Salivary Gland Disease Flashcards
Causes of permanent Xerostomia
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
Temporary Xerostomia causes
1 Obstruction of salivary ducts.
- 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
Clinical symptoms of xerostomia usually forgotten
- oral candidiasis
- atrophy of filliform papilla
- residual saliva is thick foamy
Clinical of mumps
- 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
Time of MMR vaccine
- 12 to 15 month
Booster dose 4 to 6 y
Complications of mumps
- orchitis Tinder swollen painful Then atrophy and sterility -oophoritis and mastitis with 25% abortion in 1st trimester -minengioenchephalitis - permanent deafness - pancreatitis nephritis and myocarditis
Mumps virus and its transmission
Paramyxovirus
Saliva
Urine
Respiratory droplets
Acute supportive sialadenitis surgical mumps or postoperative mumps systemic clinical symptoms
Low grade fever headache and malaise
Trismus
Histology of surgical mumps
-acute inflm. Cells in duct and acini
Why not use biopsy or sialography in surgical mumps
It helps spread the infection
Added notes to the histology of chronic sialadenitis
- dilated duct near obstruction
- with fibrosis surrounding the area in this case called chronic sclerosing sialadenitis
Primary vs secondary sjogren
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).
Sjogrens general symptoms
C/P:
- 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
Ocular symptoms of sjogren
- Keratoconjunctivitis
sicca →> tear
Xerostomia
production by the lacrimal glands or failure of tear secretion, lacrimal inflammation and mucoid discharge.,
- 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.
Etiology of sjogren
Lymphocyte-mediated destruction of exocrine glands & may include systemic CT disorders.
Sialography of sjogren
Fruit laden branchless tree
No branching of duct
Lab finding of sjogren
- 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.
Histology of sjogren
- 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
Treatment of xerophthalmia
- sealing the lacrimal punctum to prevent drainage of the lacrimal secretion into the nose
- sealed glasses to prevent evaporation
Where does necrotizing sialometaplasia occur
In junction of soft and hard palate
Rarely other salivary gland sites
necrotizing sialometaplasia etiology
- cutting of blood supply/ischaemia due to trauma surgery or local anaesthesia causing discrete necrosis which lead to squamous metaplasia of remanants duct epi
necrotizing sialometaplasia clinically
- tinder erythematous welling
- break down of mucosa
- formation of deep ulcer with grayish yellow floor that last for 6to 8 w
necrotizing sialometaplasia could be misdiagnosed as..
Sq.c.c
MEC
necrotizing sialometaplasia H/P
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
Post radiation sialadenitis
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),
