salivary gland Flashcards
robbins
dry mouth from decrease production of saliva=
xerostomia
in what population is xerostomia most common
> 70 y.o
what is xerostomia most frequently a result of
= side effect of meds= antichol, anti-depressant, anti-psychotic, diuretic, anti-hypertensive, antihistamine
sedative, M relaxant, analgesic
describe the clinical presentation of xerostomia
dry mucosa
atropy of the papillae of the tongue with fissuring and ulcerations
what are some complications secondary to xerostomia
increased rates of dental caries
candidiasis
difficulty swallowing and speaking
what is sialadenitis and what can cause it
inflammation of the salivary gland
can be induced by trauma, infection, autoimmune disese
what are the most common type of inflammatory salivary gland lesion
mucoceles = blockage or rupture of a salivary gland duct resulting in leakage of saliva into surrounding CT
what is the most common form of viral sialadenitis
mumps (paramyxovirus)
What is keratoconjunctivitis sicca?
dry eyes
Where are mucoceles most commonly found?
lower lip resulting from trauma
in what population are mucoceles most common
toddlers, YA, elderly who are more prone to falling
“fluctuant swellings of the lower lip that have a blue translucent hue, and changes in size especially with meals”
mucoceles
[mucoceles] the cystic spaces are filled with ____ and _____
mucin and inflammatory cells (Mø)
what is the treatment of mucoceles
complete removal of the cyst and gland or else will recurr
what is a ranula
Epithelial-lined cysts that arise when duct of sublingual gland has been damaged
= a real cyst
what is a plunge ranula
a cyst that has dissected through the CT stroma connecting the two bellies of the mylohyoid M
what is the connection between sialolithiasis and sialadenitis
nonspecific bacterial sialadenitis (most often of the major salivary glands) is usually secondary to ductal obstruction produced by stones (sialolithiasis)
what are the most common offenders in nonspecific bacterial sialadenitis
S. aureus
strep viridans
decreased salivary secretions caused by dehydration may lead to development of ____ _______ in ____ patients with a recent history of major ____ __ ____ ____
bacterial suppurative parotitis
elderly
thoracic or abdominal surgery
sialolithiasis can be associated with what development
overt suppurative necrosis and abscess formation, unilaterally with a painful enlargement and sometimes purulent ductal discharge
what is the most common benign tumor of the salivary gland
pleomorphic adenoma
what are the two most common malignant tumors of the salivary gland
mucoepidermoid carcinoma
adenocarcinoma
most salivary gland tumors arise within the ____ gland
parotid
the likelihood of a salivary gland tumor being malignant is more or less ____ ___ to the size of the gland
inversely proportional
salivary gland tumors mostly present in ____, with slight __ predominance. warthin tumors more often occur in ____, perhaps due to the historically higher prevalence of ____. benign tumors more often appear in the ____ to _____ decades of life, with malignant ones tending to appear somewhat ____
adults, female
males, smoking
fifth, seventh, later
neoplasms in the parotid glands produce what distinctive physical exam finding
swellings in front of and below the ear, 4-6 cm in diameter and mobile on palpation
____ are benign tumors of the salivary gland consisting of a mixture of ductal (epithelial) and myoepithelial cells, show both ____ and ____ differentiation
pleomorphic adenomas, epithelial and mesenchymal
i.e. epithelial elements, with varying degress of myxoid, hyaline, chondroid, osseous tissue
pleomorphic adenomas are often associated with what gene mutation
PLAG1 overexpression –> upregulates expression of genes that increase cell growth
mass rarely exceeding 6 cm, rounded, well demarcated, encapsulated but expansile growth produces protrusions into the surrounding gland, grey-white with some blue
pleomorphic adenoma
trx for pleomorphic adenoma
total parotidectomy (most are in the parotid gland)
a carcinoma arising in a pleomorphic adenoma is called a _______ and tends to complete ___ the pre-existing pleomorphic adenoma
carcinoma ex pleomorphic adenoma or malignant mixed tumor
overrun and replace
what is the prognosis of a pleomorphic adenoma
mortality rate of 30-50% at 5 years
the second most common salivary gland neoplasm is ____ ___ and it almost exclusively arises in _____
warthin tumor
the parotid gland
in what population will you likely see a warthin tumor
males, 50s-70s, smokers
round to oval encapsulated masses 2-5 cm in diameter, arising in the superficial parotid gland where they are readily palpable.
mucinous or serous secretions
pale gray surface punctuated by narrow cystic or cleftlike spaces lined by double layer of epithelial cells resting on a dense lymphoid stroma
squamous metaplasia with germinal centers
warthin tumors
neoplasms of the salivary gland composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells
mucoepidermoid carcinoma
genetic mutations associated with mucoepidermoid carcinoma
(11;19) (q21;p13) translocation–> MEC1+ MAML2 fusion gene–> perturbs Notch and cAMP dependent signalling
salivary grand tumors that can grow as large as 8 cm, well circumscribed and contain small mucin containing cysts
cords, sheets, or cystic configuration of squamous, mucous, or intermediate cells
mucoepidermoid carcinoma
what is the prognosis of mucoepidermoid carcinomas
low grade= 5 year survival of 90%
high grade= 5 year survival of 50%
anti-RoSSA and anti-LaSSB, decreased amylase in the saliva
sjogren syndome
what is the treatment for mucocele
take out the nodule and its associated minor salivary gland
if not the whole thing, will recur
carcinoma found in minor glands (specifically palatine)
adenoid cystic carcinoma
(tumor in gland) small, poorly encapsulated, gray-pink. the spaces between the tumor cells are often filled with a hyaline material
adenoid cystic carcinoma
describe the progression of adenoid cystic carcinoma
slow growing, tendency to invade perineural spaces, 50% will disseminate to bone, liver, brain
describe the prognosis of adenoid cystic carcinoma
worse in smaller GLANDS
