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Oral Med > Salivary gland disease > Flashcards

Salivary gland disease Flashcards

1
Q

how many minor salivary glands are present?

A

600-1000

located in inner lips/cheek/throat/palate/pharynx

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2
Q

what are the two broad categories of salivary gland disease?

A

neoplastic: benign or malignant

non neoplastic: congenital or aquired

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3
Q

what is silaloithiasis ?

A

calcium rich stones deposits in the salivary glands

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4
Q

what can predispose you to salivary gland stones?

A 
xerostomia
dehydration
antihistamines
antihypertensives
antipsychotics
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5
Q

what are the signs and symptoms of sialolithiasis?

A

painful lump in FOM
Pain worsened on eating
stone can block the glands duct partially or completely

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6
Q

what can salivary stones predispose you to?

A

infection

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7
Q

what is acute supparative sialadentitis?

A

this is an infection of the salivary gland usually caused by staph areus/strep viridans ,

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8
Q

which poeple are commonly affected by sialadentis?

A

older people

following surgery and period of dehydration, poor OH

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9
Q

what are the signs of sialadenitis?

A

tender , painful lump in cheek or under the chin
foul taste
fever and weakness

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10
Q

how do you treat sialedenitis?

A

metronidazole, flucloxicillin

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11
Q

which viral infections can cause salivary gland disease?

A

mumps caused by paramyxovirus

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12
Q

which congenital cysts affect the salivary glands?

A

cysts in parotid gland due to problems related to the ear development before birth

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13
Q

which congenital diseases of the salivary glands exist?

A

aplasia/heterotropic
Stafne defect
cysts

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14
Q

what is a stafne defect?

A

congenital salivary gland disease ectopic portion of salivary gland tissue causing the bone in the mandible to remodel

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15
Q

which acquired diseases of the salivary glands exist?

A 
TIIINMAN
vascular
infective
traumatic
autoimmune
metabolic
inflamm
neurological
neoplastic
idiopathic
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16
Q

Which traumatic lesionsc an cause salivary gland disease?

A

mucoceles/ranula
nicotinic stomatitis

Ranula: 2-3cm in FOM soft blue and fluctuant mucocele from the SM or SL gland

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17
Q

what is nicotinic stomatitis?

A

heat from tobacco causes hyperkeratosis of palate

can also cause inflam of the duct opening of tiny salivary glands on the palate become dialiated

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18
Q

what does nictonic stomatitis look like?

A

red patches or spots on a white background

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19
Q

what infections of the salivary glands can occur?

A

Sialadenitis: inflammation of the Saliavry gland and most common in parotid

bacterial: usually ascending infection from oral cavity
viral: paramyxovirus, HIV
rarely fungal

Management: hydration, AB flucloxillin and metron, analgesia

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20
Q

what inflammatory diseases can affect the salivary glands?

A

irradiation

sarcoidodis

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21
Q

which idiopathic diseases can affect the salivary glands?

A

saliliothiasis and sialosis/sialodenosis

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22
Q

what is sialosis?

A

this is an uncommon, non-inflam, non-neoplastic recurrent swelling of the salivary glands

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23
Q

Which benign neoplasms of the salivary glands are there?

A

PWC
pleiomorphic adenoma
Warthins tumour
Canalicular adenoma

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24
Q

which malignant salivary gland diseases are there?

A

Mucoepidermoid
acinic cell
SCC
adenoid cystic

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25
Q

Which metabolic diseases can affect the salivary glands?

A

diabetes

anaorexia

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26
Q

which autoimmune diseases can affect the salivary glands?

A

Sjrogens

GvHD

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27
Q

how can a benign tumour of the parotid present?

A

painless slow growing lump near earlobe

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28
Q

malignant tumours typically present with which feature?

A

facial nerve weakness

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29
Q

which neurological diseases of the salivary glands are there?

A

freys syndrome

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30
Q

which vascualr lesions of the saliavry glands are there?

A

Necrotising sialometaplasia

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31
Q

what are the three common injuries to the parotid gland?

A

effusion
sialocele
external fistula

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32
Q

what is the treatment for salivary caliculi?

A

conservative management for small stones: promote hydration, sucking on citrus fruits, extracorpeal lithotripsy

invasive: Sialoendoscopy with basket retrieval or fragmentation, surgery

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33
Q

what surgical treatment options are there for SM glands?

A

gland preserving surgery, incision is made through FOM and then through the SM duct to gain access to stone when in distal duct

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34
Q

what surgical treatment is performed for parotid stone?

A

meatotomy this is when you excise the duct and make the opening larger to get the stone out
perfomed when stone in distal duct

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35
Q

when would you perform intra-oral surgery?

A

stone is not palpable I/O

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36
Q

when would you perform extracorpeal lithotripsy?

A

cannot see stone on US

patients with blood dyscrasaias, pregnant or abnormal clotting, undergone stapedectomy or ossicular repair

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37
Q

what proportion of salivary gland tumours account for head and neck tumours?

A

3%

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38
Q

what are the long standing injuries that can occur from salivary gland trauma?

A

effusion
sialocele
external fistula

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39
Q

What is the demographics of necrotising sialometaplsia?

A

more common inmales 3:1 ratio

occurs aged 50 and above

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40
Q

What are the clinical features of sialosis?

A

painless bilateral cheek swelling

peak ages 30-60, more common in women

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41
Q

What is the aetiology behind silaosis?

A

hormonal disturbances: diabetes, hypothyroidism, pregnancy and lactation
malnutrition: protein defciency, alcoholics, bullimia
Drugs: iodine, antihypertensives, isoprenaline

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42
Q

How can we investigate salivary gland disease?

A

Intermittent swelling and persistent swelling US
intermittent swelling associates with meals consider radiography as well as US
If a mass is identified: MRI/CT following US
If a calculus or dilatation or structure identified on US then sialgography

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43
Q

which glands are calculi more common in? and at what percentages?

A

Submanidbular ( 83-94%, 20% have 2 or more)
parotid (4-10%)
SL (1-7%)

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44
Q

what are the causes of obstructive disease?

A

stone or stricture

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45
Q

When are plain films used and how useful are they?

A

intra oral films used to look at duct course
extra-oral films used to look at glands

Not useful and may identify unrelated disease

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46
Q

What percentage of stones are radiolucent?

A

40% of parotid

20% SM

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47
Q

What is the incidence for stones?

A

30-50

2:1 M:F

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48
Q

Which radiographic views could you consider taking for a stone?

A

lower 90

olique lateral or tru lateral

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49
Q

What should be the first choice for investigating salivary gland disease?

A

ULTRASOUND

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50
Q

What are the indications for US?

A

swellings in and around salivary glands
detect stones in SM or Parotid
US guided biopsy
Lithotrotrpisy

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51
Q

What are the contra-indications to US?

A

NONE

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52
Q

When would you use Sialographay?

A 
Following US
symptoms of obstructive disease (stone or stricture)
recurrent infection
sjrogens
prior to interventional procedure
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53
Q

what are the contraindiations of silaogrpahy?

A

allergy to iodine
Acute infection
calculus near orifice
single epiode of problems

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54
Q

What are the advanatges of a sialogram?

A

Excellent imaging of the ductal system

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55
Q

What are the disadvantages of sialogrpahy?

A

LImited infromation about the parenchymal tissue
operator dependant
radition dose

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56
Q

How much contract media is injected into the duct in sialography?

A

0.3-0.5ml

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57
Q

How many x ray films need to be taken when carrying out sialography?

A

a film to establish exposure and any radiopaque calculi
2 films after the sialgroam has been administered at 90 degrees to eachother
film to establish if contrast retained after the sialoggue has been gieven

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58
Q

what should the appearance of the main salivary duct be?

A

uniform dimension

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59
Q

What is the diameter of the SM duct compared with the parotid?

A

SM: 3-4mm
parotid: 1-2mm

60
Q

What should the intraglandular ducts look like for the parotid gland and sm gland?

A

Parotid: tree in winter
SM: bush in winter

61
Q

If there is stenosis in the salivary gland how will this affect the contrast media?

A

the contrast media will be slow to empty and may be reatined

62
Q

If there is a caliculi in the gland how will this affect the contrast media?

A

contrast maybe retained once the sialogoue has been adminstered

63
Q

Which obstructive disease has a filling defect in duct with proximal ductal dilatation (near gland)?

A

caliculi

64
Q

Which obstructive disease has narrowing of the duct with proximal ductal dilatation?

A

Stenosis

65
Q

What are the management options for stricture management?

A

Balloon dilatation

66
Q

When would you use an endoscope?

A

TO break up the stone or to utilise with the basket

67
Q

What is the appearance of the salivary glands radiologically in sjoregns syndrome?

A

Punctate sialectasis

68
Q

what is sialodochitits?

A

Ductal inflammation or infection

69
Q

How does sialodochitis appear radio graphically? what can it be associated with?

A

string of sausages
segmented sacculation or dialatation of the main duct
it can be associated with stenosis or caliculi

70
Q

When would you use a MRI scan in saliavry disease?

A

a suspected mass identified with US

71
Q

When would we use nucelar medicine in salivary gland disease?

A

rarely now

replaced with US

72
Q

When would we use a CT scan in salivary gland disease?

A

persistent mass where MRI contraindicated

73
Q

What percentage of sialoliths occur in the distal third of duct (near orifice) SM?

A

50%

74
Q

What percentage of stones occur within the SM gland?

A

30%

75
Q

What percentage of stones occur within the proximal part of the duct in SM glands?

A

20%

76
Q

What are the causes of silalorrhoea/ptyaliasm?

A

Swallowing problems: Cancer/infection blocking airway
Excessive production: RIley day syndrome
Neuromuscular dysfunction: parkinsons, muscular dystrophy, cerebral palsy, CVA
Anatomical: macroglossia/thrusting
Drugs: anticholinsterases/Clozapine/haloperiodol

77
Q

What are the medical treatment options for excessive saliva?

A

Scopalamine patch (1.5mg)
Glycopyrrolate tablets (1-2mg)
Botox
oral motor training

78
Q

What are the disadvantage of scoplalmine patches?

A

can lead to glaucoma

79
Q

What are the disadvantages of glycopyrolate tablets?

A

Can cause constipation (antocholinergic and antimuscarinic action)

80
Q

What are the surgical treatment options for silorrhoea?

A

GLand excision
Re-route the parotid duct
duct ligation

81
Q

When would you carry out surgery for excess salivation?

A

when symptoms present for more than 6 months

patients that suffer from learning difficulties

82
Q

Which antibiotics would you normaly prescribe for acute parotitis?

A

flucloxacillin or metroinidzaole

83
Q

What are the predisposing factrors for acute parotits?

A 
Caliculi or strictures 
dehydration
xerostomIa
diabetes
history of obstrcutive dieases

And recurrent parotitis of childhood

84
Q

What are the causes of xerostomia?

A

iatrogenic: drugs, radiation, GvHD
Dehydration
Sjoren, Sarcoidodis, Primary biliary cirrhosis
Diabetes, cystic fribrosis, autonomic dysfunction, hyperparathyrosism

85
Q

What investigations would you do in a patient suffering from xerostomia?

A 
Haematological investigations: ESR/C reactive protein
AI immune dieaase: RF, ANA, SSA, SSB
SACE
Serum calcoum and phorphate
blood glucose

US
carlessen critten test (stimulated saliva)
Labial gland biopsy

86
Q

what is the noirmal rate for unstimulated salivary flow?

A

0.1ml

87
Q

What is the normal rate for stimulated saliva flow?

A

> 1ml/min

88
Q

What would the labial gland biopsy show in people with sjrogens?

A

70% have focal lymphocytic infiltration

since there is lymphopcyte mediated destruction of salivary gland

89
Q

which immune cell maybe lacking in people with sjorgens?>

A

t supressor cells

90
Q

What is the implication of lacking t supressor cells?

A

B cells are able to increase which may lead to lymphpoma

91
Q

What happens to the glandular tissue in sjrogens and what happens to the ductal tissue in sjrogens?

A

acina show atrophy

ductal cells multiply and can block the duct forming epimyoepithelial islands

92
Q

What are the causes of hallitotis?

A 
Drugs: Antithyroids, Baclofen, biguanides
resp infection
periodontal diseaae
dry socket
sinusitis
periconronitis
poor OH
ulcers
93
Q

What are the components of salivary glands?

A

Acini-serous or mucous
lipids
ducts
myoepithelial cells

94
Q

the partoid gland is composed of which type of acini?

A

serous

95
Q

The SM gland is composed of?

A

mixed mainly serous

96
Q

the SL gland is composed of?

A

Mixed mainly mucous

97
Q

What are the three types of mucoceless?

A

superfical
extravastion
rentention

98
Q

What is the incidence of salivary cysts?

A

common

2nd-3rd decade

99
Q

What sites do mucoceles occur on?

A 
50% lower lip
cheek
tongue
FOM
rare on upper lip
100
Q

Which type of salivary glands do mucoceles usually arise from? minor and major?

A

minor

101
Q

what is a mucous extrvastion cyst?

A

younger type

duct ruptures and leaks out into the connective tissue and becomes lined by granulation tissue and muciphages

102
Q

What is a retention mucocele?

A

older type and caused by blockage of the duct by a stone for example, it is lined by epithelium

103
Q

What are superficial mucoceles?

A

causes by a subepithelial or intraeputhelial blister

they rupture and leave shallow ulcers

104
Q

Superficial mucoceles are more common in males or females?

A

females

105
Q

What is a adifferntial diagnosis for a subepithelial blister?

A

Pemphigoid, DH, EM, Liner IgA

106
Q

What is a differential for intraeipthelial blisters?

A

pemphigus

107
Q

What are the benign neoplasms of saliavry gland?

A

PWC
pleiomorphic adenoma
Warthins tumour
Canalicicluar adenoma

108
Q

What are predisposing factors for salivary gland tumours?

A

link between salivary gland and breast cancer

109
Q

What is the frequency for salivary gland tumours?

A

Parotid: 73%
Minor glands: 14%
SM gland: 11%
SL: 0.3%

110
Q

What is the percentage malignancy for salivary gland tumours?

A

parotid: 15%
Minor: 46%
SM: 37%
SL: 86%

111
Q

What is a pleiomorphic adenoma?

A

a well circumscribed tumour with a pleiomorphic (mixed) appaerance
slow growing well demarcated and smooth and mobile

112
Q

What is special about the epithelial tissue of a pleiomorphioc adenoma?

A

recognisbale epithelial tissue intermignled with mucoid, myxoiud and chondroid appearance

113
Q

What are the features of pleiomorphic adenoma?

A

commonest salivary gland tumour (65% of parotid)
Affects all ages
2:1 F:M

114
Q

What site do pleiomorphic adeomas usually affect?

A

Palate (most common I/O site)

can present as swelling behind the ear

115
Q

what are the macroscopic features of a pleoimorophic adenoma?

A

Fibrous capsule
capsular invasion
bosselated surface
satellite nodeules

116
Q

What are the microscopial features of a pleimorphic ademona?

A

Epithelial: stands, sheet and duct like

Connective tissue: Mucoid, chondroid and fibrous

117
Q

What complications can arise fro a pleiomorphic adenoma?

A

Recurrence and malignant progression

118
Q

What are the reurrence rates for pleimorphoic adenoma?

A

5 years: 3.4% and 10 years 6.8%

119
Q

Why do pleiomorphic tumours recurr?

A 
diffluant nature
varibale thickness of capsule
intra-tumoural splittins
nodules bulging through capsule
low biological requirement
120
Q

What is a warthins tumour?

A

this is a benign neoplasm of the salivary glands also known as, circumscribed, slow growing, mobile and painless
adenolymphoma
cysctic lymphadenoma
papilliary cyst adenoma lyphomatsum

121
Q

What is a warthins tumour composed of?

A

cystic and glandular structures with a papilliary cystic arrnagemnt

122
Q

What is a warthins tumour lined by?

A

eosinophilic epithelium

123
Q

What is in the stroma of a warthins tumour?

A

lymohoid tissue with follicles

124
Q

What percentage of parotid tumours are warthins?

A

14% of primary epithelial tumours

125
Q

Who is at risk from warthins tumour? where does it affect?

A

50-70 year old males
smoke

5-10% are bilateral and mulitfocal
lower pole of parotid gland

126
Q

what are the macroscopic features of a warthins tumour?

A

Gelatiunous contect

cystic structures with papilliary in growth

127
Q

What are the microscopical features of warthins tumour?

A

double layered, oncocytic, columnar epithelium lining the cysts
lymphoid stroma with germinal follicles
capsule and subcapsular sinus

128
Q

Where do warthins tumour arise from?

A

ectopic salivary gland tissue in the intra or para parotid lymph nodes

129
Q

What are the consequences of warthins tumour?

A

benign

can infarct or become infarct

130
Q

What is a canalicular adenoma?

A 
benign
CALM
Columnar epithelial cells
anastomising bi layered strands
Loose vascular stroma and cysts
Minor glands (90% upper lip, 10% lower lip)
131
Q

what is a mucoepidermoid carcinoma?

A

tumour which has sqaumous cells, mucus secreting type cells and cells of an intermdiate type

132
Q

What is the clincal behaviour of a mucoepidermoid carcnima?

A

variable
Low grade presents as PA
High grade: rapid growth, pain, nerve fixation, unlceration, metastases

133
Q

What is the prevelance of mucoepidermoid carcinomas? which age group does it affect?

A

5-10% of all salivary gland tumours
15% of minor glands

can affect any age

134
Q

What are the microscopial features of a low grade mucoepidermoid carcinoma?

A

large number of mucous cells, small number of epidermoid cells, cysts which rupture, cause inflammation and lead to fibrosis

135
Q

What are the microscopical featurs of high grade mucoepidermoid cancrinoma?

A

Large number of epidermoid cells, small number of mucous cells, solid and causes necrosis

136
Q

What is acinic cells carinoma?

A

cells similar to cerous cells which from solid sheets

small to large cystic spaces

137
Q

What percentage of parotid tumours are affected by acinic cells carcinoma?

A

2%

138
Q

What are the complications of acincic cells carcinoma?

A

they may recurr and metastasise locoregionally

139
Q

what is an adenoid cystic carcinoma?

A

infiltrative malignant tumour which is a cribiforom appearance.
the tumour cells are two types: duct lining cells and myoepthelial cells

140
Q

what are the clinical features of adenoid cystic carcinoma?

A

middle aged to eldery people

slow growing, fixation , ulceration and pain, causes facial nerve palasy and bone destruction

141
Q

What percentage of adenoid cystic carcinomas are seen in parotid gland?

A

3%

142
Q

what percentag of adenoid cystic carcinomas are seen in minor salivary glands?

A

palate

10-15%

143
Q

what are the microscopical features of adenoid cystic carinomas?

A

non encapsulated
surface mophology can be: Cribiform, tubular, solid
Perineural involvment

144
Q

what are the behavioural characteristics of adenoid cystic carcinomas?

A

local invasion (extensive)
peri and intra neural spread
lymoh node invilvement
distant spread to lungs bone and brain

145
Q

what is the 5 and 15 year surival rate for adenoid cystic carcinoma?

A

5 years: 75%

15 years : 13%

Oral Med (31 decks)

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