Salivary disease: infective disorders and non-neoplastic lesions Flashcards
Structure of salivary glands (4)
Parotid next to ear
Submandibular
Sublingual
Minor glands throughout the mouth
Describe the parotid gland (4)
Largest
Preauricular
Serous secretion - not as thick
Contributes 20-40% of saliva
Describe the submandibular gland (3)
Smaller in size
Mixed (mucous and serous) secretion - mainly mucous
Contributes to 60-70% of saliva
Describe the sublingual gland (5)
Smallest
Located at the floor of mouth (under tongue) between submandibular gland and tongue
Mucous
Contributes up to 10% of saliva
Describe the minor salivary glands (4)
Found mainly throughout mouth -lips, palate, cheeks, tongue Approx 800+ in total Mucous secretion (EXCEPT von Ebner gland at posterior lateral of tongue is serous) Contributes 5-10% of saliva
Non-neoplastic lesions of salivary glands (not tumours)
subcategories (3)
Developmental anomalies
Inflammatory: sialodenitis (inflammation of salivary glands)
Obstruction and trauma
Non-neoplastic lesions of salivary glands: Developmental anomalies (3)
All very rare
May see aplasia (absence of glands)
• Usually associated with other anomalies or syndromes
Heterotopic salivary tissue: (glands normal but in abnormal place
• Stafne’s bone cavity
• Present under the ID nerve close to the angle of the mandible
• Salivary gland tissue in the wrong location, causes a dent in the mandible
• e.g. Salivary gland tissue in the angle of mandible
Causes of sialodenitis (2)
Acute (always related to the infection):
• bacterial or viral
Chronic:
• bacterial, post-irradiation, Sjogren’s
Bacterial sialodenitis (2)
Acute parotitis: o Ascending infection, ascending upwards into the salivary gland o Oral bacterial (S.aureus) bacteria going into the gland o Acute swelling and pain o Pus exudates from ducts Usually secondary to dry mouth: o Radiotherapy o Sjogren's syndrome o Drug induced - anti-depressants
Two forms of recurrent parotitis (3)
o In adults - recurrent infection secondary to dry mouth
o In children - recurrent Parotitis of childhood (recurrent infection of the parotid gland)
o Both forms are associated with ascending infection, often Staph Aureus
Recurrent parotitis in adults - epidemiology and causes (6)
40-60 f>M Often unilateral Secondary to xerostomia (mirror sticking to the mouth) Due to recurrent ascending infections Often secondary to: • Sjogren's syndrome • Drug-induced dry mouth • Radiation damage
Recurrent parotitis in children - epidemiology and causes (5)
o 4 months - 15 years o M=F o May resolve at puberty o Bilateral o No obvious cause or predisposing factors
Recurrent parotitis in children - signs and symptoms (6)
o Bilateral parotid swellings o Sudden onset o Days - weeks duration o Periods of quiescence o Not suppurative - no pus will come out o May be evidence of infection: • Pain • Redness • Fever
Recurrent parotitis in children - imaging (4)
o Sialography shows punctate sialectasis
o Iodine into salivary duct, if a normal gland would see branching architecture, when there’s damage to the ducts, the iodine leaks out, get a ‘snowstorm’ appearance
o Gradual destruction of acinar elements
o Reduced flow
Recurrent parotitis in children - histology (4)
o Salivary ducts dilated
o Acini produces the saliva that goes into the ducts and then into the mouth
o If there is infection, the acini are the first to get irreversibly damaged
o Inflammatory cells (lymphocytes) present
Viral sialodenitis (mumps) epidemiology (5)
o Epidemic parotitis o Mumps virus (paramyoxovirus) o Now quite rare since MMR vaccine introduced o <1000 cases per year o 2006-08 epidemic
Viral sialodenitis (mumps) incubation period and signs/ symptoms (6)
o Incubation period 2-3 weeks • Direct or droplet spread o Acute bilateral parotid swelling o Usually in children o Very painful, malaise and fever o Self-limiting 10-14 days o May spread to other glands/organs
Complications of mumps (6)
o Orchitis (up to 30%) o Meningitis (10%) o Oophoritis (5%) o Pancreatitis (5%) o Cranial nerve palsies o VIII nerve deafness
Chronic sialodenitis - causes (2)
- Stone forming in gland or secretion really thick - blockage present
- Usually secondary to duct obstruction due to calculi
Salivary calculi - what are they and who do they affect (6)
o An accumulation of calcium and phosphate salts which deposit in the salivary ducts or gland the saliva slows down, produce less/thicker saliva, as a result becomes static and starts to solidify o Usually unilateral o Male : Female 2:1 o Submandibular approx 80% o Parotid 20% o Minor glands 1-15%
Submandibular gland calculi (2)
- Distribution is equal in posterior duct, gland and floor of mouth
- Lower occlusal, standard occlusal x-rays if you think it is in the floor of the mouth
What is a salivary calculus (2)
• Concentric accumulation of calcium salts around cellular debris and mucous - formed in increments
Sequestrae of a salivary calculus (4)
Obstruction by calculus: narrowing of duct, trauma or changes in saliva flow
–>
Saliva retention and inflammation: inflammation destroys the acini, replaced by fibrous tissue that squeezes duct more
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Swelling and fibrosis
–>
Fibrosis and loss of function
Submandibular salivary calculi histology (5)
o Dark purple - serous acini o Light purple - mucous o There are a lot more acini than ducts o Gland with stone o Right: Sialinitis, cant see any acini because they have been destroyed but cans see some ducts, seeing lymphocytes which have destroyed the acini
