Non-Neoplastic Salivary Disease

Question 1

What is a mucocele? What are the two types? How do they change over time?

Answer 1

A mucus filled cavity.
Classified as a mucous extravasation cyst (caused by trauma) or a mucous retention cyst.
Early stages = rounded, fleshy swellings
Later stages = cystic, fluctuant, bluish due to thin wall

Question 2

Who are mucous extravasation cysts common in? Where are they commonly found?

Answer 2

Common in children and young adults who traumatise the areas.
Commonly found in the lower lip, floor or mouth, ventral tongue, buccal mucosa, palate, retromolar.

Question 3

Describe how the extravasation cyst occurs?

Answer 3

Trauma causes damage to the salivary duct causing it to rupture.
Saliva is then excreted into surrounding connective tissue and pools there.
Eventually gets surrounded by granulation tissue and inflammatory cells.
Macrophages then infiltrate and degrade the mucin, the duct then heals and a scar remains,

Question 4

What is a ranula and how does it occur?

Answer 4

Mucous extravasation cyst in the floor of the cavity arising from sublingual glands.
- Occurs when there is damage to a sublingual duct
- Sublingual glands produces saliva without any need for stimulation so the ranula can become very large
- Can limit mouth opening, speech and mastication

Question 5

What is a mucus retention cyst and how does this occur?

Answer 5

• retention of mucin in a dilated cyst caused by ductal obstruction
• causes an epithelial lined cavity
• How does it occur? ductal lumen gets obstructed building up pressure behind it, this causes expansion of the duct

Question 6

Where does a mucous retention cyst commonly occur?

Answer 6

Buccal mucosa and palate

Question 6

Explain what sialadenitis is and the difference between acute and chronic

Answer 6

Sialadenitis = salivary gland infection.

Acute = occurs due to viral infection such as mumps (caused by paramyxovirus) or bacterial such as staphylococcus aureus

Chronic = usually caused by duct obstruction leading to a unilateral gland swelling. Typically caused by salivary calculi. Leads to mealtime syndrome.

Question 6

What does a salivary stone consist of?

Answer 6

• Calcium and magnesium phosphate are deposited

Question 6

What occurs in prolonged cases of a salivary stones?

Answer 6

• The gland can become so fibrotic so that it can become hard with no secretion
• Kuttner tumour (end stage sialadenitis = hard stage fibrotic swelling with constant low grade pain with no salivary secretion)

Question 7

What is HIV associated salivary gland disease?
What is the treatment needed?

Answer 7

• Aetiology unknown
• Parotid gland enlargement
• Lymphocyte infiltration and lymphoepithelial cyst formation
• Anti-retroviral or surgical treatment

Question 8

What is sialadenosis and what is the treatment?

Answer 8

• Non inflammatory disorder
• Enlargement of salivary glands due to hypertrophy
• Bilateral
• Commonly associated with diabetes, alcoholism and bulimia
• Treatment = treat the underlying cause

Question 9

What is sarcoidosis and what is the treatment? How does it affect salivary glands?

Answer 9

Multisystem disease leading to non-caseating granulomas.
Mainly affects lungs & lymph nodes - can affect salivary glands e.g. enlargement and xerostomia.
Patient presents with a dry cough and chest discomfort.
Treatment = corticosteroids

Question 10

What is IgG4 sclerosing disease and how does it affect the salivary glands? What is the treatment?

Answer 10

Causes fibrotic masses e.g. pancreatic fibrosis, lung plasma cell granulomas.
Raised IgG4 in many cases.
Mainly affects the parotid gland with a mass which can destroy the gland.
Treatment = corticosteroid therapy