Dry Mouth Flashcards
Xerostomia, salivary gland disease (primary + secondary inc Srojens disease)
Define Xerostomia?
Dry mouth resulting rom reduced or absent salivary flow
(Can be subjective + objective as pt might complain of dry mouth but clinically there has been no reduction in salivary flow + salivary glands are working as normal)
Define hyposalivation?
Objective reduction in salivary secretion consequent of reduced salivary gland function
What lifestyle and medical factors are related to xerostomia?
Lifestyle: smoking + drinking
Medical: age, polypharmacy, systemic disease (especially diabetes)
State the 5 functions/properties of saliva?
Saliva of normal flow rate + composition are necessary to provide:
1. LUBRICATION for speech + swallowing
2. Defensive + ANTIMICROBIAL properties
3. Taste perception
4. Initiation of DIGESTION (salivary amylase + lipase start digestion of starch + fat)
5. Lavage (washing out) + buffering properties
What 2 aspects of saliva are important?
- Normal flow rate (i.e. amount of salivary flow)
- Composition of saliva (i.e. concentration of minerals)
What are the 9 aetiologies of dry mouth?
- Dehydration/reduced fluid intake? (ask pt about fluid intake? - 8 glasses of water recommended/day, ask about high caffeine intake, smoking or drinking?)
- Are they mouth breather? (check for incompetent lips), Does pt snore?
- Salivary gland disease
- Systemic disease
- Medication
- Age
- Idiopathic
- Psychological
- Change in pral perception due to nerve damage (surgery/trauma) or conditions i.e. Alzheimer’s or stroke
What 8 questions would you ask for DIAGNOSIS of xerostomia during HISTORY TAKING during clinical examination?
- Have you had a daily feeling of dry mouth for > 3months?
- Do you drink liquids to aid in swallowing of dry foods?
- Do you wake up at night to drink liquids?
- Have you had recurrently or persistently swollen salivary glands?
- Are you drinking enough water during the day? Approx. 2-3L
- Are you drinking tea or coffee? (Diuretics make the mouth dy)
- What medications are you taking?
- Are you experiencing dry eyes and/or genital dryness?
Who is xerostomia most likely to affect?
F>M
Mostly >85yrs
Name 7 possible complications of xerostomia?
- Dental caries
- Difficulty speaking + swallowing
- Oral soft tissue disease
- Voice hoarseness
- Dryness of the rest of GIT
- Nutrition
- Psychological issues
Explain the link between medications and xerostomia?
- Over 400 drugs can cause dry mouth
- There is a significant reduction in salivary flow when 2-3 drugs are taken at once i.e. polypharmacy increases risk of xerostomia)
List categories of xerogenic medications:
-Antihypertensive drugs e.g. beta-blockers (lol), ACE inhibitors (pril), diuretic (thiazide)
- Hypoglycaemic drugs (formin)
- Antidepressants e.g. tricyclics, SSRIs
- Anti-psychotics
- Opioids
- Benzodiazepines e.g. diazepam
- Bronchodialators
- Anticonvulsants
- Amphetamine derivatives
- Some GI + GU drugs
- Proton pump inhibitors (PPIs) e.g. omeprazole, lansoprazole
- Anti-allergic drugs including antihistamines
- Antiparkinsonian drugs
- Some steroidal and NSAIDs
- Anti-neoplastic drugs
- Vitamin A analogues e.g. isotretinoin
List 7 SYSTEMIC diseases associated with dry mouth?
Srogren’s syndrome
Diabetes
Liver disease
Amyloidosis
Sarcoidosis
Thyroid disease
HIV-related salivary gland disease
(normally when they conditions are well managed, they most likely
will not have dry mouth. However, if they start to develop it/complain
of it, then this may indicate to you that their disease is not well managed
anymore; therefore, write to pt’s GP to review pt and their medication)
State aim of tx + management of pts w hyposalivation?
Tx aim: provide symptomatic relief + promote oral health
Management:
-Regular dental visits, OHI, F- MW
-Diet advice: reduce freq. of sugar intake, avoid caffeine, carbonated drinks, alcohol, tobacco + spicy foods
- Sip water frequently
- Use sugar free gums to stimulate own saliva
- Artificial saliva to help lubricate the mouth
- Use a humidifier at night
- Tx/prevent development of candidiasis
State pharmacological and non-pharmacological tx of hyposalivation:
Pharmacological tx:
-pilocarpine = drug that can be
used to manage hyposalivation
but lots of systemic side effects
Non-pharmacological tx:
- Accupuncture
- Electrostimulation
State 3 intra-oral signs of xerostomia:
- Atrophic oral mucosa
- Fissured tongue
- No pooling of saliva in the mouth
Difference between using the word xerostomia and hyposalivation?
Xerostomia is another word for dry mouth but when use the word hyposalivation we are indicating that the salivary glands are not working normally.
Name 5 different causes of salivary gland disease?
- Infections - viral (mumps) or bacterial
- Obstruction- meal time syndrome, mucocele or radula
- Damage - 2” to cancer tx
- Tumours- benign + malignant tumours of the major + minor salivary glands
- Degenerative disease- i.e. autoimmune conditions like Sjogren’s resulting in dry eyes + mouth (autoantibodies produced against exocrine glands
including the salivary glands!)
How do you examine the salivary glands?
H+N examination should be performed every visit
- Palpate the glands + note any pain or tenderness
- Note any gland enlargement or swellings
- Feel for presence of any mass within the glands (note size, mobility + fixation to surrounding structures)
- Note facial asymmetry
- Not changes in muscle tone, weakness, paralysis or facial nerve palsy
- CN VII (facial) should be assessed carefully to rule out malignant tumours invading the nerve
Meal time syndrome is an example of salivary gland obstruction causing salivary gland disease - how would you detect this syndrome?
Meal time syndome- if there is a stone in the gland i.e. an obstruction it is easy to diagnose as each time the pt eats/sees food the salivary gland swells up because the gland would start producing saliva but because of the stone/obstruction in the duct, the saliva cannot seep out and that causes the swelling; and pt will tell you that within an hour the swelling will subside.
What is a mucocele?
(A mucocele is an example of salivary gland OBSTRUCTION)
it occurs when there is damage in a minor salivary gland and it balloons up producing a small translucent nodule in the mouth, which resolves usually by itself over time. (BUBBLE/BALLOON)
What is a ranula?
(It is another example of salivary gland OBSTRUCTION)
Ranula- is similar to mucocele but bigger and located on the floor of the mouth.
What is SIALOLITHIASIS? (think of Taha)
= presence of stones or calculi in the salivary glands causing pain + swelling (aka meal time syndrome); often affects submandibular gland
What is SialadenITIS?
= enlargement of 1 or more salivary glands due to infection, inflammation or obstruction
Commonly affects submandibular + parotid glands
Aetiological factors: 1) Sjrogens 2) Sarcoidosis
(so in siaLADenitis there is enlargement of the salivary glands due to KNOWN AETIOLOGY)
What is SialadenOSIS (aka Sialosis)?
= Nonspecific salivary gland enlargement
- Typically not painful
- Usually affects parotid gland bilaterally
- UNKNOWN AETIOLOGY (not rx to infection, inflammation or neoplasm) therefore, investigations will come back normal, we don’t know why the enlargement is there; thus reported as sialosis when seen on ultrasound
However, generally associated with:
- eating disorders (bulimia bullosa)
- medication
- alcohol abuse
- nutritional deficiencies
- diabetes
- pregnancy
(overall, if salivary gland enlargement with unknown aetiology we call it sialadenosis/sialosis)
What are two types of salivary gland tumours?
- Malignant (epithelial or non-epithelial)
- Benign (epithelial or non-epithelial)
What is the most common type of benign salivary gland tumour?
Pleomorphic adenoma
State all key facts about pleomorphic adenoma:
= most common salivary neoplasm
- 60-70% parotid neoplasm (if parotid then likely benign)
- 40-60% submandibular (50:50 benign or malignant)
Presentation:
-slowing growing painless mass, smooth + mobile
- larger tumours usually bumpy + overlaying mucosa/skin may be swollen
- pain + facial nerve palsy = rare (only when tumour is infected/ infarction)
Pathology:
- there is a diversity in cell type + pattern
- Chondromyxoid matrix (major=well capsulated, minor= not well-capsulated)
Tx:
surgical excision- important to remove the whole tumour + gland (incomplete removal/spillage –> inc.risk of reoccurrence + malignant metastases)
Prognosis:
- very low reoccurrence if completion resection
- 6% chances of malignant transformation of pleomorphic adenoma = ex-pleomorphic adenoma
State all key facts about Carcinoma ex-pleomorphic adenoma:
= rare ~ 3.6% of salivary gland neoplasms (generally poor prog.)
= long standing (or is a recurrent pleomorphic adenoma)
= Rapid growth occurs in a parotid gland swelling that has been present a white
Signs of malignancy:
Pain, ulceration, nerve involvement, fixation
Most tumours= high grade adenocarcinoma (typically of salivary gland)
Classification:
1) Intracapsular - still confined to pleomorphic adenoma capsule; good prognosis
2) Minimally invasive- ~5mm extension beyond PA border
3) Widely invasive- >6mm extension beyond PA border; poor prognosis
State all key facts about Warthin tumour:
Warthin tumour =benign tumor in the salivary glands
Location: MOSTLY parotid gland (less likely in intra/peri parotid lymph nodes)
Appearance: multifocial, bilateral, in assoc. w/ other salivary gland neoplasms
Demographic: 60-70yrs, M>F, assoc. w/ smoking
Features: Painless, slow-growing, fluctuating swell. Pain + facial nerve palsy rare - only if tumour is infected (metaplastic)
Pathology:
Epithelial cells: The tumor has a double layer of oncocytic epithelium with a papillary, glandular-cystic, and/or solid growth pattern.
Lymphoid stroma: The tumor has a dense lymphoid stroma with lymph follicles (germinal centers).
Fibrous capsule: The tumor has a pink and homogenous fibrous capsule.
Cystic spaces: The tumor has cystic spaces filled with debris.
Tx: Curable w good prognosis, complete surgical excision w/ adequate margin
In elderly it is monitored rather than surgically excised
Prognosis: V.low reoccurrence rate + rare malignant transformation
- Can arise from epithelia or lymphoid origin
List 9 systemic diseases that can cause salivary gland conditions?
Sjögren’s syndrome
Diabetes
RA
HIV
Sarcoidosis
End-stage renal failure
GVHD
Scleroderma
Mumps
What is Sjögren’s syndrome?
- an multisystem autoimmune disease of unknown aetiology
Characterised by inflammation of the exocrine glands + lymphocytic infiltration of the salivary glands (xerostomia) + lacrimal glands (xerophthalmia)
Who does Sjögren’s syndrome affect?
Females
Mean age 50 yrs old
10% of SS patients will develop non-Hodgkins lymphoma
What is Lymphoepithelial sialadenitis (LESA) ?
Lymphoepithelial sialadenitis (LESA) is a benign salivary gland lesion often found in patients with Sjögren disease.
What are the two types of SS?
- Primary (“Sicca”) SS: dry eyes, mouth + kerato-conjunctivitis
- Secondary SS: dry mouth + eyes, CT disorder (e.g. primary biliary cirrhosis or systemic sclerosis)
What are signs + symptoms of SS?
- Tiredness
- Joint pain w/out inflammation
- Dry eyes + mouth
- Oral burning sensation
What would you find upon clinical examination of a Sjogren’s syndrome pt?
Cracked lips
Dry, atrophic oral mucosa
No saliva pooling
Atrophic depapillated, fissured tongue
Keratoconjunctivitis = eye dryness+ conjunctivitis
Salivary gland enlargement (usually bilateral + affecting parotid ~30% of pts)
Difficulty wearing dentures, chewing, speaking, taste sensation, interrupted sleep, halitosis
State the key histopathological changes in SS?
- Foci of lymphocytic infiltration, glandular atrophy, formation of lympho-epithelial islands
Lymphocytic infiltrates: These infiltrates are the hallmark of Sjögren’s syndrome. They can be found around the ducts of the salivary glands.
B-cell hyperactivity: Parotid glands of patients with Sjögren’s syndrome show more evidence of B-cell hyperactivity than labial glands.
Loss of tissue architecture: The inflammation can cause the loss of tissue architecture in the salivary glands.
Acini loss: The number of acini in the salivary glands can decrease or even disappear.
Lining cell proliferation: The lining cells of the salivary glands can proliferate.
Hyaline material accumulation: Hyaline material can accumulate in the lumen of altered ducts and around blood vessels.
State investigations used to diagnose Sjögren’s syndrome?
Tests: Salivary flow rates+ Schirmer eye test
Serology: Increased ESR, autoantibodies
Imaging: US, salography, sialometry, MRI
State management for Sjögren’s syndrome?
No cure- relieve symptoms + prevent complications (oral + lifestyle changes)
- increase water consumption (+ limit tea/coffee)
- Good OH
- Preventative dental care- plaque control, F- varnish, diet advice
- Tx any candidiasis as it can dry out mouth
- Salivary stimulation/ sugar free chewing gums
- Oil MW
- use moistened cottonwool rolls during dental tx
- Smoking + alcohol cessation
- Avoid dry + windy environments (use of humidifier)
- Aqueous creams rather than soaps
- Massage salivary glands to encourage production
- Referral to OM or rheumatology via GP
- Make aware of 10% chance of development of non-Hodgkins lymphoma
- Pharmacological- e.g. PILOCARPINE or HYDROXYCHLOROQUINE
- Non-pharmacological e.g. electrostimulation and acupuncture
What is the key complication of Sjögren’s syndrome?
40x greater risk of B-cell lymphoma (MALT origin)
RF for developing lymphoma:
- autoantibodies
- Myoepithelial sialadenitis (pre-malignant lesion)
- Low complement level
- Monoclonal gammopathies
What investigations can be used to diagnose salivary gland conditions? (general)
1) Salivary assays - whole unstimulated salivary flow, parotid/submandibular stimulated flow rate
2) Blood tests- detect specific autoantibodies (Anti Ro/La)
3) Radiography- sialogram, ultrasound or biopsy
What classification system is used to diagnose and differentiate between primary and secondary SS?
International Classification Criteria for
Sjögren’s Syndrome
Other complications of SS?
- Development of lymphoma
- Heart block in babies
- Eye damage + loss of vision
Exam drive
A 60 year old woman, who is a widow is complaining of dry mouth, which has lasted for several years.
a. What questions would you ask to determine dry mouth?
- Have you had a daily feeling of dry mouth for more than 3 months? N.B. transient dry mouth secondary to dehydration e.g. as a result of sports is common
- Do you drink liquids to aid in swallowing dry food?
- Do you wake up at night to drink liquids?
- Have you had recurrently or persistently swollen salivary glands?
Exam drive
A 60 year old woman, who is a widow is complaining of dry mouth, which has lasted for several years.
b. What other features may she have?
Complications of xerostomia (dry mouth):
* Dental problems - increased risk of caries
* Oral soft tissue disease e.g. Recurrent Aphthous Stomatitis and infections such as candida
* Difficulty speaking and swallowing
* Voice hoarseness
* Dryness of rest of GIT
Exam drive
A 60 year old woman, who is a widow is complaining of dry mouth, which has lasted for several years.
c. Patient informs you she also has Rheumatoid Arthritis - how does this influence your diagnosis and explain the diagnosis
- Patients with Rheumatoid Arthritis are at a higher risk of (secondary) Sjogren’s syndrome, which is an autoimmune disorder whose main symptoms are dry mouth and eyes)
EXAM DRIVE
d. List other medical conditions that cause dry mouth
- Systemic disease: Sjogren’s syndrome (listed above), Diabetes, Thyroid and HIV-related salivary gland disease
- Salivary gland disease: Infection, obstruction, damage (2ry to radiotherapy), tumours and degenerative disease
Other causes:
3. Medications: Antidepressants, Anticonvulsants, Anti-Parkinsonian and Antihistamine drugs
4. Habits: Mouth breathing
5. Dehydration/reduced fluid intake: Sports, caffiene
6. Change in oral perception (due to nerve damage as a result of surgery or trauma) such as Alzheimer’s or Stroke
7. Psychological
8. Age
9. Idiopathic
EXAM DRIVE
e. How would you treat dry mouth symptoms and what advice would you give?
General management:
* Regular dental visits, oral hygiene instructions, fluoride mouthwash
* Diet advice: reduce frequency of sugar intake, avoid caffeine and carbonated drinks, alcohol and tobacco. Avoid strong tasting food that may irritate the mouth. Consider coconut/olive oil rinses
* Sip water frequently especially while eating and speaking
* Use sugar-free gum or sweets to stimulate own saliva
* Artificial saliva to help lubricate the mouth
* Use a humidifier, particularly at night
* Treat/prevent candidiasis
Pharmacological therapies:
* The parasympathetic agent pilocarpine is used in severe dry mouth (e.g. Sjogren’s and after radiotherapy)
Non-pharmacological therapies:
* Acupuncture
* Electrostimulation to induce salivation
EXAM DRIVE
Sjogrens
a. What questions would you ask a patient to determine how much the syndrome is affecting their quality of life?
Relevant questions to ask are:
*Have you had a daily feeling of dry mouth for more than 3 months?
*Do you drink liquids to aid in swallowing dry food?
*Do you wake up at night to drink liquids?
*Have you had recurrently or persistently swollen salivary glands?
EXAM DRIVE
b. List TWO medical conditions that cause dry mouth
- Sjogren’s Syndrome
- Diabetes
Others include: Thyroid disease, Sarcoidosis, Amyloidosis, Liver disease and HIV-related salivary gland disease
EXAM DRIVE
c. What other EXTRA-ORAL features would you expect to see in a patient with dry mouth
Extra-oral:
* Xerophthalmia - dryness of eyes
* Raynaud’s Phenomenon
* Fatigue/fibromyalgia
* Dry skin and dryness of other mucous membranes
* Peripheral neuropathy
Others: Rheumatoid arthritis or other connective tissue disease
EXAM DRIVE
d. What is the dental management of this patient? (Dry mouth)
General management:
* Regular dental visits, oral hygiene instructions, fluoride mouthwash
* Diet advice: reduce frequency of sugar intake, avoid caffeine and carbonated drinks, alcohol and tobacco. Avoid strong tasting food that may irritate the mouth. Consider coconut/olive oil rinses
* Sip water frequently especially while eating and speaking
* Use sugar-free gum or sweets to stimulate own saliva
* Artificial saliva to help lubricate the mouth
* Treat/prevent candidiasis
———————————————————-
* Use a humidifier, particularly at night
Pharmacological therapies:
* The parasympathetic agent pilocarpine is used in severe dry mouth (e.g. Sjogren’s and after radiotherapy)
Non-pharmacological therapies:
* Acupuncture
* Electrostimulation to induce salivation
EXAM DRIVE
e. List TWO medications which cause dry mouth and the mechanism of one of them
- Antihistamines - antimuscarinic action that inhibits the parasympathetic system, which under normal circumstances stimulates saliva secretion. As a result salivary flow is reduced leading to dry mouth
- Antihypertensives e.g. Beta blockers
- Anti-Parkinsonism agents e.g. L-DOPA
EXAM DRIVE
f. List TWO therapies to treat dry mouth
- Pharmacological: Pilocarpine
- Non-pharmacological: Acupuncture and Electrostimulation
EXAM DRIVE
g. What ORAL features would be present? (Dry mouth)
Intra-oral:
* Dry and atrophic mucosa
* No saliva pooling
* Sticky or glassy mucosa
* Oral soreness
Others include: cracked lips, oral burning sensation, +/- dental caries and oral candidiasis
EXAM DRIVE
A 40 year old female comes to see you. She brings a letter from her GP which says that she is being investigated for Sjogrens Syndrome and she would like you to take care of her oral cavity.
a. List FOUR intra-oral (2 marks) and FOUR extra-oral symptoms the patient may present with (2 marks)
Intra-oral: no/little saliva pooling, dry and atrophic mucosa which may be sore
Extra-oral: dryness of eyes (xerophthalmia), Raynaud’s Phenomenon
Full list of intra and extra-oral features
Intra-oral:
* Dry and atrophic mucosa
* No saliva pooling
* Sticky or glassy mucosa
* Oral soreness
Others include: cracked lips, oral burning sensation, +/- dental caries and oral candidiasis
Extra-oral:
* Xerophthalmia - dryness of eyes
* Raynaud’s Phenomenon
* Fatigue/fibromyalgia
* Dry skin and dryness of other mucous membranes
* Peripheral neuropathy
Others: Rheumatoid arthritis or other connective tissue disease
EXAM DRIVE
b. How would you help the patient manage the symptoms? SS (4 marks)
General management:
* Regular dental visits, oral hygiene instructions, fluoride mouthwash
* Diet advice: reduce frequency of sugar intake, avoid caffeine and carbonated drinks, alcohol and tobacco. Avoid strong tasting food that may irritate the mouth. Consider coconut/olive oil rinses
* Sip water frequently especially while eating and speaking
* Use sugar-free gum or sweets to stimulate own saliva
* Artificial saliva to help lubricate the mouth
* Use a humidifier, particularly at night
* Treat/prevent candidiasis
Pharmacological therapies:
* The parasympathetic agent pilocarpine is used in severe dry mouth (e.g. Sjogren’s and after radiotherapy)
Non-pharmacological therapies:
* Acupuncture
* Electrostimulation to induce salivation
EXAM DRIVE
c. List FOUR other medical causes for oral dryness (2 marks)
- Systemic disease: Sjogren’s syndrome (listed above), Diabetes, Thyroid and HIV-related salivary gland disease
- Salivary gland disease: Infection, obstruction, damage (2ry to radiotherapy), tumours and degenerative disease
Other causes:
3. Medications: Antidepressants, Anticonvulsants, Anti-Parkinsonian and Antihistamine drugs
4. Habits: Mouth breathing
5. Dehydration/reduced fluid intake: Sports, caffiene
6. Change in oral perception (due to nerve damage as a result of surgery or trauma) such as Alzheimer’s or Stroke
7. Psychological
8. Age
9. Idiopathic
EXAM DRIVE
d. List THREE ways of imaging the salivary glands and for one modality list the histopathology you would see (6 marks)
- Ultrasound (1st line in all cases): early - normal or enlarged, late - mutlicystic or reticular pattern with atrophy
- Sialography: e.g., DS sialography, which is the gold standard for detection of calculi (i.e. stones) or strictures, indicated when US is inconclusive or normal
- MRI: essential for identifying deep lobe tumours, malignant tumours and any mass in smaller glands
Histopathological findings (with SS):
* Diffuse lymphocytic infiltration causing destruction of acinar cells and ductal epithelium
* Ducts get blocked by inspissated (thickened) material causing pseudocystic acini
* With time larger cyst develop due to parenchymal destruction
* Lymphocyte accumulation may result in solid mass like components
EXAM DRIVE
e. List TWO oral infections the patient is at risk of (2 marks) and state why (1 mark)
- Oral Candidiasis
- Sialadenitis (salivary gland infection)
Saliva plays in an important role (listed below), all of which are diminished when salivary flow rate is reduced:
* Wash food & debris from mouth – lavage
* Act as a buffer (neutralise acid in mouth)
* Defensive & antimicrobial properties
EXAM DRIVE
Mucoceles and Adenoma
A 25 year old male has a 1 cm lesion on the gland area of the lower lip
a. List THREE clinical features if this is a mucocele (3 marks)
Mucocele is the most common benign minor salivary gland lesion caused due to trauma to the excretory duct of the gland
- Location: Lower lip, floor of mouth and buccal mucosa
- Fluctuant, translucent, may discharge, sessile (fixed in one place/immobile), bluish swelling
- Ruptures easily and may recur if damaged gland not excised
- Most common in 2nd decade and most under 30yrs
EXAM DRIVE
b. What histopathology do you expect if this is a mucocele (3 marks)
- Cyst containing mucus and inflammatory cell reaction
– Macrophages - Lined by condensed granulation tissue
- May become fibrous if long standing
EXAM DRIVE
c. What treatment would you carry out as a dentist? (2 marks) (for removal of mucocele)
- Surgery: excision and primary closure
– Include underlying minor salivary gland - Recurrence - cryotherapy
EXAM DRIVE
d. Name one other site where a mucocele can present (2 marks)
- Floor of mouth
- Buccal mucosa
EXAM DRIVE
e. This lesion could be a pleomorphic adenoma. What are the histopathological characteristics of a pleomorphic adenoma? (4 marks)
Histological characteristics:
* Highly variable in apperance (even within individual tumours) - hence the name pleomorphism
* Diverse histological patterns of epithelium and connective tissue (most characteristic feature of this neoplasm)
* Incomplete capsule (not enveloped but surrounded by a fibrous pseudocapsule of varying thickness)
* Biphasic
* Polygonal epithelial and spindle-shaped myoepithelial elements
* Extends through normal glandular parenchyna in the form of finger-like pseudopodia
EXAM DRIVE
f. Where are pleomorphic adenomas commonly found? (1 marks)
Parotid gland (followed by minor salivary glands of the hard palate and upper lip)
EXAM DRIVE
g. What are the clinical features of a pleomorphic adenoma? (2 marks)
- Most common benign salivary gland tumour
Clinically presents as:
* Slow growing
* Asymptomatic (although depending on the stage symptoms may occur, such as those listed below)
* Mostly found in the (tail) of the parotid gland, followed by the minor salivary glands of the hard palate and the upper lip
Symptoms may include:
* A lump or swelling on neck or inside mouth (in areas listed above)
* Numbness in part of face
* Muscle weakness on one side of face
* Persistent pain in the area of a salivary gland
* Difficulty swallowing
* Difficulty opening mouth
EXAM DRIVE
h. If this was a squamous cell carcinoma of the lower lip how would it present. (2 marks) Why is this unlikely to be a squamous cell carcinoma? (1 marks)
- Sun exposed sites eg face, neck, forearm, hand
- Starts within an area of ‘actinic keratosis’ as a small papule – ulcerates-crusts
- Patient age and no apparent risk factors for developing SSC
