Salivary Gland Disease

Question 1

Causes of permanent Xerostomia

Answer 1

Local radiation therapy 2 Sjogren’s syndrome.

3 Sarcoidosis DM & HIV infection.

S Salivary gland aplasia &

atresta 6) Aging

Deficiency of vit A vit 8

Question 2

Temporary Xerostomia causes

Answer 2

1 Obstruction of salivary ducts.

2. Inflammation of salivary glands bacterial & viral

sialadenitis 3. Medications antihypertensive, antidepressant,

antihistaminic. 4. Mouth breathing.
5. Smoking
5. Water & metabolites loss as in hemorrhage, persistent diarrhea, vomiting, dehydration, excessive sweating deficiency which lead to atrophy 7. Psychogenic emotional stress, anxiety, depression. 8. Decreased mastication

Question 3

Clinical symptoms of xerostomia usually forgotten

Answer 3

• oral candidiasis
• atrophy of filliform papilla
• residual saliva is thick foamy

Question 4

Clinical of mumps

Answer 4

• swelling I’m preauricular area
• painful with moving jaw and salivary flow
• tinder
• bi or uni
• 70%parotid rest in other 2
• fever headache malaise anorexia and myalgia
• swelling and redness of stenson Wharton duct opening
• peak swelling at 2 to 3 days and decreases after 10d

Question 5

Time of MMR vaccine

Answer 5

• 12 to 15 month

Booster dose 4 to 6 y

Question 6

Complications of mumps

Answer 6

- orchitis 
Tinder swollen painful 
Then atrophy and sterility
-oophoritis and mastitis with 25%  abortion in 1st trimester
-minengioenchephalitis
- permanent deafness
- pancreatitis nephritis and myocarditis

Question 7

Mumps virus and its transmission

Answer 7

Paramyxovirus

Saliva
Urine
Respiratory droplets

Question 8

Acute supportive sialadenitis surgical mumps or postoperative mumps systemic clinical symptoms

Answer 8

Low grade fever headache and malaise

Trismus

Question 9

Histology of surgical mumps

Answer 9

-acute inflm. Cells in duct and acini

Question 10

Why not use biopsy or sialography in surgical mumps

Answer 10

It helps spread the infection

Question 11

Added notes to the histology of chronic sialadenitis

Answer 11

• dilated duct near obstruction

- with fibrosis surrounding the area in this case called chronic sclerosing sialadenitis

Question 12

Primary vs secondary sjogren

Answer 12

i. Primary Sjogren’s syndrome (Sicca syndrome):

➤Xerostomia and xerophthalmia only..

Cause more severe oral and ocular changes and has a higher risk of

malignancy than the secondary form (lymphoma).

il. Secondary Sjogren’s syndrome:

> Primary form + autoimmune connective tissue diseases (the most common →

rheumatoid arthritis then lupus erythematosus).

Question 13

Sjogrens general symptoms

Answer 13

C/P:

1. Age & sex→ 50 years, females: males (9:1).
   (2) From 1/3 to 1/2 of cases have diffuse firm unilateral or bilateral enlargement

of major salivary glands mainly.parotisl 3) May be slightly painful (intermittent or persistent).

4 Severe tiredness (patient rest or sleep 10-15 hours a day or more).

5 Various other body tissues are affected → dryness of skin, nasal and vaginal mucosa.
It has 2 forma 1ry and 2ry

Question 14

Ocular symptoms of sjogren

Answer 14

1. Keratoconjunctivitis

sicca →> tear

Xerostomia

production by the lacrimal glands or failure of tear secretion, lacrimal inflammation and mucoid discharge.,

2. Patients complain of:

Scratchy, gritty sensation (feeling of a foreign body in the eyes).

Blurred vision and aching pain in eyes.

Less severe manifestation in the morning on wakening & ↑

symptoms as the day progress.

Question 15

Etiology of sjogren

Answer 15

Lymphocyte-mediated destruction of exocrine glands & may include systemic CT disorders.

Question 16

Sialography of sjogren

Answer 16

Fruit laden branchless tree

No branching of duct

Question 17

Lab finding of sjogren

Answer 17

• Laboratory findings:
  i. Rheumatoid factor (RF) is positive in 75% of cases.
  ii. Elevated ESR.
  iii. Elevation of serum immunoglobulin levels. Ig
  iv. Antinuclear antibody (ANA)→ Anti-SS A (Ro) in Secondary SS, anti-SS B (La) in Primary SS.

Question 18

Histology of sjogren

Answer 18

• dense infiltration of L. Around the intralobular ducts
• destruction of acini
• replacement of lobules by lymphocytes
• proliferation of myoepithelial cells and duct epi
• obliterating the duct
• forming epimyoepithelial Islands surrounded by sheets of lymphocytes

Question 19

Treatment of xerophthalmia

Answer 19

• sealing the lacrimal punctum to prevent drainage of the lacrimal secretion into the nose
• sealed glasses to prevent evaporation

Question 20

Where does necrotizing sialometaplasia occur

Answer 20

In junction of soft and hard palate

Rarely other salivary gland sites

Question 21

necrotizing sialometaplasia etiology

Answer 21

• cutting of blood supply/ischaemia due to trauma surgery or local anaesthesia causing discrete necrosis which lead to squamous metaplasia of remanants duct epi

Question 22

necrotizing sialometaplasia clinically

Answer 22

• tinder erythematous welling
• break down of mucosa
• formation of deep ulcer with grayish yellow floor that last for 6to 8 w

Question 23

necrotizing sialometaplasia could be misdiagnosed as..

Answer 23

Sq.c.c

MEC

Question 24

necrotizing sialometaplasia H/P

Answer 24

Necrosis of salivary gland
Not a malignant tumor as
..Preserved lobular architecture
..No signes of dysplasia

There is squamous metaplasia of duct epi

inflammatory cells infiltration

Question 25

Post radiation sialadenitis

Answer 25

If any of the salivary glands is included in the field of therapeutic radiation; irreversible destruction of acini and replacement by fibrous tissue can result.

Serous acini are severely affected while mucous acini are more resistant; the ductal cells

tend to persist longer. As levels of radiation increase → decrease of salivary of salivary flow (xerostomia),