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4th yr- CMS- The Oral Cavity > Salivary gland disease > Flashcards

Salivary gland disease Flashcards

1
Q

How do we examine the salivary glands

A
  1. Inspect from the front side and behind the patient

2. Palpate the salivary glands

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2
Q

What is the minor salivary gland innervated by

A

Greater petrosal nerve which is a branch of cranial nerve VII
Chorda tympani which is a branch of cranial nerve VII

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3
Q

What is the submandibular gland innervated by

A

Chorda tympani which is a branch of cranial nerve VII

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4
Q

What is the sublingual gland innervated by

A

Chorda tympani which is a branch of cranial nerve VII

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5
Q

What is the parotid gland innervated by

A

Lesser petrosal nerve which is a branch of cranial nerve IX

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6
Q

What is the greater petrosal nerve a branch of

A

Cranial nerve VII

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7
Q

What is the Chords tympani nerve a branch of

A

Cranial nerve VII

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8
Q

What is the lesser petrosal nerve a branch of

A

Cranial nerve IX

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9
Q

How many minor salivary glands are present in the oral mucosa

A

Approximately 450

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10
Q

Where are minor salivary glands found

A

They are distributed throughout the mucosa, including lips, cheeks, palates, floor of mouth and retro molar pad

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11
Q

What is saliva made up of

A
  1. 4% water

0. 6% minerals and proteins

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12
Q

State a normal saliva flow rate in a non stimulated patient

A

0.3-0.4 ml/min

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13
Q

State a normal saliva flow rate in a stimulated patient

A

4-5 ml/min

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14
Q

What are the 3 categories minerals and proteins in saliva fall under

A
  1. Inorganic
  2. Organic
  3. Macromolecules
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15
Q

What is the inorganic part of saliva made up of

A
  1. Sodium
  2. Potassium
  3. Chloride
  4. Bicarbonate
  5. Hydrogen
  6. iodine
  7. Floruide
  8. Thiocynate
  9. Calcium phosphate
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16
Q

What is the organic part of saliva made up of

A
  1. Urea
  2. Uric acid
  3. Amino acid
  4. Glucose
  5. Lactate
  6. Fatty acids
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17
Q

Name the macromolecules found in saliva

A
  1. serum proteins,
  2. glycoproteins, peroxidases,
  3. amylase,
  4. lysozyme,
  5. lipase,
  6. kallikrein,
  7. IgA/G/M,
  8. lipids,
  9. blood group substances,
  10. hormones and carbohydrates
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18
Q

How can we investigate for salivary gland disease

A
  1. Sialometry
  2. Plane film radiography
  3. Ultrasoudns
  4. Bloods
  5. MRIs
  6. Biopsies
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19
Q

When is it indicated to take a venous blood sample

A

In reports of dry mouth

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20
Q

What does a sjogrens screen involve

A
  1. FBC
  2. U&E and LFTs
  3. HbA1C
  4. Serum ACE levels
  5. ANA screen
  6. Serum immunoglobulins and electrophoresis
  7. Hepatitis C serology and HIV serology if clinically suspicious
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21
Q

What is ultrasonography

A

The use of high frequency sound ways

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22
Q

What can we identify through ultrasonography

A
  1. Solid lesions
  2. Cysts
  3. Textural changes in Sjogren’s
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23
Q

What can radiographs of salivary glands identify

A

Radio opaque calculi

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24
Q

What is retrograde sialogrpahy

A

A radiographie examination of the ductal system using radio iodide as a contrast medium

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25
Q

what can retrograde sialogrpahy help us identify

A
  1. Strictures
  2. Sialectasia (ductal dilatation)
  3. Filling defects
  4. Localised, e.g. calculi, mucus plugs
  5. Punctate sialectasis – typical of Sjögren’s Syndrome
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26
Q

What are MRIs of salivary gables good at showing

A

Better demonstrate soft tissue detail

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27
Q

How do we take a biopsy of minor salivary glands

A

Excisional done from an intra oral approach

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28
Q

How do we take a biopsy of major salivary glands

A

Incisional and can be done intra or extra orally

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29
Q

How do we describe salivary gland swellings

A
  1. Localised or generalised
  2. Unilateral or bilateral
  3. Persistent or transient
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30
Q

How do we describe salivary glands

A
  1. Swellings
  2. Pain
  3. Discharge
  4. Decreased saliva
  5. Increased saliva
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31
Q

List salivary gland disease we need to know

A
  1. Obstructive Salivary gland disease
  2. Xerostomia
  3. Sialorrhoea
  4. Sarcoidosis/HIV/GvHD related salivary gland disease
  5. Cancers
  6. Benign neoplasias e.g. pleomorphic adenoma and Warthin’s tumour
  7. Benign cysts/pseudocysts
  8. Acute/chronic sialadenitis
  9. Frey ’s syndrome
  10. Developmental abnormalities e.g. atresia or hypoplasia
  11. Primary and Secondary Sjogren’s syndrome
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32
Q

What is obstructive salivary gland disease due to

A

Calculi, strictures or infections

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33
Q

What does sialadenitis mean

A

Inflammation of the salivary glands

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34
Q

What does sialadenitis need to be further classified into

A

Infective or obstructive

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35
Q

Name the most common cause of obstructive

A

sialadenitis

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36
Q

What is sialadenitis described as

A

hard sludge

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37
Q

What are strictures caused by

A

Nearly always acquired usually following trauma rot duct following fibrosis

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38
Q

How can localised strictures be treated

A

Balloon dilation

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39
Q

What is acute obstruction caused by

A

Usually calculus or mucous plug

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40
Q

What can acute obstruction lead to

A

If chronic damage occurs gland can become more and more damaged and produce less saliva

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41
Q

What is obstructive sialadenitis caused by

A

Usually calculus or mucous plug

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42
Q

What is obstructive sialadenitis characterised as

A

Recurrent pre prandial painful swelling of a major salivary gland

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43
Q

How do we treat asymptomatic calculi

A

Leave it alone

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44
Q

How do we treat symptomatic calculi

A

If small and proximal: remove via incision of the duct and relaxing the stone

If large and more distal: Can be retrieved endoscopically, via lithotripsy

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45
Q

What are the risk associated with removal of the submandibular gland

A
  1. Damage to marginal mandibular nerve
  2. Damage to lingual nerve
  3. Damage to hypoglossal nerve
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46
Q

What can damage to the marginal mandibular nerve lead to

A

Diminished motor innervation of muscles that depress and evert the muscles that elevate the lower lip

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47
Q

What can damage to the lingual nerve lead to

A

Leads to diminished somatic sensory sensations to the lingual tissue3

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48
Q

What can damage to the hypoglossal nerve lead to

A

Leads to diminished motor function to tongue causing tongue to deviate to affected site

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49
Q

What are the risk associated with removal of the parotid gland

A

Damage to the facial nerve

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50
Q

What can damage to the facial nerve lead to

A

Unilateral facial weakness of all branches

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51
Q

What is xerostomia

A

technically means the subjective perception of dry mouth

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52
Q

What is hyposalivation

A

An objective reduced saliva production

53
Q

What can xerostomia be caused by

A
  1. Diabetes mellitus
  2. Iatrogenic damage due to medication
  3. Anxiety related
  4. Mouth breathing
  5. Dehydration
  6. Irradiation to the salivary glands
  7. Acute infections
  8. Recreational drug use
  9. endogenous salivary gland disease
54
Q

How many drugs are known to have dry mouth as a side effect

55
Q

How do some medications lead to dry mouth

A
  1. Central effects in the brain
    2, Anti-muscarinic effects
  2. Symphathomimetics
56
Q

Give examples of prescribed drugs that can cause xerostomia

A
  1. Tricyclic depressants
  2. Antihistamines
  3. Diuretics
  4. Antipsychotics
  5. Antiparkinsonian
57
Q

What advice can we give to patients with dry mouth

A
  1. Smoking cessation
  2. Minimise alcohol intake e
  3. Increase plain water consumption via small frequent sips
  4. Avoid caffeinated drinks
  5. Sugar free chewing gum
  6. Use of high fluoride concentration toothpaste and mouthwash
  7. Avoid cariogenic food
  8. Discourage mouthbreathign
  9. ohi
58
Q

List some saliva substitutes and oral lubricants we can give

A
  1. glandosane
  2. BioXtra
  3. Saliva Orthana
59
Q

What are the disadvantages of glandosane

A

Is acidic so only use in edentulous patients to prevent tooth erosion

60
Q

What are the disadvantages of BioXtra

A

Is made from cows milk proteins so may be unsuitable for patients for due to religion or dietary needs

61
Q

What are the disadvantages of Saliva Orthana

A

It is produced from porcine proteins so may not be acceptable for Muslim or Jewish patients

62
Q

What is Ptyalism

A

Too much saliva

63
Q

What type of sialorrhoea do most patients have

A

Psychogenic usually secondary to anxiety or phobias

64
Q

What is true Ptyalism due to

A
  1. Parkinsons, cerebral palsy, ALS
  2. Acute viral infection
  3. Rabies
  4. Pregnancy
  5. Teething
  6. New dentures
  7. Pancreatitis
  8. Poisoning with mercury, copper, arsenic
65
Q

How do we manage sialorrhoea

A
  1. Anti-muscarinis
  2. Botulinum toxin A (Botox) can be injected into the salivary gland to reduce ACh release and therefore inhibit salivation
  3. Surgical management
66
Q

What is sarcoidosis

A

Chronic multisystem, non-caseating granulomatous inflammatory disease of unknown cause

67
Q

What can sarcoidosis cause

A

Salivary gland swelling or xerostomia

68
Q

What is a rare complication of sarcoidosis

A

Heerfordts syndrome

69
Q

How does Heerfordts syndrome present

A
  1. Chronic pyrexia
  2. Salivary and lacrimal gland swelling
  3. Uveitis
  4. LMN facial nerve palsy
70
Q

What does HIV salivary gland disease involve

A

Uni/ bilateral parotid gland swelling

71
Q

How can HIV affect salivary glands

A

Can cause cystic changes

72
Q

Which gland is most affected in hIV salivary gland disease

73
Q

What does HIV salivary gland disease histologically appear like

A

developmental lymphoepithelial salivary gland cysts

74
Q

What is grant versus host disease (GvHD) caused by

A

Consequence of transplants eg bone marrow transplantation

75
Q

Describe grant versus host disease (GvHD)

A

Is a systemic condition with high mortality and morbidity

Lymphocytes from the donor recognise the recipient cells as foreign and so graft cell attacks the host

76
Q

How does grant versus host disease (GvHD) present

A
  1. Xerostomia
  2. Oral lichenoid lesions
  3. Generalised mucosal inflammation
  4. Candidoses
  5. Oral hairy leukoplakia
77
Q

How common are salivary gland cancers

A

Uncommon They only account fro 2-4% of head and neck tumours

78
Q

Give examples of salivary gland cancers

A
  1. Benign neoplasm

2. Malignant neoplasm

79
Q

What does benign neoplasm include

A
  1. Pleomorphic adenomas

2. Warthin’s tumour

80
Q

What does malignant neoplasm include

A
  1. Primary tumours such as lymphoma
  2. Mucoepidermoid
  3. Adenoid cycstic carcinomas
81
Q

What does secondary neoplasms include

A

Deposits from renal lung cancers

82
Q

When is radiotherapy required

A

May be required for various head and neck primary or secondary malignancies

83
Q

Which cells are most susceptible to radiotherapy damage

A

Serous cells more than mucus cells

84
Q

What can happen to cells damaged by radiotherapy

A

Saliva production drops and the saliva has a thick tenacious quality with altered biochemistry and properties

85
Q

Name the most common benign neoplasia

A

Pleomorphic adenoma (80%)

86
Q

Which salivary gland is most affected by benign neoplasia

87
Q

How are war thins tumours managed

A

Surgical excision

88
Q

What are Mucoceles

A

A cyst of a minor salivary gland

89
Q

Where do cysts of the major salivary glands form

A

Present as a radula in the floor of the mouth

90
Q

How do Mucoceles present

A

As recurrent or persistent fluctuant swellings which transilluminate in the lower lip or buccal mucosa

91
Q

Where on the lips is it suspicious if a Mucoceles forms

92
Q

Why is a Mucoceles on the upper lip a red flag

A

As they are very rare and mostly turn out to be s form salivary gland neoplasia

93
Q

What are the risk of surgical excision of Mucoceles

A

Risks damage to adjacent minor salivary gland

94
Q

What is a ranula

A

It is used to describe a sialocyst arising in the floor of the mouth from one of the sublingual glands

95
Q

How do ranulas present

A

Some are confined within the sublingual gland capsule

Most are unilateral and may raise the tongue

96
Q

How do we manage ranula

A

Marsupialisation

Or rarely excision

97
Q

What can mumps cause

A

dramatic, self-limiting, swelling of glandular tissue with an associated transient xerostomia

98
Q

Which gland is affected by acute sialadenitis

A

mostly parotid

99
Q

Which gland is affected by chronic sialadenitis

A

Mostly submandibular

100
Q

How do we manage acute bacterial sialadenitis

A
  1. Antibiotics
  2. Hydration and anti pyretics
  3. Maintain oral hygiene to reduce the chances of further infection
101
Q

Describe chronic bacterial sialadenitis

A

Chronically inflamed gland that becomes progressively more fibrosed
Intermittent episodes of pain
Occasional expression of pus

102
Q

What Is freys syndrome also known as

A

Gustatory sweating or “auriculotemporal syndrome”

103
Q

When do patients develop Freys syndrome

A

Common after parotid surgery

104
Q

What is Freys syndrome a result of

A

Surgical damage to the autonomic nerves supplying salivary glands and skin sweat glands

105
Q

What can happen in Freys syndrome

A

Mastication can lead to inappropriate stimulation of sweat glands and skin
This is localised facial sweating and flushing

106
Q

How can we manage Freys syndrome

A

Botox injections

107
Q

How does Freys syndrome present

A

Inappropriate facial sweating and flushing in the distraction of the auriculotemporal nerve

108
Q

Name some developmental abnormalities of the salivary glands

A
  1. Atresia

2. Hypoplasia

109
Q

What is atresia

A

Total absence

110
Q

What is hypoplasia

A

Shrunken appearance

111
Q

What is sjogrens syndrome

A

An autoimmune exocrinopathy

112
Q

What does sjogrens syndrome affect

A

Affects internal exocrine tissues in the pancreas, bowel, kidneys and hepatobiliary

113
Q

What is the incidence rate of sjogrens syndrome

114
Q

list the systemic features seen in sjogrens

A
  1. Generalised fatigue
  2. Inflammatory vascular disease
  3. Skin, muscle, joints, serosa, CNS/PNS
  4. Raynaud’s phenomenon
  5. Thyroiditis
  6. Anaemia
115
Q

List soem subjective symptoms in patients with sjogrens syndrome

A
  1. Difficulty swallowing
  2. Sensitivity to spicy food
  3. Altered salty bitter metalic taste
  4. Burning mucosa
  5. Lack or diminished taste
  6. Salivary gland swelling/ pain
  7. Cough
  8. Voice disturbance
  9. Nocturnal discomfort
  10. Altered quality of saliva
116
Q

Describe the tongue in sjogrens syndrome

A

Dry red lobulated and loss of papilla

117
Q

Describe the teeth in sjogrens syndrome

A

Increased caries experience, failed restoration

Frequent tooth/ restoration fractures

118
Q

Describe the salivary glands in sjogrens syndrome

A

firm on palpation if swollen

119
Q

Describe the oral mucosa in sjogrens syndrome

A

dry, atrophic, wrinkled, ulcerated, increased debris, sticky when trying to move mirror around the mouth, frothy saliva, lack of pooling of saliva in the floor of the mouth

120
Q

How do we classify sjogrens syndrome

A

How many of these signs or symptoms the patietn has:

  1. Ocular symptoms
  2. Oral symptoms
  3. Occular signs
  4. Histopathology
  5. Salivary gland involvement
  6. Autoantibodies
121
Q

How is primary sjogrens syndrome categorised

A

Presence of any 4 out of 6 items on the diagnostic criteria list (as long as item IV or VI are present)

OR

Presence of any 3 of II, IV, V or VI

122
Q

How is secondary sjogrens syndrome categorised

A

Well defined CT disease and presence of item I or II plus any 2 forms of III, IV, V

123
Q

What is SICCA syndrome

A

A term used to describe patients who complain of dry eyes and/or dry mouth BUT:

  1. Do not fulfil criteria for sjogrens syndrome
  2. Do not have another recongnised explanation for their symt[poms
124
Q

How do we manage sjogrens syndrom

A
  1. Palliative measures
  2. General health looked after by Rheumatology, Opthalmology and GMP
  3. Therapeutic measures
125
Q

What is palliative management for sjogrens syndrom

A
  1. Increase lubrication
  2. Maintain oral and dental health
  3. Review candida status
126
Q

What is sialosis

A

Painless enlargement of the major salivary glands

127
Q

Describe how sialosis presents

A
  1. Usually bilateral and symmetrical
  2. Usually parotid gland afffected
  3. Soft to palpate
  4. No xerostomia
  5. No fever
  6. No trismus
128
Q

What can sialosis be associated with

A
  1. Alcoholism
  2. Pregnancy
  3. Diabetes
  4. Thyroid disorders
  5. Anorexia or bulimia

4th yr- CMS- The Oral Cavity (6 decks)

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