Salivary Gland

Question 1

Daily salivary output

Answer 1

1000 -1500ml

Question 2

pH at which Demineralization of tooth enamel is optimal

Answer 2

5 to 5.5

Question 3

Parasympathetic supply of parotid gland

Answer 3

Inferior salivatory nucleus> Glossopharyngeal n > Jacobson n > Otic ganglion

Postganglionic: auriculotemporal br of trigeminal n

Question 4

Parasympathetic supply of sub mandibular gland

Answer 4

Superior salivatory nucleus > nervous intermedius and chorda tympani

Question 5

Areas with highest intraoral flow volume

Answer 5

Mandibular lingual

Question 6

Lowest intraoral volume

Answer 6

Maxillary incisors

Question 7

Specific gravity of saliva

Answer 7

1.002 to 1.0012

Question 8

Principal saliva buffer

Answer 8

Bicarbonate

Question 9

Promotes remineralization of enamel, phosphoprotein

Answer 9

Statherin

Question 10

optimal pH for α-amylase activity

Answer 10

6-8 ; Cl as cofactors

Question 11

the most potent stimuli to the salivary center

Answer 11

Gustatory stimuli

Question 12

Stimuli leading to Greatest increase in salivary flow

Answer 12

Acids

Question 13

Stimuli leading to Least increase in salivary flow

Answer 13

Sweets

Question 14

the least potent stimuli to the salivary center

Answer 14

Olfaction

Question 15

What salivary gland tumors can present bilaterally ?

Answer 15

Warthin Tumor

Lymphoepithelial cyst of HIV

Question 16

is an epithelial-lined retention cyst of the sublingual gland

Answer 16

simple ranula

Question 17

simple ranula ruptures and dissects through the mylohyoid muscle into the submandibular space, it forms a mucocele

Answer 17

Plunging Randal

Question 18

Ultrasound can detect up to 90% of sialolith more than __ mm

Answer 18

2

Question 19

benign lymphoepithelial lesion is characterized by a lymphoreticular infiltrate with acinar atrophy, irregularly placed nuclei, and ductal metaplasia;

Answer 19

Mikulicz Disease

• affects women with 50th to 60th decade of life
• associated with Sjogren syndrome

Question 20

5o-60 Yo female presenting with firm painful sm mass, on FNAB: parenchyma atrophy &a progressive fibrosis

Answer 20

Kuttner tumor, chronic sclerosing sialadenitis

• exclusively in SMG
• increased risk for salivary ductal carcinoma

Question 21

For post abdominal and hip surgery patients when do we expect their risk highest for acute parotitis?

Answer 21

Within two weeks post op

Due to postop dehydration

Question 22

Risk factors for developing Neonatal suppurative parotitis?

Answer 22

Preterm
Male
Dehydration
NGT feeding

Question 23

second most common inflammatory salivary gland disease of childhood after mumps.

Answer 23

Recurrent Parotitis of Childhood (RPC)

Risk factors:
congenital abnormalities or strictures of the Stensen duct and a history of viral mumps, trauma, or foreign bodies within the duct

S.aureus , Strep viridans

Question 24

Patient presenting with acute inflammation and swelling of right parotid gland eventually involving contralateral gland, with prodrome of fever, myalgia, anorexia. Exacerbated pain when eating or chewing

Answer 24

MUMPS

acute bilateral, nonsuppurative, viral parotitis caused by the paramyxovirus

Complications:orchitis, aseptic meningitis, pancreatitis, nephritis, and sensorineural hearing loss

Vaccine: live attenuated Jerry Lyn; after 12mo age, effective for at least five years

Question 25

Patient with history of dental caries , post extraction noted to have progressive swelling of preauricular area with multiple draining sinuses. On smear, (+) gram positive filamentous rods with sulfur granules. Diagnosis & tx?

Answer 25

Actinomycosis 6 weeks IV then 6 months oral Med: penicillin Alternative: clindamycin, doxycycline ,erythromycin

Question 26

Patient with history of cat scratch, progressive enlargement and suppurations of submandibular LAD, what is the etiologic agent?

Answer 26

Bartonella henselae > Cat scratch disease Parinaud oculoglandular syndrome - unilateral conjunctivitis on ipsilateral side of CLAD Self limiting disease in most cases

Question 27

What autoantibodies are present among Sjögren Syndrome patients?

Answer 27

Ro (SS-a), La (SS-b) Xerostomia, C albicans on tongue

Question 28

What drug classes are associated with xerostomia?

Answer 28

Sedatives, antipsychotics, antidepressants, antihistamines, and diuretics

Question 29

3 presentations of Sarcoidosis 1. Major salivary gland involvement 2. Non caseating granuloma of minor salivary gland 3. ?

Answer 29

Heerfordt syndrome/Uveoparotid fever FN palsy and uveitis Do. Biopsy of labial mucosa

Question 30

Most commonly involved location for minor salivary gland neoplasms?

Answer 30

Palate

Question 31

Explain the bicellular stem cell theory (reserve cell theory) of salivary gland tumorigenesis.

Answer 31

Excretory duct cell and intercalated duct cell can be sources of stem cell for neoplasms

Question 32

Explain multicellular theory

Answer 32

Salivary gland neoplasms can arise from various cells making up the salivary gland unit Warthin and oncocytic tumors - Striated duct Mixed tumors from intercalated and myoepithelial cells

Question 33

Milan Staging

Answer 33

``` I. Non diagnostic 25% II. Non Neoplastic 10% III. Atypia of unknown significance (AUS) 10-35% IV. Neoplasm Benign <5% Salivary gland of Unknown Malignant Potential (SUMP) 35% V. Suspicious for malignancy 60% VI. Malignant 90% ```

Question 34

On MRI, this tumor occupies post styloid compartment, displaces carotid artery anteriorly, with serpiginous flow voids. What is the entity and sign?

Answer 34

Glomus tumor ; Salt and pepper appearance

Question 35

Pleomorphic adenoma is the most common benign tumor of the lacrimal gland. It occupies the prestyloid space vs neurogenic or glomus tumors which occupy the post styloid compartment

Answer 35

Both statements are true

Question 36

Risk of malignancy of pleomorphic adenoma?

Answer 36

1.5% within the first 5 years of diagnosis | 10% if observed >15 years

Question 37

Histopathologically, Basal cell adenoma can be mistaken for what salivary gland malignancy?

Answer 37

Adenoid cystic carcinoma

Question 38

What is he microscopic characteristic of Warthin tumor?

Answer 38

Papillae of epithelium into cystic space of Lymphid matrix Other names: papillary cystadenomalymphomatosum, adenolymphoma