Chapter 25: Head and Neck- Salivary Glands and Ear

Question 1

What are the differences in saliva between parotid glands vs submandibular/sublingual glands?

Answer 1

parotid: serous

submandibular/sublingual: mixed serous/mucous

Question 2

Rapid fire terminology! Define:
Xerostomia
Sialorrhea
Enlargement
Sialolithiasis
Parotitis

Answer 2

dry mouth from lack of saliva

increased salivary flow

usually from cysts/neoplasm/inflammation

calcific stones in glands

inflammation of parotid. Usually s aureus, but mumps causes “epidemic parotitis”

Question 3

Progression of Sjogren’s Syndrome

What is it caused by? What type of cells are involved? What happens late in disease course?

Answer 3

(autoimmune chronic inflammation of salivary and lacrimal glands, characterized by xerostomia and keratoconjunctivitis sicca. Can also be associated with systemic collagen vascular disease)

chronic inflammation -> glands replaced with polyclonal lymphocytes, immunoblasts, germinal centers and plasma cells -> atropy and fibrosis/fatty infiltration of parenchyma

Question 4

What is a viral illness that causes parotitis? What is this illness also associated with?

Answer 4

Mumps. Also associated with pancreatitis and orchitis.

Question 5

Tell me about the composition of the most common tumor of the salivary glands

Where do they usually present? What gene can be involved?

Answer 5

Pleomorphic adenoma: mix of stromal and epithelial elements

nodular, mobile, painless mass usually in parotid. PLAG1 gene is rearranged in most tumors

Question 6

Your patient had a pleomorphic adenoma of the parotid, and you removed the benign tumor surgically. What is the patient at risk for because of the nature of pleomorphic adenomas?

What would his tumor be called if it progressed to malignancy?

Answer 6

High rate of recurrence because of extensions of small islands of tumor through the capsule, therefore incomplete resection can result with tumor left behind.

“carcinoma ex pleomorphic adenoma”, or “in situ/noninvasive carcinoma ex pleomorphic adenoma” if it is fully confined to the tumor capsule

Question 7

Tumor of parotid gland with cystic changes and dense lymphoid tissue? What are the characteristic epithelial cells lining the cysts called?

Answer 7

Warthin tumor

cysts are lined with “oncocytes” (epithelial cells swollen with mitochondria. Tumors of these cells only are called “oncocytoma” and occur in parotid of elderly)

Question 8

What are mucoepidermoid carcinomas characterized by?

Answer 8

Malignant tumor (most common malignancy of salivary gland), mixed mucinous, epidermoid, and epithelial cells

Question 9

Which malignancy grows in a characteristic tubular/cribriform arrangement? What is the prognosis of this malignancy?

Answer 9

Adenoid cystic carcinoma (growth is also called “sieve-like”). Prognosis is poor, with tendency to recur and invade even after surgical resection.

Question 10

Why is adenoid cystic carcinoma so painful?

Answer 10

tends to infiltrate perineural spaces

Question 11

Term for inflammation of the middle ear, and what is a common etiologic factor?

Answer 11

otitis media. commonly from obstruction of the Eustachian Tube.

Question 12

Cholesterol granuloma vs cholesteatoma?

What are the dangers of cholesteatoma?

Answer 12

cholesterol granuloma: degredation of erythrocytes after hemorrhage during an acute otitis media, liberates cholesterol, and this stimulates a foreign body response and granulation tissue.

cholesteatoma: mass of accumulated keratin and squamous mucosa, from growth of squamous epithelium from external ear through a perforated eardrum into the middle ear. Caused by chronic suppurative otitis. They can block Abx access to bacteria, and also erode bone and destroy contiguous structures.

Question 13

Common etiologies of the following:

1. Acute serous otitis media
2. chronic serous otitis media
3. acute suppurative otitis media
4. acute mastoiditis
5. chronic suppurative otitis media and mastoiditis

Answer 13

1. sudden changes in atmospheric pressure, causes acute obstruction of Eustachian tube
2. same causes as acute, but recurrent. Also nasopharyngeal carcinoma (esp. if unilateral otitis)
3. S. pneumonia and H. influenza mostly, most common in children
4. if otitis is not treated properly
5. from neglected or recurrent infections

Question 14

What is the most common cause of conductive hearing loss in young and middle age in the US? What is the etiology? Is it acute or slowly developing?

Answer 14

Otosclerosis: formation of new spongy bone about the stapes and oval window. It is autosomal dominant, and is a progressive hearing loss.

Question 15

Most common benign tumor of the middle ear?

Answer 15

Jugulotympanic paraganglioma. Grows as lobules of cells in richly vascular CT

Question 16

Meniere Disease triad and pathological change?

Answer 16

Vertigo, sensorineural hearing loss, tinnitus. Characterized by dilatation of the cochlear duct and saccule, and the membranous wall may tear as disease progresses.

Symptoms are thought to occur when the endolymphatic system ruptures and endolymph escapes into the perilymph

Question 17

Common viral causes of congenital and postnatal deafness from labyrinthitis?

Answer 17

CMV and rubella congenital, and mumps postnatal.

Many other viruses such as EBV, Herpesviruses and adenoviruses can cause labyrinthitis and deafness if severe

Question 18

Most common tumor of the inner ear?

Answer 18

Schwannoma: slowly progressive vestibular and auditory symptoms

Meningioma is less common