Salivary Gland Flashcards
Daily salivary output
1000 -1500ml
pH at which Demineralization of tooth enamel is optimal
5 to 5.5
Parasympathetic supply of parotid gland
Inferior salivatory nucleus> Glossopharyngeal n > Jacobson n > Otic ganglion
Postganglionic: auriculotemporal br of trigeminal n
Parasympathetic supply of sub mandibular gland
Superior salivatory nucleus > nervous intermedius and chorda tympani
Areas with highest intraoral flow volume
Mandibular lingual
Lowest intraoral volume
Maxillary incisors
Specific gravity of saliva
1.002 to 1.0012
Principal saliva buffer
Bicarbonate
Promotes remineralization of enamel, phosphoprotein
Statherin
optimal pH for α-amylase activity
6-8 ; Cl as cofactors
the most potent stimuli to the salivary center
Gustatory stimuli
Stimuli leading to Greatest increase in salivary flow
Acids
Stimuli leading to Least increase in salivary flow
Sweets
the least potent stimuli to the salivary center
Olfaction
What salivary gland tumors can present bilaterally ?
Warthin Tumor
Lymphoepithelial cyst of HIV
is an epithelial-lined retention cyst of the sublingual gland
simple ranula
simple ranula ruptures and dissects through the mylohyoid muscle into the submandibular space, it forms a mucocele
Plunging Randal
Ultrasound can detect up to 90% of sialolith more than __ mm
2
benign lymphoepithelial lesion is characterized by a lymphoreticular infiltrate with acinar atrophy, irregularly placed nuclei, and ductal metaplasia;
Mikulicz Disease
- affects women with 50th to 60th decade of life
- associated with Sjogren syndrome
5o-60 Yo female presenting with firm painful sm mass, on FNAB: parenchyma atrophy &a progressive fibrosis
Kuttner tumor, chronic sclerosing sialadenitis
- exclusively in SMG
- increased risk for salivary ductal carcinoma
For post abdominal and hip surgery patients when do we expect their risk highest for acute parotitis?
Within two weeks post op
Due to postop dehydration
Risk factors for developing Neonatal suppurative parotitis?
Preterm
Male
Dehydration
NGT feeding
second most common inflammatory salivary gland disease of childhood after mumps.
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
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
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
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?
Actinomycosis
6 weeks IV then 6 months oral Med: penicillin
Alternative: clindamycin, doxycycline
,erythromycin
Patient with history of cat scratch, progressive enlargement and suppurations of submandibular LAD, what is the etiologic agent?
Bartonella henselae > Cat scratch disease
Parinaud oculoglandular syndrome - unilateral conjunctivitis on ipsilateral side of CLAD
Self limiting disease in most cases
What autoantibodies are present among Sjögren Syndrome patients?
Ro (SS-a), La (SS-b)
Xerostomia, C albicans on tongue
What drug classes are associated with xerostomia?
Sedatives, antipsychotics, antidepressants, antihistamines, and diuretics
3 presentations of Sarcoidosis
- Major salivary gland involvement
- Non caseating granuloma of minor salivary gland
- ?
Heerfordt syndrome/Uveoparotid fever
FN palsy and uveitis
Do. Biopsy of labial mucosa
Most commonly involved location for minor salivary gland neoplasms?
Palate
Explain the bicellular stem cell theory (reserve cell theory) of salivary gland tumorigenesis.
Excretory duct cell and intercalated duct cell can be sources of stem cell for neoplasms
Explain multicellular theory
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
Milan Staging
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%
On MRI, this tumor occupies post styloid compartment, displaces carotid artery anteriorly, with serpiginous flow voids. What is the entity and sign?
Glomus tumor ; Salt and pepper appearance
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
Both statements are true
Risk of malignancy of pleomorphic adenoma?
1.5% within the first 5 years of diagnosis
10% if observed >15 years
Histopathologically, Basal cell adenoma can be mistaken for what salivary gland malignancy?
Adenoid cystic carcinoma
What is he microscopic characteristic of Warthin tumor?
Papillae of epithelium into cystic space of Lymphid matrix
Other names: papillary cystadenomalymphomatosum, adenolymphoma
