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Oral Path 2 > Chapter 11 > Flashcards

Chapter 11 Flashcards

1
Q

Describe the saliva composition of the submandibular, sublingual, and parotid glands

A

Sublingual - mucous

Submandibular - mostly serous with some mucous

Parotid - serous

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2
Q

Which salivary gland is more likely to have a mass (benign)? Why?

A

Parotid gland because it is a large gland with lymph nodes embedded in it.

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3
Q

Where in the oral cavity are minor salivary glands found? Where are they not found?

A

Found in hard palate, soft palate, labial and buccal mucosa, ventral tongue

Not found in anterior hard palate (rugae), attached gingiva, dorsal tongue

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4
Q

What is the definition of a neoplasm?

A

New growth with unlimited growing potential. Tumors and neoplasms aren’t necessarily the same things

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5
Q

What is a mucocele?

A

Spillage of mucin/saliva into the soft tissues due to rupture of a salivary gland duct, usually caused by trauma

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6
Q

What population are mucoceles most common in? Why?

A

Children and young adults because they are more prone to injury

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7
Q

What is the most common location for mucoceles?

A

Lower lip (83%)

Other common locations are the FOM, anterior ventral tongue, and buccal mucosa

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8
Q

Why is it important to remove the adjacent minor salivary gland when treating a mucocele?

A

So that the mucocele doesn’t reoccur

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9
Q

Clinical mucoceles of the upper lip are more likely to be a ___ than an actual mucocele.

A

Salivary gland tumor

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10
Q

Mucoceles of the retromolar region are distinctly unusual. Most clinical mucoceles in this region will prove to be _____

A

Mucoepidermoid carcinoma

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11
Q

What is a mucocele in the FOM called?

A

A ranula

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12
Q

Where are ranulas found? They are associate with the rupture of the ____ duct.

A

FOM

Lateral to midline

Sublingual gland duct

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13
Q

You can treat ranulas by surgical excision or marsupialization. What is marsupialization?

A

Removal of the roof of the intraoral lesion

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14
Q

Why are ranulas a serious medical concern?

A

They can get big enough that it could go through the mylohyoid muscle and elevate the tongue and obstruct the airway

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15
Q

What is a mucus extravasation phenomenon called?

A

A mucocele

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16
Q

What is another name for a salivary duct cyst?

A

Mucus retention cyst

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17
Q

True or false… salivary duct cysts are most commonly found in children

A

False. Occurs mostly in adults

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18
Q

What is a salivary duct cyst?

A

An epithelium-lined cavity that arises from saliavary gland tissue

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19
Q

What is a plunging ranula?

A

Spilled mucin dissects through the mylohyoid and is dangerous

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20
Q

Where are salivary duct cysts typically found?

A

Usually in the parotid gland but also common in FOM, buccal mucosa, lips

may be in any major or minor salivary glands

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21
Q

If you find a mass on the hard palate, what should you assume it is?

A

A mass on the hard palate is considered a neoplasm until proven otherwise

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22
Q

What is the coloring of a salivary duct cyst?

A

Bluish (may be normal or yellowish)

Soft fluctuatant swelling

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23
Q

What is the treatment of a salivary duct cyst?

A

Surgical excision

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24
Q

What are sialoliths?

A

Salivary stones

These are calcifications that develop in salivary ducts

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25
Q

Where is the most common location for sialoliths? Why?

A

Submandibular gland because it has a long and tortuous duct with thick secretions

May also be found in the upper lip and buccal mucosa

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26
Q

What are the symptoms of a sialolith?

A

Pain or swelling especially at meal time

You can diagnose it by radiographs, sialography, ultrasound, CT

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27
Q

What is the treatment for a sialolith?

A

Gentle massage, increase fluid intake, moist heat, sialogogue, surgery

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28
Q

What are some things that slows or inhibits salivary flow through the duct system which may predispose to development of stones?

A

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)

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29
Q

What is another name for mumps?

A

Epidemic parotitis

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30
Q

Mumps is caused by a ___ infection primarily affecting the salivary glands. Some complications associated with mumps are ___, ___, and ___.

A

Paramyxovirus

Epididymoorchitis (swollen testes)

Oophoritis

Mastitis

Diagnosis is based on clinical findings, viral culture, serological tests

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31
Q

What are anesthesia mumps? How long does it take for this to spontaneously resolve?

A

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

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32
Q

What is sialadenosis? (Sialosis)

A

Non inflammatory asymptomatic* salivary gland enlargement

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33
Q

Where does sialadenosis typically occur?

A

Parotid gland. Hypertrophic of acini

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34
Q

What are some underlying systemic conditions that could lead to sialadenosis?

A

Endocrine disorders: diabetes*, hypothyroidism, pregnancy

Malnutrition: general malnutrition, alcoholism, anorexia, bulimia

Drugs: anti-hypertensive drugs, psychotropic drugs

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35
Q

What is the clinical presentation of sialenosis?

A

Parotid swelling

Usually slowly evolving

Usually bilateral

could have pain

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36
Q

What is adenomatoid hyperplasia of the minor salivary glands?

A

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.

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37
Q

What is necrotizing sialometaplasia? What is it caused by?

A

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

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38
Q

Where does necrotizing sialometaplasia typically occur?

A

Palate. Unilateral

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39
Q

Necrotizing sialometaplasia is a non-ulcerated swelling, pain and paraesthesia leading to necrotic tissue sloughs out, ulcer heals in __-__ weeks

A

5-6 weeks

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40
Q

You must biopsy necrotizing sialometaplasia to rule out ___

A

Malignancy.

It mimics malignancy clinically (except too acute onset) and histologically

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41
Q

What is sialadenitis?

A

Inflammation of the salivary glands

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42
Q

What are the infectious and non infectious causes of sialadenitis?

A

Infection: mumps (viral). Bacterial

Non-infectious: sjogren syndrome. Sarcoidosis, radiation induced, recent surgery, allergic reaction, obstruction of the salivary duct.

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43
Q

What is chelitus glandularis?

A

Swelling and version of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands

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44
Q

Although the cause of chelitus glandularis is unknown, what.are some possible causes?

A

Sun damage, tobacco, syphilis, poor hygiene, heredity

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45
Q

What is the clinical presentation of cheilitis glandularis

A

Swelling and pain, typically lower lip

Eversion of the lip

Red dots indicate duct orifices

Weeping mucopurulent secretions often are seen

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46
Q

What population is cheilitis glandularis most commonly found in?

A

Middle aged to older males

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47
Q

What does the histology of cheilitis glandularis look like?

A

Chronic sialentitis and ductal dialation

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48
Q

Cheilitis glanduaris can sometimes look like ___. It is important to determine which it is because ___ may be ___.

A

Actinic chelosis

Actinic chelosis may be premalignant

(Cheilitis glandularis still has a well defined vermillion border)

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49
Q

What is sialorrhea?

A

Excess salivation

50
Q

What are some things that can cause sialorrhea?

A

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

51
Q

What are some things that can cause drooling (leading to sialorrhea), why?

A

Down syndrome (macroglossia)

Neurological disorder (cerebral palsy)

52
Q

What is the treatment of sialorrhea?

A

Treat the underlying cause

Anticholinergic medications, scopolamine transdermal patch (not for children)

Surgery: relocation of the salivary ducts to tonsillar fossa, tympanic neurectomy

53
Q

How common is xerostomia?

A

Xerostomia is subjective sensation of a dry mouth common in 25% of older adults

54
Q

What are 3 complications with xerostomia?

A

Candidiasis (due to changes in oral microflora)

Prone to cervical and root caries

Alteration of taste

55
Q

What are some common causes for xerostomia?

A

Medications

Caffeine/alcohol

Smoking

Radiation therapy to head and neck

Sjögren’s syndrome

Diabetes mellitus

Sarcoidosis (noncaeseating granulamouts inflammation)

Surgery of salivary glands

56
Q

How do you manage xerostomia?

A

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)

57
Q

What does xerostomia look like intraorally?

A

Fissured tongue

With dry glove, wipe hard palate, it will stick

Prone to angular cheilitis

Rampant caries

58
Q

What is another name for Sjögren’s syndrome (if they also have dry eyes)?

A

Sicca syndrome

59
Q

SS mainly affects what population?

A

Women

60
Q

What is the difference between primary and secondary SS?

A

Primary SS - no other autoimmune disease

Secondary SS - associated with other autoimmune diseases (rheumatoid arthritis)

61
Q

In order to be diagnosed with SS, you must have 2 out of the 3 criteria. What are the three criteria?

A

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

62
Q

What are the exclusion criteria for SS?

A

Past head and neck radiation treatment

Hep. C infection

AIDS

Preexisting lymphoma

Sarcoidosis

Graft vs. host disease

Use of anticholinergic drugs

63
Q

A lymphocytic focus has at least how many lymphocytes?

A

50 or more lymphocytes

64
Q

What is the treatment for SS?

A

Management of xerostomia.. which includes.. sugarless gum, dry mouth products, sialogauges, emphasize oral hygiene, monitor lymphoma

65
Q

Name two sialogauges used to treat SS?

A

Pilocarpine (salagen)

Cevimeline (evoxac)

66
Q

Patients with SS are ___ times more likely for a certain type of lymphoma called ___

A

40 times

MALT lymphoma (marginal zone lymphoma)

67
Q

What does a salivary neoplasm look like?

A

Smooth surfaced

Dome shaped

Non-ulcerated

68
Q

What is the incidence of salivary neoplasms?

A

4/100,000 people

69
Q

Where are the most common locations for salivary neoplasms? Give the percentage of incidence for each location.

A

Parotid gland (70%)

Minor glands (25%)

Submandibular (~5%)

Sublingual (<1%)

70
Q

Sublingual neoplasms have the highest likelihood of being malignant. What percentage of sublingual neoplasms are malignant?

A

70-90%

71
Q

What is the most common site for minor salivary gland neoplasms? What percentage of minor salivary gland neoplasms occur here?

A

Palate

50% especially on the lateral hard or soft palate*

72
Q

What percent of all major salivary gland neoplasms are benign, what percent is malignant?

A

Benign 66%

Malignant 34%

73
Q

What percentage of parotid salivary gland neoplasms are benign, what percent are malignant?

A

Benign - 70%

Malignant - 30%

74
Q

What percentage of submandibular gland neoplasms are benign, what percent are malignant?

A

Benign - 60%

Malignant - 40%

75
Q

What percentage of sublingual neoplasms are benign, what percent are malignant?

A

Benign - 30%

Malignant - 70%

76
Q

What percentage of minor salivary glands are malignant for the following locations…

All minor glands
Upper lip
Lower lip
Palate
Tongue
Cheek
Retromolar pad
A

Malignant…

All minor glands - 50%
Retromolar pad - 90%
Tongue - 85%
Lower lip - 60%
Cheek - 50%
Palate - 50%
Upper lip - 20%
77
Q

Salivary gland neoplasms are more common in the ___ lip than the __ lip

A

More common in upper lip than lower lip

78
Q

Upper lip neoplasms are mostly __ whereas lower lip neoplasms are mostly ___

A

Benign

Malignant

79
Q

What percentage of neoplasms in the retromolar area are malignant?

A

90%

80
Q

What s the most common neoplasm?

A

Pleomorphic adenoma (benign)

81
Q

What is the most common malignant neoplasm?

A

Mucoepidermoid carcinoma

82
Q

Name four different benign salivary gland neoplasms

A

Canalicular adenoma

Pleomorphic adenoma

Warthin tumor (papillary cystadenoma lymphomatosum)

Oncoctyoma

83
Q

What is another name for a warthin tumor?

A

Papillary cystadenoma lymphomatosum

84
Q

What is a canalicula adenoma?

A

A type of monomorphic adenoma

It is slow growing, painless mass, blue or normal color, may be multifocal

85
Q

Where do canlicular adenoma typically occur?

A

Exclusively in minor salivary glands of the upper lip (75%) and buccal mucosa

86
Q

Only a ___ is found more commonly in the upper lip than a canalicular adenoma

A

Pleomorphic adenoma

87
Q

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 ___.

A

<50

> 60

Canalicular adenomas are found in older age groups (7th decade peak), with a slight female predominance

88
Q

What is another name for a pleomorphic adenoma?

A

Benign mixed tumor

*note that this is the most common salivary neoplasm

89
Q

~60% of parotid tumors (superficial lobe), and ~55% of submandibular tumors are what kind of neoplasm?

A

Pleomorphic adenoma

90
Q

What kinds of cells are pleomorphic adenomas made out of?

A

Mixture of ductal and myoepithelial cells

Remarkable microscopic diversity accounts for the name

91
Q

Name, in order, the most common sites for minor gland pleomorphic adenomas.

A

Palate

Upper lip

Buccal mucosa

92
Q

True or false.. pleomorphic adenomas can grow to grotesque proportions if untreated.

A

True

93
Q

Which salivary neoplasm is encapsulated? How is it encapsulated?

A

Pleomorphic adenomas are encapsulated.

They are well-circumscribed and have a firm fibrous tissue lining. This allows you to basically peel the growth out.

94
Q

Which tumor is a benign tumor of oncocytes?

A

Oncocytoma

95
Q

What is an oncocyte?

A

Cell that went through metaplastic processes that made mitochondria fill up the cell.

96
Q

What is the second most common benign parotid tumor?

A

Warthin’s tumor (papillary cystadenoma lymphomatosum)

These occur almost exclusively in the parotid gland and may be bilateral

97
Q

What population is warthin’s tumor predominately found in?

A

Older men

Smokers

98
Q

Smokers have a __ times greater risk of developing a warthin’s tumor

A

8

99
Q

While a pleomorphic adenoma is typically found in the superior tail of the parotid gland, where are warthin’s tumors typically found?

A

Posterior inferior tail of the parotid

100
Q

Name 5 malignant salivary neoplasms

A

Mucoepidermoid carcinoma

Acinic cell adenocarcinoma

Adenoid cystic carcinoma

Polymorphous low-grade adenocarcinoma

Malignant mixed tumor

101
Q

What is the most common malignant salivary neoplasm?

A

Mucoepidermoid carcinoma

102
Q

Where is the most common location for mucoepidermoid carcinomas?

A

Parotid gland

They most common is minor glands (remember that the palate is the most common minor gland neoplasm site)

103
Q

True or false… benign tumors are typically unuclerative while malignant tumors are ulcerative

A

True

104
Q

True or false… prognosis of mucoepidermoid carcinoma solely depends on the clinical stage.

A

False. It depends on the histopathologic grade and clinical stage

105
Q

True or false… mucoepidermoid carcinoma has a better prognosis in the submandibular gland the parotid gland.

A

False… the submandibular gland tumors are associated with a poorer prognosis than in the parotid gland

106
Q

What is the pathogenesis of intraosseous mucoepidermoid carcinoma?

A

Ectopic salivary gland tissue that was developmentally entrapped within the jaw

Odontogenic epithelium, mucous metaplasia

107
Q

Where are the most common locations of intraosseous mucoepidermoid carcinoma in middle aged adults?

A

Mandible>maxilla>molar-ramus region

108
Q

True or false… intraosseous mucoepidermoid carcinoma has a survival rate of 90%

A

True

109
Q

What is an acinic cell adenocarcinoma?

A

Low-grade malignant neoplasm showing serous acinar differentiation

Slow growing mass with pain

110
Q

Where are the most common locations for acinic cell adenocarcinoma?

A

Parotid gland (85% of cases) > minor glands > submandibular

111
Q

What is the second most common malignant neoplasm?

A

Acinic cell adenocarcinoma

112
Q

What is the local recurrence, metastasis, and survival rate of acinic cell adenocarcinoma?

A

Local recurrence: 1/3

Metastasis: 10-15%

Survival: 80-94%

113
Q

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

A

Adenoid cyst carcinoma

114
Q

True or false.. adenoid cystic carcinomas are more commonly found in minor glands than in the parotid gland or submandibular glands

A

True

115
Q

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?

A

Adenoid cystic carcinoma

116
Q

Which salivar gland tumor almost exclusively occurs in minor glands, and is found in older adults, and exhibits different growth patterns histologically?

A

Polymorphous low-grade adenocarcinoma (terminal duct carcinoma)

117
Q

What is another name for a malignant mixed tumor?

A

Carcinoma ex pleomorphic adenoma

118
Q

Malignant mixed tumors are most commonly found in ___ glands

A

Major glands.

119
Q

Malignant mixed tumors result from malignant transformation of the ___ cells. Mass presents for many years but a recent rapid growth with pain and/or ___

A

Epithelial cells

Ulceration

120
Q

What is a carcinosarcoma?

A

A type of malignant mixed tumor. It has carcinomatous and sarcomatous components. (Epithelial and mesenchymal components)

Oral Path 2 (2 decks)

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