Salivary gland disease (1st test material only) Flashcards
What is a mucocele/ranula?
It’s the swelling that occurs due to a ruptured salivary gland duct with spillage of mucin into the surrounding tissue
Is a mucocele/ranula common? Does it hurt?
Sure is
sure doesn’t
Ranula comes from the latin word _____. Just kidding, that’s a dumb question. it’s rana. Where does a ranula arise from?
the sublingual gland
Where will a ranula be found?
to the right or left of the midline on the floor of the mouth
How do you treat a mucocele/ranula? Do they recur?
Excise the mucous deposit and the involved gland. You do an unroofing procedure for a ranula. They may recur
What is a sialolith?
stones in the salivary gland
Where does sialolithiasis occur most frequently?
submandibular gland
If a pt. has symptomatic sialolithiasis, what will those symptoms be?
The pt. will complain of swelling of the involved gland prior to or during meals
What causes sialolithiasis?
Who knows…
How do you treat sialolithiasis?
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.
What is acute sialadentitis?
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
What causes acute sialadentitis?
there are both infectious and non infectious causes- bacterial, viral, ductal obstruction
How do you treat acute sialadentitis?
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
What is chronic sialadentitis?
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.
What are the three subtypes of chronic sialadentitis?
Juvenile recurrent parotitis
subacute necrotizing sialadentitis
erythematous nodule of palate
Juvenile recurrent parotitis usually resolves around puberty. What do you do in the meantime to help treat it?
sialoendoscopy and irrigation can help reduce the number of episodes to manage the condition until it resolves
How do you treat subacute necrotizing sialadenitis?
It is self limiting and resolves itself in about 2 weeks
With chronic sialadenitis there are a variety of treatments that you can do. Name some.
antibiotic therapy massage and sialogogues sialoendoscopy with saline irrigation ductal stenting surgical removal of offending gland
Xerostomia-
you know what this is
What is the most common cause of xerostomia in the US?
medication related xerostomia or as others have called it: “polypharmacy”
What are some medications that can cause dryness?
antihistamines
antidepressants
sedatives and anxiolytics
antihypertensive agents
In the xerostomic mouth, the mouth is more susceptible to what?
injury due to lack of lubrication,
candidiasis,
increased dental caries
How do you treat xerostomia?
artificial saliva or lubricants
sialogogues- sugar-free lemon drops
use a sodium fluoride toothpaste nightly
anti fungal therapy as needed
What does BLEL stand for?
Benign lymphoepithelial lesion
What are BLELs associated with?
sjogrens syndrome
Who gets more BLELs?
women
What do BLELs look like clinically?
Unilateral or bilateral swelling of the parotid area is seen. It’s firm and non-tender
With a BLEL, what will the sialograph look like?
blossoms on a tree
On a cellular level, what’s happening with BLELs?
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.
How do you treat the BLEL?
do nothing, low dose radiation, or corticosteroid therapy
Prognosis for BLEL?
good, but malignant transformation of both lymphoid and epithelial components have been reported
Sjogrens can be a continuation of what?
BLELs
Sjogrens has how many forms? what are they?
2 forms: primary and secondary
What is the primary form of Sjogrens?
xerostomia and keratoconjunctivitis sicca
What’s happening in Sjogrens?
autoimmune process that affects salivary and lacrimal glands
Dry mouth is often associated with rampant
cervical caries
With Sjogrens you’ll also get an increased prevalence of ____
oral candidiasis, burning, angular cheilitis, atrophy of dorsal tongue papillae and other things as well
There is no universally accepted criteria for Sjogrens
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
How many questions is this test?
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..
Here’s a good one: patients with Sjogrens syndrome have a ____X increased risk for lymphoma.
44X
How do you manage Sjogrens?
Basically the same way you’d manage xerostomia
Necrotizing sialometaplasia. Sounds terrible, is terrible. How do the lesions progress?
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
The borders of Necrotizing sialometaplasia are____
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
What causes Necrotizing sialometaplasia?
ischemic necrosis
Necrotizing sialometaplasia resembles what in the early stages?
mucoepidermoid cancer or squamous cell carcinoma
The histopathologic features of the Necrotizing sialometaplasia are:
PEH- pseudoepitheliomatous hyperplasia of surface epithelium- it’s a reactive hyperplasia which stimulates squamous cell carcinoma
Where is the necrosis happening in Necrotizing sialometaplasia?
it’s acing necrosis, but the overall architecture of the glands is preserved, squamous metaplasia of the ductal epithelium also occurs,
How do you treat Necrotizing sialometaplasia?
you can do nothing or biopsy it for a definitive diagnosis
Whats the prognosis for Necrotizing sialometaplasia?
excellent, as long as you make sure that there was no invading malignancy present
