Salivary gland disease (1st test material only)

Question 1

What is a mucocele/ranula?

Answer 1

It’s the swelling that occurs due to a ruptured salivary gland duct with spillage of mucin into the surrounding tissue

Question 2

Is a mucocele/ranula common? Does it hurt?

Answer 2

Sure is

sure doesn’t

Question 3

Ranula comes from the latin word _____. Just kidding, that’s a dumb question. it’s rana. Where does a ranula arise from?

Answer 3

the sublingual gland

Question 4

Where will a ranula be found?

Answer 4

to the right or left of the midline on the floor of the mouth

Question 5

How do you treat a mucocele/ranula? Do they recur?

Answer 5

Excise the mucous deposit and the involved gland. You do an unroofing procedure for a ranula. They may recur

Question 6

What is a sialolith?

Answer 6

stones in the salivary gland

Question 7

Where does sialolithiasis occur most frequently?

Answer 7

submandibular gland

Question 8

If a pt. has symptomatic sialolithiasis, what will those symptoms be?

Answer 8

The pt. will complain of swelling of the involved gland prior to or during meals

Question 9

What causes sialolithiasis?

Answer 9

Who knows…

Question 10

How do you treat sialolithiasis?

Answer 10

With sialogogues- increased fluid intake and moist heat in an attempt to flush out the stone.
Surgical excision is acceptable as well.
If inflammatory damage to the gland has occurred, there is the possibility of excising the gland too.

Question 11

What is acute sialadentitis?

Answer 11

it’s a diffuse, painful, unilateral swelling. Usually the parotid gland- purulent exudate can be expressed from the parotid papilla. Pain occurs, especially around meal times

Question 12

What causes acute sialadentitis?

Answer 12

there are both infectious and non infectious causes- bacterial, viral, ductal obstruction

Question 13

How do you treat acute sialadentitis?

Answer 13

Culture and sensitivity tests if purulent exudate is present and then boom- antibiotic that crap. Usually the bacteria has a penicillinase, so you’ll to use something else

Question 14

What is chronic sialadentitis?

Answer 14

it may follow acute sialadentitis due to ductal damage, but it’s basically recurrent episodes of tender swelling of the salivary gland and you get a “sausage-link” appearance of the ductal system.

Question 15

What are the three subtypes of chronic sialadentitis?

Answer 15

Juvenile recurrent parotitis
subacute necrotizing sialadentitis
erythematous nodule of palate

Question 16

Juvenile recurrent parotitis usually resolves around puberty. What do you do in the meantime to help treat it?

Answer 16

sialoendoscopy and irrigation can help reduce the number of episodes to manage the condition until it resolves

Question 17

How do you treat subacute necrotizing sialadenitis?

Answer 17

It is self limiting and resolves itself in about 2 weeks

Question 18

With chronic sialadenitis there are a variety of treatments that you can do. Name some.

Answer 18

antibiotic therapy
massage and sialogogues
sialoendoscopy with saline irrigation
ductal stenting
surgical removal of offending gland

Question 19

Xerostomia-

Answer 19

you know what this is

Question 20

What is the most common cause of xerostomia in the US?

Answer 20

medication related xerostomia or as others have called it: “polypharmacy”

Question 21

What are some medications that can cause dryness?

Answer 21

antihistamines
antidepressants
sedatives and anxiolytics
antihypertensive agents

Question 22

In the xerostomic mouth, the mouth is more susceptible to what?

Answer 22

injury due to lack of lubrication,
candidiasis,
increased dental caries

Question 23

How do you treat xerostomia?

Answer 23

artificial saliva or lubricants
sialogogues- sugar-free lemon drops
use a sodium fluoride toothpaste nightly
anti fungal therapy as needed

Question 24

What does BLEL stand for?

Answer 24

Benign lymphoepithelial lesion

Question 25

What are BLELs associated with?

Answer 25

sjogrens syndrome

Question 26

Who gets more BLELs?

Answer 26

women

Question 27

What do BLELs look like clinically?

Answer 27

Unilateral or bilateral swelling of the parotid area is seen. It's firm and non-tender

Question 28

With a BLEL, what will the sialograph look like?

Answer 28

blossoms on a tree

Question 29

On a cellular level, what's happening with BLELs?

Answer 29

Destruction of the normal parotid parenchyma that is replaced by a diffuse lymphocytic infiltrate. Key here is something called epimyoepithelial islands- they are present in BLEL.

Question 30

How do you treat the BLEL?

Answer 30

do nothing, low dose radiation, or corticosteroid therapy

Question 31

Prognosis for BLEL?

Answer 31

good, but malignant transformation of both lymphoid and epithelial components have been reported

Question 32

Sjogrens can be a continuation of what?

Answer 32

BLELs

Question 33

Sjogrens has how many forms? what are they?

Answer 33

2 forms: primary and secondary

Question 34

What is the primary form of Sjogrens?

Answer 34

xerostomia and keratoconjunctivitis sicca

Question 35

What's happening in Sjogrens?

Answer 35

autoimmune process that affects salivary and lacrimal glands

Question 36

Dry mouth is often associated with rampant

Answer 36

cervical caries

Question 37

With Sjogrens you'll also get an increased prevalence of ____

Answer 37

oral candidiasis, burning, angular cheilitis, atrophy of dorsal tongue papillae and other things as well

Question 38

There is no universally accepted criteria for Sjogrens

Answer 38

great. Also, there are several slides on excising 5 minor glands and putting them in a solution to test the pt. and see if they actually have Sjogrens, but I haven't included that information in the cards

Question 39

How many questions is this test?

Answer 39

Do we really need to know all of this Sjogrens garbage? It seems like there's a lot of stuff that we wouldn't be involved with in real life, but who's to say, I wasn't in the lecture..

Question 40

Here's a good one: patients with Sjogrens syndrome have a ____X increased risk for lymphoma.

Answer 40

44X

Question 41

How do you manage Sjogrens?

Answer 41

Basically the same way you'd manage xerostomia

Question 42

Necrotizing sialometaplasia. Sounds terrible, is terrible. How do the lesions progress?

Answer 42

Usually they begin as a swelling which persists for 2 weeks (possibility of pain here) and then the pt. reports that "a piece of my palate fell out" and boom- you've got necrotizing sialometaplasia

Question 43

The borders of Necrotizing sialometaplasia are____

Answer 43

sharply marginated. It's a very clearly defined ulcer. It's been described like a golf hole on a putting green. It's that crisp of a border

Question 44

What causes Necrotizing sialometaplasia?

Answer 44

ischemic necrosis

Question 45

Necrotizing sialometaplasia resembles what in the early stages?

Answer 45

mucoepidermoid cancer or squamous cell carcinoma

Question 46

The histopathologic features of the Necrotizing sialometaplasia are:

Answer 46

PEH- pseudoepitheliomatous hyperplasia of surface epithelium- it's a reactive hyperplasia which stimulates squamous cell carcinoma

Question 47

Where is the necrosis happening in Necrotizing sialometaplasia?

Answer 47

it's acing necrosis, but the overall architecture of the glands is preserved, squamous metaplasia of the ductal epithelium also occurs,

Question 48

How do you treat Necrotizing sialometaplasia?

Answer 48

you can do nothing or biopsy it for a definitive diagnosis

Question 49

Whats the prognosis for Necrotizing sialometaplasia?

Answer 49

excellent, as long as you make sure that there was no invading malignancy present