis (due to changes in oral microflora)
Prone to cervical and root caries
Alteration of taste
What are some common causes for xerostomia?
Medications
Caffeine/alcohol
Smoking
Radiation therapy to head and neck
Sjögren’s syndrome
Diabetes mellitus
Sarcoidosis (noncaeseating granulamouts inflammation)
Surgery of salivary glands
How do you manage xerostomia?
Elimination of alcohol, smoking, caffeine
Drug modification, if possible. (Sleep aids are really bad about causing xerostomia
Sugarless gum/candies
Oral lubricants (mouthwash, biotene, spray)
What does xerostomia look like intraorally?
Fissured tongue
With dry glove, wipe hard palate, it will stick
Prone to angular cheilitis
Rampant caries
What is another name for Sjögren’s syndrome (if they also have dry eyes)?
Sicca syndrome
SS mainly affects what population?
Women
What is the difference between primary and secondary SS?
Primary SS - no other autoimmune disease
Secondary SS - associated with other autoimmune diseases (rheumatoid arthritis)
In order to be diagnosed with SS, you must have 2 out of the 3 criteria. What are the three criteria?
Positive serum anti-SSA or and SSB
Ocular staining score of 3 or greater. (Sum of fluorescein staining of cornea 0-6 and lissamine green staining of both nasal and temporal bulbar conjunctiva (0-3)
Presence of focal lymphocytic sialadenitis with a focus score of one or greater/4mm^2 in labial salivary gland biopsy samples
What are the exclusion criteria for SS?
Past head and neck radiation treatment
Hep. C infection
AIDS
Preexisting lymphoma
Sarcoidosis
Graft vs. host disease
Use of anticholinergic drugs
A lymphocytic focus has at least how many lymphocytes?
50 or more lymphocytes
What is the treatment for SS?
Management of xerostomia.. which includes.. sugarless gum, dry mouth products, sialogauges, emphasize oral hygiene, monitor lymphoma
Name two sialogauges used to treat SS?
Pilocarpine (salagen)
Cevimeline (evoxac)
Patients with SS are ___ times more likely for a certain type of lymphoma called ___
40 times
MALT lymphoma (marginal zone lymphoma)
What does a salivary neoplasm look like?
Smooth surfaced
Dome shaped
Non-ulcerated
What is the incidence of salivary neoplasms?
4/100,000 people
Where are the most common locations for salivary neoplasms? Give the percentage of incidence for each location.
Parotid gland (70%)
Minor glands (25%)
Submandibular (~5%)
Sublingual (<1%)
Sublingual neoplasms have the highest likelihood of being malignant. What percentage of sublingual neoplasms are malignant?
70-90%
What is the most common site for minor salivary gland neoplasms? What percentage of minor salivary gland neoplasms occur here?
Palate
50% especially on the lateral hard or soft palate*
What percent of all major salivary gland neoplasms are benign, what percent is malignant?
Benign 66%
Malignant 34%
What percentage of parotid salivary gland neoplasms are benign, what percent are malignant?
Benign - 70%
Malignant - 30%
What percentage of submandibular gland neoplasms are benign, what percent are malignant?
Benign - 60%
Malignant - 40%
What percentage of sublingual neoplasms are benign, what percent are malignant?
Benign - 30%
Malignant - 70%
What percentage of minor salivary glands are malignant for the following locations…
All minor glands Upper lip Lower lip Palate Tongue Cheek Retromolar pad
Malignant…
All minor glands - 50% Retromolar pad - 90% Tongue - 85% Lower lip - 60% Cheek - 50% Palate - 50% Upper lip - 20%
Salivary gland neoplasms are more common in the ___ lip than the __ lip
More common in upper lip than lower lip
Upper lip neoplasms are mostly __ whereas lower lip neoplasms are mostly ___
Benign
Malignant
What percentage of neoplasms in the retromolar area are malignant?
90%
What s the most common neoplasm?
Pleomorphic adenoma (benign)
What is the most common malignant neoplasm?
Mucoepidermoid carcinoma
Name four different benign salivary gland neoplasms
Canalicular adenoma
Pleomorphic adenoma
Warthin tumor (papillary cystadenoma lymphomatosum)
Oncoctyoma
What is another name for a warthin tumor?
Papillary cystadenoma lymphomatosum
What is a canalicula adenoma?
A type of monomorphic adenoma
It is slow growing, painless mass, blue or normal color, may be multifocal
Where do canlicular adenoma typically occur?
Exclusively in minor salivary glands of the upper lip (75%) and buccal mucosa
Only a ___ is found more commonly in the upper lip than a canalicular adenoma
Pleomorphic adenoma
If you find a neoplasm in the upper lip. It is likely a pleomorphic adenoma if the patient is of the age ___. It is likely a canalicular adenoma if the patient is of the age ___.
<50
> 60
Canalicular adenomas are found in older age groups (7th decade peak), with a slight female predominance
What is another name for a pleomorphic adenoma?
Benign mixed tumor
*note that this is the most common salivary neoplasm
~60% of parotid tumors (superficial lobe), and ~55% of submandibular tumors are what kind of neoplasm?
Pleomorphic adenoma
What kinds of cells are pleomorphic adenomas made out of?
Mixture of ductal and myoepithelial cells
Remarkable microscopic diversity accounts for the name
Name, in order, the most common sites for minor gland pleomorphic adenomas.
Palate
Upper lip
Buccal mucosa
True or false.. pleomorphic adenomas can grow to grotesque proportions if untreated.
True
Which salivary neoplasm is encapsulated? How is it encapsulated?
Pleomorphic adenomas are encapsulated.
They are well-circumscribed and have a firm fibrous tissue lining. This allows you to basically peel the growth out.
Which tumor is a benign tumor of oncocytes?
Oncocytoma
What is an oncocyte?
Cell that went through metaplastic processes that made mitochondria fill up the cell.
What is the second most common benign parotid tumor?
Warthin’s tumor (papillary cystadenoma lymphomatosum)
These occur almost exclusively in the parotid gland and may be bilateral
What population is warthin’s tumor predominately found in?
Older men
Smokers
Smokers have a __ times greater risk of developing a warthin’s tumor
8
While a pleomorphic adenoma is typically found in the superior tail of the parotid gland, where are warthin’s tumors typically found?
Posterior inferior tail of the parotid
Name 5 malignant salivary neoplasms
Mucoepidermoid carcinoma
Acinic cell adenocarcinoma
Adenoid cystic carcinoma
Polymorphous low-grade adenocarcinoma
Malignant mixed tumor
What is the most common malignant salivary neoplasm?
Mucoepidermoid carcinoma
Where is the most common location for mucoepidermoid carcinomas?
Parotid gland
They most common is minor glands (remember that the palate is the most common minor gland neoplasm site)
True or false… benign tumors are typically unuclerative while malignant tumors are ulcerative
True
True or false… prognosis of mucoepidermoid carcinoma solely depends on the clinical stage.
False. It depends on the histopathologic grade and clinical stage
True or false… mucoepidermoid carcinoma has a better prognosis in the submandibular gland the parotid gland.
False… the submandibular gland tumors are associated with a poorer prognosis than in the parotid gland
What is the pathogenesis of intraosseous mucoepidermoid carcinoma?
Ectopic salivary gland tissue that was developmentally entrapped within the jaw
Odontogenic epithelium, mucous metaplasia
Where are the most common locations of intraosseous mucoepidermoid carcinoma in middle aged adults?
Mandible>maxilla>molar-ramus region
True or false… intraosseous mucoepidermoid carcinoma has a survival rate of 90%
True
What is an acinic cell adenocarcinoma?
Low-grade malignant neoplasm showing serous acinar differentiation
Slow growing mass with pain
Where are the most common locations for acinic cell adenocarcinoma?
Parotid gland (85% of cases) > minor glands > submandibular
What is the second most common malignant neoplasm?
Acinic cell adenocarcinoma
What is the local recurrence, metastasis, and survival rate of acinic cell adenocarcinoma?
Local recurrence: 1/3
Metastasis: 10-15%
Survival: 80-94%
What is the most common malignant salivary gland tumor of the submandibular gland?
Adenoid cyst carcinoma
True or false.. adenoid cystic carcinomas are more commonly found in minor glands than in the parotid gland or submandibular glands
True
Which tumor is slow-growing, widely infiltrative, has a tendency for perineural spread, surrounds nerves to cause pain and facial nerve paralysis, and most commonly affects middle aged adults?
Adenoid cystic carcinoma
Which salivar gland tumor almost exclusively occurs in minor glands, and is found in older adults, and exhibits different growth patterns histologically?
Polymorphous low-grade adenocarcinoma (terminal duct carcinoma)
What is another name for a malignant mixed tumor?
Carcinoma ex pleomorphic adenoma
Malignant mixed tumors are most commonly found in ___ glands
Major glands.
Malignant mixed tumors result from malignant transformation of the ___ cells. Mass presents for many years but a recent rapid growth with pain and/or ___
Epithelial cells
Ulceration
What is a carcinosarcoma?
A type of malignant mixed tumor. It has carcinomatous and sarcomatous components. (Epithelial and mesenchymal components)
