Chapter 83. Inflammatory Disorders of the Salivary Glands Flashcards
Most common cause if inflammation in the salivary glands. Described as the formation if calculi in the ductal system of the salivary glands.
Sialolithiasis
Components of salivary stones
a. Calcium phosphate
b. Calcium carbonate
c. Glycoproteins
d. A&B
e. all of the above
Ans. E
Factor accounting for the propensity of salivary stones to form in SMG
a. Anatomy of Wharton duct (longer, narrower, angulated)
b. Saliva has high calcium but low phosphorus concentration
c. Saliva produced by the gland is more viscuous
d. All of the above
Ans. C
Wharton duct- longer, wider, more tortuous, angulated against gravity
Saliva- high in calcium and phosphorus
Common location of stones in the parotid gland
a. Duct
b. Hilum
c. Parenchyma
d. b & c
e. all of the above
Ans. D
True in imaging of salivary glands for sialolithiasis
a. Plain radiographs (intraoral and occlusal views) are the diagnostic of choice
b. Ultrasound can detect stones >2mm 90% of the time
c. CT scan with contrast is preferrable
d. Sialography is indicated for stones in oral portion of Wharton duct
Ans. B
a. not done anymore, tendency to miss radiolucent stones
c. Contrast is avoided as opacified blood vessels can be confused with stones
d. Sialography - CONTRAindicated for stones in oral portion of Wharton duct and in active infection
Initial nonsurgical management of patients with sialolithiasis
Sialogogues
local heat
hydration
massage
Most common causative microorganism involved in chronic sialadenitis in adults
Staphylococcus aureus
A procedure that serves as diagnostic and interventional tool for sialolithiasis if medical treatment fails. It involves washing out the salivary ducts with a continuous normal saline lavage, intraglandular steroid instillation, hydrostatic dilation of the ductal system
Sialendoscopy
A complication of chronic sialadenitis that presents as an asymptomatic mass that commonly affects women in the 5th-6th decades of life
a. Benign lymphoepithelial lesion
b. Küttner tumor
c. Chronic sclerosing sialadenitis
d. Ductal carcinoma
Ans. A
characterized by a lymphoreticular infiltrate with acinar atrophy, irregularly placed nuclei, and ductal metaplasia; the metaplasia results in the development of epimyoepithelial islands.
Complication of chronic sialadenitis that occurs almost exclusively in the submandibular gland, common in 5th-7th decade of life. Presents as firm, painful, unilateral swelling of the gland.
a. Benign lymphoepithelial lesion
b. Küttner tumor
c. Chronic sclerosing sialadenitis
d. Ductal carcinoma
Ans. B or C (a.k.a)
Benign chronic inflammatory process similar to A. Periductal fibrosis and ductal ectasia occur in early stages of the disease, caused by foci of chronic inflammation. However, as the disease progresses, fibrosis, acinar atrophy, and ductal dilation increase. Consequentially, the entire gland becomes fibrotic, and inflammation decreases.
Histologically, a heavy lymphoid infiltrate is found among discrete tubular structures with regularly aligned nuclei, which differentiates them from a benign lymphoepithelial lesion.
Most susceptible to acute sialadenitis
a. Parotid
b. SMG
c. Minor salivary gland
d. Sublingual
Ans. A
produces saliva that is mainly serous, which, unlike mucinous saliva, lacks lysosomes, immunoglobulin A antibodies, and sialic acid, all of which have antimicrobial properties.
Factors that lead to acute sialadenitis, except
a. Retrograde bacterial contamination from the oral cavity
b. Stasis of salivary flow secondary to dehydration
c. Presence of high-molecular-weight glycoproteins that promote bacterial attachment
d. Stenosis of salivary ducts secondary to trauma
e. none of the above
Ans. C - competitively inhibit bacterial attachment to epithelial cells of salivary ducts. present in SMG and sublingual glands (not in parotid)
Contraindicated in acute sialadenitis
a. Sialendoscopy
b. CT scan
c. MRI
d. FNAB
Ans. A
inflammation of the ducts makes dilation difficult and increases the risk of iatrogenic ductal trauma from rigid and semirigid instrumentation. Exacerbation of the infection is also a potential risk.
FNAB - caution, may result in fistula formation
Most common inflammatory salivary gland disease of childhood
a. Mumps
b. Recurrent parotitis of childhood (RPC)
c. Neonatal suppurative parotitis (NSP)
d. Tuberculous mycobacterial disease
Ans. A
Viral etiology of mumps. Disseminated by airborne droplets from salivary, nasal, urinary secretions that enters through upper respiratory tract with an incubation period of 2-3 weeks.
Paramyxovirus
