cysts and other non neoplastic diseases of salivary glands Flashcards
what are the 3 major salivary glands ?
> parotid (serous)
> submandibular (mucous and serous)
> sublingual (mucous and serous)
how many minor salivary glands are there?
600 - 1000
what is the submandibular gland duct referred to as?
Wharton’s duct
what are mucoceles?
> common, benign, cystic in nature
painless swellings
mucous filled cysts
affects any minor salivary gland
who does mucoceles effect the most?
> young adults/ children
M>F
what is the most common site of mucocele?
> inner aspect of the lower lip
upper lip very uncommon
what is the main cause of a mucocele?
> traumatic
what is the clinical presentation of a mucocele? (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
what is a superficial mucocele?
> small fluid filled vesicle
> common on the soft palate, retromolar pad, posterior buccal mucosa, the lower labial mucosa
> can grow at meal time
what happens when a superficial mucocele ruptures?
> develops a superficial ulcer
what are superficial mucoceles associated with?
> Lichen planus
> Lichenoid drug reactions
> Graft versus host disease
how do you diagnose a mucocele?
> History
> clinical examination
> histology (definitive confirmation)
what are the 2 variants of mucocele as seen under the microscope?
> 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
describe the histopathology of a mucous extravasation cyst?
> Pool of extravasated mucous
> Wall of compressed granulation tissue
> Mixed inflammatory cell infiltrate
describe the histopathology of a mucous retention cyst?
> Cyst forms lined by ductal epithelium
> Pool of mucous in cyst
> Minimal inflammatory reaction
> Wall of fibrous tissue lined by altered ductal epithelium
what is the management of a mucocele?
> reassurance
> nil
> excisional biopsy (larger is easier than small)
> cryosurgery
> sclerotic agents
> complications - bbpsi, recurrence
what is a Ranula?
> Mucocele affecting floor of mouth
> involves Sublingual/submandibular glands
> Uncommon
> can be either aMucous extravasation or retention cyst
> Pathogenesis - ? obstruction
what is the clinical presentation of a Ranula?
> Anterior floor of mouth
> Unilateral
> 2-3cm in diameter (larger than mucocele)
> Soft, fluctuant, blue
> Painless - speech
> overlying mucosa is normal
what is the difference between plunging ranula and and a simple ranula?
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
what gland does the plunging ranula involve?
the sublingual gland
how do you diagnose a Ranula?
> clinical
> histopathology (for definitive diagnosis)
what is the management for a ranula?
> 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
what is sialosis?
> uncommon
> benign - non-inflammatory + non infective
> bilateral swelling, with a gradual onset
> mainly effects the major salivary glands especially the parotids
> persistant
what is the aetiology of sialosis?
> Drugs = anti-hypertensives
> Alcohol
> Endocrine conditions = diabetes
> Nutritional disorders = malnutrition
what is the clinical presentation of sialosis?
> Parotid glands commonly effected
> Soft, painless swelling
> Outward deflection of the ear lobe
how do you diagnose sialosis?
> 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
what is the treatment of sialosis?
> nil = often no treatment is undertaken
> remove systemic cause (predisposing factors)
what is necrotising sialometaplasia?
> rare
> benign inflammatory disorder of the minor salivary glands located towards the posterior of the palate
> tumour like lesion
> usually unilateral
what does necrotising sialometaplasia resemble?
> squamous cell carcinoma
what is the age and sex demographic of necrotising sialometaplasia?
> 2M : F
> middle age
what is the aetiology of necrotising sialometaplasia?
> Unknown cause
> Trauma
> Predisposing factors = Middle age, Male, Smokers
what is the clinical presentation of necrotising sialometaplasia?
> Preceded by paraesthesia
> Resembles scc = Irregular margins + “Heaped up” appearance
