Oral Medicine And Pathology Flashcards
What is the meaning of “aplasia”?
Failure to develop normally
What does “atresia” mean?
A condition in which an orifice or passage in the body is closed or absent
What duct is most often affected if atresia of the head and neck occurs?
Submandibular duct
What is heterotrophic salivary gland tissue?
The presence of normal salivary tissue occurring outside of the normal distribution of the major and minor salivary glands
What is a mucocoele?
A cystic filled cavity filled with mucus
what are the two types of mucocoele?
- Extravasation mucocoele (or mucous extravasation cyst)
- Retention mucocoele (or mucous retention cyst)
How does an extravasation mucoceole present clinically?
As a bluish or transparent swelling most commonly affecting minor salivary glands, especially in the lower lip
Trauma is associated with which type of mucocoele?
Extravasation mucoceole
Why does an Extravasation mucocoele form?
Due to a ruptured duct with leakage of saliva into surrounding connective tissue
What protein fills a mucous Extravasation cyst?
Mucin
Why is a mucous Extravasation cyst not classed as a true cyst?
It has no epithelial lining
How would you treat an Extravasation mucocoele?
Initially, treatment is not needed, these lesions can resolve themselves. However, in the case of more troublesome lesions, excision of all of the mucocoele with the associated ruptured duct and gland so to prevent recurrence
How does a mucous retention cyst differ from an Extravasation mucocoele?
The mucin pooling is confined within a dilated excretory duct or cyst, typically due to obstruction. Doesn’t escape into surrounding connective tissue
Which is more common, a mucous extravasation cyst or a mucous retention cyst?
Mucous extravasation cyst
Why is mucous retention cyst likely to present with less inflammation than an Extravasation cyst?
Because the saliva is retained within the duct and doesn’t escape into the surrounding connective tissue
What is the treatment for mucous retention cyst?
Excision
What is a Ranula?
A painlesss soft bluish swelling in the FOM
What is an uncommon form of mucous Extravasation cyst arising from the sublingual gland?
Ranula
What is a “plunging Ranula”?
Arises when the mucin passes through and develops below the mylohyoid muscle as a welling in the neck
How would you treat a Ranula?
Drainage of the cystic cavity and removal of sublingual gland
What is Sialadenitis?
Infection and inflammation of the salivary glands
What are the two most common cause of Sialadenitis?
Bacterial or viral infection
What salivary gland is most often affected by bacterial Sialadenitis?
Parotid gland
What is a major predisposing factor of acute bacterial Sialadenitis?
Decreased salivary flow
What are the frequently associated bacteria of acute bacterial Sialadenitis?
- staphylococcus aureus
- streptococci
- oral anaerobes
What would be the appropriate treatment for acute bacterial Sialadenitis?
Antibiotics after culture/sensitivity testing
What may chronic bacterial sialadenitis be a result of?
Duct obstruction most frequently caused by stones/salivary calculus/mucous plugs
what salivary gland is most likely to be affected by chronic bacterial Sialadenitis?
Submandibular gland
What causes salivary calculi?
Mineralisation of phosphates from supersaturated saliva being deposited around a central nidus of cell debris
What gland is most commonly affected by salivary calculi?
Submandibular
How do salivary calculi elicit an inflammatory response?
Bacteria often grow on the stone surface, causing an inflammatory response
What is the treatment for salivary calculi?
Depends on size and location of stone:
- may be possible to remove or breakdown some stones
- may be necessary to remove the gland, especially if it has become very damaged by longstanding infection
If not treated, what May progressive chronic bacterial Sialadenitis inflammation result in?
Almost complete replacement of salivary parenchyma by fibrous tissue, resulting in a firm mass within the gland.
How would you treat chronic bacterial Sialadenitis?
Aim to remove obstruction, and if not the obstruction and gland should be excised
What is a commonly known viral Sialadenitis infection?
Mumps
what virus causes mumps?
Paramyxovirus
What are the three significant complications that can arise due to mumps?
Orchitis: inflammation of testicles
Oophoritis: inflammation of ovaries
Nephritis: inflammation of kidneys
What are the main characteristics of HIV associated Salivary gland disease?
- causes swelling of major salivary glands
- swelling can be painful and soft to palpate
- multiple cysts can be seen on imaging of glands
What is necrotising Sialometapalsia?
A benign, self-limiting inflammatory reaction that mainly affects the minor salivary glands of the hard palate. It usually presents as a large, deep ulcer.
What is necrotising Sialometaplasia most likely caused by?
Ischaemia or infarction secondary to trauma (e.g. dental injection or hot liquid burn)
What is the treatment for necrotising Sialometaplasia?
None required, it slowly resolves itself.
What is Sjögren’s syndrome?
An autoimmune disease of unknown cause characterised by lymphocytic infiltration and acinar destruction of lacrimal and salivary glands
What are the two forms of Sjögren’s syndrome that exist?
- primary Sjögren’s syndrome
- secondary Sjögren’s syndrome
What are the characteristics of primary Sjögren’s syndrome?
Patients have dry eyes and/or a dry mouth with no associated connective tissue disease
What are the characteristics of secondary Sjögren’s syndrome?
Patients have dry eyes and/or, a dry mouth and a connective tissue disease, e.g. RA
what are the common systemic symptoms of Sjögren’s syndrome?
Fatigue, joint pain and peripheral neuropathy
What do patients with primary Sjögren’s syndrome have an increased risk of developing, in regards to affected glands?
Lymphoma in affected glands
What is the labial gland biopsy test?
A diagnostic test for Sjögren’s syndrome, where a biopsy is taken from the lower lip. It examines focal periductal collections of lymphocytes and a score of one or more is suggestive of Sjogrens.
What may be prescribed by specialists to patients with Sjögren’s syndrome, in order to stimulate saliva production?
Systemic acetylcholine esterase inhibitor pilocarpine
What is Sialadenosis?
A non-inflammatory, non-neoplastic, bilateral, symmetrical swelling if salivary glands
what salivary glands does Sialadenosis predominantly affect?
Parotid glands
what conditions are associated with Sialadenosis?
-malnutrition
- anorexia
- bulimia
-alcoholism
-diabetes mellitus
What does Sialadenosis result in?
Hypertrophy of serous acini
Are tumours (including benign and malignant) more common in major or minor salivary glands?
Major glands
In what salivary gland does 90% of major salivary gland tumours occur?
Parotid
Where is the most common region for minor salivary gland tumours?
Palate (55%)
Are carcinomas more common in major or minor salivary glands?
Minor salivary glands
what are the 4 methods of obtaining tissue to confirm a definitive diagnosis of a salivary gland tumour?
- Fine needle aspiration (FNA)
- Core biopsy
- Open biopsy
- Excision
What diagnostic test for salivary gland tumours is this:
“A needle is used to aspirate cells from the lesion and the cell features examined”
Fine needle aspiration (FNA)
What diagnostic test for salivary gland tumours is this:
“ a larger hollow needle is used to remove a core of tissue”
Core biopsy
What diagnostic test for salivary gland tumours is this:
“ a surgical incision is made then an incisional biopsy of the lesion taken”
Open biopsy
What diagnostic test for salivary gland tumours is this:
“ all of the tumour is removed for diagnosis and treatment”
Excision
Which two diagnostic techniques for salivary gland tumours are quickest and easiest to do but given the limited sampling, can be nondiagnostic?
Fine needle aspiration (FNA) and core biopsy
what are the five current WHO classification categories of salivary gland tumours?
- Malignant tumours
- Benign tumours
- Non-neoplastic epithelial lesions
- Benign soft tissue lesions
- Haematolymphoid tumours
What is a Mucoepidermoid carcinoma?
The most common of the 22 epithelial salivary gland malignant tumours, often affecting the parotids, it is locally invasive and can recur and metastasise.
Fusion of what gene is found in up to 80% of Mucoepidermoid carcinoma cases?
MAML2
What three types of tumour cells make up a Mucoepidermoid carcinoma?
- Mucous-secreting cells
- Epidermiod (squamous) cells
- Intermediate cells
Tumours with high mucous cell numbers tend to be what?
Cystic
Tumours with mainly epidermoid lesions tend to be what?
Solid and often aggressive
How would you treat Mucoepidermoid carcinoma?
Complete excision of tumour
What is the most common type of benign salivary gland tumour?
Pleomorphic adenoma
What are the key features of pleomorphic adenoma?
1.benign
2.painless
3.slow-growing
4.”rubbery” lump
Rearrangements of what two genes is mostly associated with pleomorphic adenoma?
PLAG1 and HMGA2
How would you treat pleomorphic adenoma?
Complete excision
What is the concern if pleomorphic adenoma is incompletely excised?
It has a high recurrence rate and malignant transformation can occur.
what are malignant pleomorphic adenomas known as and what is their prognosis?
Carcinoma ex pleomorphic adenoma, are typically high grade malignancies with poor prognosis
