Salivary Disease - Non-Neoplastic Lesions Flashcards
List the major salivary glands
Parotid
Submandibular
Sublingual
Submandibular gland features?
Mixed (serous and mucus secretion)
60-70% of saliva
Sublingual gland features?
Located in floor of mouth (under tongue)
Mucus secretion
10% of saliva
Parotid gland features?
Preauricular region
Serous secretion
20-40% of saliva
Minor salivary gland features?
Found throughout mouth: - Lips - Palate - Cheeks - Tongue Approx 800 in total Mucus secretion 5-10% of saliva
Examples of non-neoplastic lesions of salivary glands?
Developmental anomalies
Inflammatory: Sialoadenitis
Obstruction and trauma
Developmental anomalies of salivary glands?
Very rare
May see aplasia
Heterotopic salivary tissue: Safne’s bone cavity
Types of sialoadenitis?
Acute - bac or viral
Chronic - bac, post-irradiation, sjogren’s syndrome
Acute parotitis features?
Ascending infection
Linked to oral bac including staph. aureus
Acute swelling and pain
Pus exudes ducts
Usually secondary to dry mouth:
- Drug induced
- Sjogren’s syndrome
- Radiotherapy
Recurrent parotitis in adults?
Recurrent infection secondary to dry mouth 40-60 years old F>M Often unilateral Secondary to xerostomia Due to recurrent ascending infections
Recurrent parotitis in children?
4 months - 15 years old M = F May resolve at puberty Bilateral parotid swelling No obvious cause or predisposing factors Days - weeks duration Sudden onset May be evidence of infection: - Pain, redness, fever Sialography shows punctate sialectasis Reduced salivary flow
Viral sialoadenitis - features of mumps?
Epidemic parotitis Mumps virus - paramyxovirus Incubation period 2-3 weeks Direct or droplet spread Acute bilateral parotid swelling Usually in children Very painful, fever, malaise Self limiting 10-14 days May spread to other glands/organs
Complications of mumps?
Orchitis (30%) Meningitis (10%) Oophoritis (5%) Pancreatitis (5%) Cranial nerve palsies VIII nerve deafness
What is chronic sialoadenitis secondary to?
Chronic sialoadenitis is usually secondary to duct obstruction due to calculi
What is a salivary calculi?
An accumulation of calcium and phosphate salts which deposit in the salivary ducts or gland
- Usually unilateral
- M:F
- Submandibular gland approx 80%: 35% in FoM, 35% in posterior duct, 30% in gland
- Parotid 20%
- Minor glands 1-15%
What is calculus?
Concentric accumulation of calcium salts around cellular debris and mucous
What can salivary duct obstruction by calculus cause?
Obstruction by calculus = saliva retention and inflammation = swelling and fibrosis = fibrosis and loss of function
Radiation sialoadenitis features?
Occurs at doses over 20Gy
High risk of permanent damage over 30Gy
Severe damage at doses of over 50Gy
Serous acini most sensitive
Inflammation and fibrosis of glands
Loss of function
What result from obstruction and trauma to the salivary glands?
Salivary calculi Mucous cysts (mucoceles) Necrotising sialometaplasia
Types of mucoceles?
Mucous extravasation cyst
Mucous retention cyst
Mucocele features?
Usually extravasation cyst Lower lip most common site Painless swelling Rupture and recur Most common in children
Mucous extravasation cyst features?
85% of mucoceles
Younger age groups
Peak 20-30yrs old
Lower lip commonest site (50% plus)
Lined by granulation tissue and fibrous tissue
Due to ruptured duct
Lumen full of mucous and macrophages filled with mucous
Mucous retention cyst features?
15% of mucoceles Older age group 50-60 years old FOM, buccal mucosa Due to blocked duct = dilation and cyst formation Lined by duct epithelium Lumen filled with mucous
Ranula features?
Usually children Usually extravasation cyst Arise in FOM in sublingual gland Painless swelling 2-3cm in size Rupture and recur
Necrotising sialometaplasia features?
Can be mistaken for malignancy Presents as indurated, ulcerated swelling Usually on palate Heals spontaneously in 4-8 weeks Benign inflammatory disease
Necrotising sialometaplasia histology?
Squamous metaplasia of salivary ducts - islands of squamous epithelium deep in CT
Necrosis of acini
