Chapter 16--Salivary glands Flashcards
Xerostomia–what is it? Cause?
- dry mouth
- due to lack of salivary secretions
- incidence is as high as 70% of individuals over age 70
- can occur in autoimmune inflammation and fibrosis (Sjogren syndrome) or may be complication of radiation therapy or a wide variation of pharmacologic agents
Presentation of xerostomia
-range from oral dryness to tongue fissuring and ulceration with papillary atrophy to concomitant inflammatory salivary gland enlargement (Sjogren syndrome)
Complications of xerostomia
- increased caries
- candidiasis
- difficulties with swallowing and speaking
Inflammation of salivary gland is called? Causes?
- Sialadentis
- may be traumatic, viral, bacterial or autoimmune (Sjogren syndrome)
Most common cause of viral sialadenitis
Mumps
2 common lesions of the salivary gland (causes of sialadentis)
- Mucoceles
- Sialolithiasis
Mucoceles
- Most common salivary gland lesion
- result from ductal blockage or rupture with saliva leakage into surrounding storm
Mucoceles–commonly occur where? result from?
- Most often on lower lip
- Typically result from trauma
- Lesions fluctuate in size, especially in association with meals
Ranula
-specific mucocele of the sublingual gland
Sialolithiasis
-salivary gland ductal obstruction caused by stones (due to edema and/or impacted food debris)
Non-specific sialadentitis
- painful salivary gland enlargement and purulent discharge
- typically follows ductal obstruction
In sialolithiasis, dehydration and decreased secretory function predispose to what?
-secondary infection by Staph aureus or strep viridans
Neoplasms of the salivary glands
- 30 of them
- Parotids account for 65-80%!!
- 15-30% are malignant!!
- 10% occur in submandibular glands (40% malignant)
- remainder in minor salivary glands (70-90% malignant)
Benign tumors of the salivary glands incidences
- Pleomorphic adenoma (50%)–mixed tumor
- Warthin tumor (5-10%)
- Oncocytoma (1%)
- Other adenomas (5-10%)
- Ductal papillomas
Malignant tumors of the salivary gland incidences
- Mucoepidermoid carcinoma (15%)
- Adenocarcinoma (NOS) (10%)
- Acinic cell carcinoma (5%)
- Malignant mixed tumor (3-5%)
- SCC (1%)
- Other carcinomas (2%)
Pleomorphic adenoma–what are they?
- benign tumors exhibiting mixed epithelial and mesenchymal differentiation
- constitute 60% of all parotid tumors and lesser percentages in other salivary glands
Pleomorphic adenoma–characteristics and histology
-painless, slow-growing, mobile discrete masses with epithelial nests dispersed in a variable matrix of myxoid, hyaline, chondroid or osseous differentiation
Recurrence rates and malignant transformation of pleomorphic adenoma
- recurrence rate=25% if not well excised
- Malignant transformation (usually as adenocarcinoma or undifferentiated carcinoma) occurs in 10% of tumors of >15 years duration
- Malignant transformation associated with 30% to 50% 5-yr mortality
Warthin Tumor
- aka Papillary Cystadenoma Lymphomatous
- benign tumor of unknown histogenesis
- found exclusively in parotid!
- 10% multifocal and 10% bilateral
Warthin tumor found in what population??
-8x more common in smokers!!
Wrathin tumor morphology?
- well encapsulated
- consists of glandular spaces lined by a double layer of epithelial cells atop a dense lymphoid stroma
Mucoepidermoid carcinoma
- Most common primary malignant salivary tumor!!
- up to 8cm!
- lack well defined capsules
- Histo: cords, sheets, or cystic arrangements of squamous, mucous or intermediate cells with mucous filled vacuoles
Mucoepidermoid carcinoma–low vs. high grade tumors–recurrence and survival
- Low grade tumors can invade locally with 15% recurrence rates
- High grade tumors have 25% recurrence rates and 50% year survival rates
Other salivary gland tumors–list (2)
- Adenoid cystic carcinoma
- Acinic cell tumors
