cysts and other non neoplastic diseases of salivary glands

Question 1

what are the 3 major salivary glands ?

Answer 1

> parotid (serous)

> submandibular (mucous and serous)

> sublingual (mucous and serous)

Question 2

how many minor salivary glands are there?

Answer 2

600 - 1000

Question 3

what is the submandibular gland duct referred to as?

Answer 3

Wharton’s duct

Question 4

what are mucoceles?

Answer 4

> common, benign, cystic in nature
painless swellings
mucous filled cysts
affects any minor salivary gland

Question 5

who does mucoceles effect the most?

Answer 5

> young adults/ children
M>F

Question 6

what is the most common site of mucocele?

Answer 6

> inner aspect of the lower lip
upper lip very uncommon

Question 7

what is the main cause of a mucocele?

Answer 7

> traumatic

Question 8

what is the clinical presentation of a mucocele? (8)

Answer 8

> single

> fluctuant

> dome shaped

> normal or bluish coloration

> non pulsatile (as it is not from vascular origin)

> normal overlying epithelium

> 1mm - 10mm

> mainly found on inner aspect of lower lip

Question 9

what is a superficial mucocele?

Answer 9

> small fluid filled vesicle

> common on the soft palate, retromolar pad, posterior buccal mucosa, the lower labial mucosa

> can grow at meal time

Question 10

what happens when a superficial mucocele ruptures?

Answer 10

> develops a superficial ulcer

Question 11

what are superficial mucoceles associated with?

Answer 11

> Lichen planus

> Lichenoid drug reactions

> Graft versus host disease

Question 12

how do you diagnose a mucocele?

Answer 12

> History

> clinical examination

> histology (definitive confirmation)

Question 13

what are the 2 variants of mucocele as seen under the microscope?

Answer 13

> mucus extravasation cyst = most common, occurs when there is damage to the minor salivary duct, it ruptures and mucous spills out into the surrounding tissue

> mucus retention cyst = occurs when saliva can’t get out of the minor salivary gland itself and so it builds up, caused by stricture of the duct

Question 14

describe the histopathology of a mucous extravasation cyst?

Answer 14

> Pool of extravasated mucous

> Wall of compressed granulation tissue

> Mixed inflammatory cell infiltrate

Question 15

describe the histopathology of a mucous retention cyst?

Answer 15

> Cyst forms lined by ductal epithelium

> Pool of mucous in cyst

> Minimal inflammatory reaction

> Wall of fibrous tissue lined by altered ductal epithelium

Question 16

what is the management of a mucocele?

Answer 16

> reassurance

> nil

> excisional biopsy (larger is easier than small)

> cryosurgery

> sclerotic agents

> complications - bbpsi, recurrence

Question 17

what is a Ranula?

Answer 17

> Mucocele affecting floor of mouth

> involves Sublingual/submandibular glands

> Uncommon

> can be either aMucous extravasation or retention cyst

> Pathogenesis - ? obstruction

Question 18

what is the clinical presentation of a Ranula?

Answer 18

> Anterior floor of mouth

> Unilateral

> 2-3cm in diameter (larger than mucocele)

> Soft, fluctuant, blue

> Painless - speech

> overlying mucosa is normal

Question 19

what is the difference between plunging ranula and and a simple ranula?

Answer 19

A simple ranula is contained within the sublingual space, however a plunging ranula extends into the submandibular space beyond the mylohyoid muscle causing a midline swelling

Question 20

what gland does the plunging ranula involve?

Answer 20

the sublingual gland

Question 21

how do you diagnose a Ranula?

Answer 21

> clinical

> histopathology (for definitive diagnosis)

Question 22

what is the management for a ranula?

Answer 22

> Resolve

> Aspiration

> Marsupialization

> Excision of the gland

In general, this type of surgery is more complex and extensive than excision of the mucoceles discussed earlier, and these patients will need referred to a specialist centre. This is even more-so the case if the ranula is plunging as specialist scans will be needed prior to formulating a treatment plan

Question 23

what is sialosis?

Answer 23

> uncommon

> benign - non-inflammatory + non infective

> bilateral swelling, with a gradual onset

> mainly effects the major salivary glands especially the parotids

> persistant

Question 24

what is the aetiology of sialosis?

Answer 24

> Drugs = anti-hypertensives

> Alcohol

> Endocrine conditions = diabetes

> Nutritional disorders = malnutrition

Question 25

what is the clinical presentation of sialosis?

Answer 25

> Parotid glands commonly effected

> Soft, painless swelling

> Outward deflection of the ear lobe

Question 26

how do you diagnose sialosis?

Answer 26

> diagnosis of exclusion

> blood tests = check blood sugar levels

> imaging = scans like ultrasound or MRI to check for pathology

> Biopsy = rare but can reveal acinar cell enlargement

Question 27

what is the treatment of sialosis?

Answer 27

> nil = often no treatment is undertaken

> remove systemic cause (predisposing factors)

Question 28

what is necrotising sialometaplasia?

Answer 28

> rare

> benign inflammatory disorder of the minor salivary glands located towards the posterior of the palate

> tumour like lesion

> usually unilateral

Question 29

what does necrotising sialometaplasia resemble?

Answer 29

> squamous cell carcinoma

Question 30

what is the age and sex demographic of necrotising sialometaplasia?

Answer 30

> 2M : F

> middle age

Question 31

what is the aetiology of necrotising sialometaplasia?

Answer 31

> Unknown cause

> Trauma

> Predisposing factors = Middle age, Male, Smokers

Question 32

what is the clinical presentation of necrotising sialometaplasia?

Answer 32

> Preceded by paraesthesia

> Resembles scc = Irregular margins + “Heaped up” appearance