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Oral Pathology #2 > Salivary Gland Disease > Flashcards

Salivary Gland Disease Flashcards

1
Q

common cause of oral mucosal swelling in children and young adults that is the rupture of a salivary gland duct with spillage of mucin into the surrounding tissues

A

mucocele/ranula (frog’s belly)

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2
Q

where are mucocele/ranula commonly found?

A

lower lip (82%), buccal mucosa, ventral tongue, floor of mouth

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3
Q

what does a mucocele/ranula look like?

A

non-tender, soft swelling, transulent to bluish to normal color depending on depth of mucus spillage

-pt may have history of repeated swelling and resolution

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4
Q

where does a ranula arise from?

A

sublingual gland

-floor of mouth to the right or left of midline

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5
Q

what do you see microscopically with mucocele/ranula?

A
  • extravasated mucin granulation tissue and variable numbers of inflammatory cells
  • excision of mucous deposit together with involved gland
  • unroofing procedure for ranula and may recur
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6
Q

salivary gland stone that most often affects the submandibular gland and may or may not be symptomatic

A

sialolithiasis

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7
Q

if a sialolithiasis is symptomatic, what does the pt complain of?

A

swelling of involved gland prior to or during meals

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8
Q

what is the cause of sialolithiasis?

A

cause is unclear, may be prompted by chronic sialadentis and partial duct obstruction

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9
Q

what does a radiograph of a sialolithiasis show?

A

hard submucosal mass in soft tissue

-soft tissue film will show an opaque lamellalted structure

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10
Q

what is the tx of sialolithiosis

A
  • inc fluid intake and moist heat to “flush” the stone
  • surgical excision
  • if significant inflammatory damage to the gland, evaluate function to determine if gland should be removed
  • newer techniques may preclude need to remove gland
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11
Q

what are the causes of ACUTE sialadenitis?

A
  • infectious/non-infectious causes
  • bacterial, often penicillinase-producing staph
  • viral, most often mumps
  • ductal obstruction, retrograde infection
  • —associated with xerostomia, may follow GA
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12
Q

what are the clinical features of acute sialadenitis?

A
  • diffuse, painful and tender, UNILATERAL swelling
  • usually parotid
  • purulend exudate exressed from the parotid papilla
  • PAIN, especially around meal times (bc gland is pumping out saliva at this time.
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13
Q

what is the treatment of ACUTE sialadenitis?

A
  • culture and sensitivity if purulence
  • penicillinase-resistant penicillin initially
  • adjust antibiotic depending on culture and sensitivity
  • HYDRATION, HYDRATION, HYDRATION
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14
Q

May follow ACUTE sialdenitis, due to ductal damage

-often associated with sialolithiasis and has multiple subtypes

A

CHRONIC sialodenitis

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15
Q

what are the clinical features of CHRONIC Sialodenitis?

A
  • recurrent episodes of tender swelling of salivary gland, usually submandibular
  • sialography shows “sausage - link” appearance of ductal system
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16
Q

what is the treatment of chronic sialodenitis subtype juvinile recurrent parotitis?

A

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

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17
Q

what is the tx of chronic sialodenitis subtype subacute necrotizing sialodenitis

A

self limiting, resolves in two weeks

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18
Q

what is the tx of overall CHRONIC sialodenitis?

A
  • antibiotic therapy (tetracycline)
  • short-term corticosteroids (analgesics)
  • massage and sialoloues
  • sialoendoscopy with saline irrigation
  • ductal stenting
  • surgical removal of offending gland
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19
Q

what is xerostomia associated with?

A

glandular hypofunction

-other causes include meds, radiation therapy with salivary glands in the field, sjogren syndrome, and graft vs host disease

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20
Q

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

A

meds (esp polypharmacy)

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21
Q

what are 4 main meds that cause xerostomia?

A
  • antihistamines
  • antidepressants
  • sedatives and anxiolytic agents
  • antihypertensive agetns
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22
Q

what does xerostomia dryness result in?

A
  • mucosa that is suseptible to injury due to lack of lubrication
  • candadiasis
  • inc dental caries
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23
Q

what is the tx for xerostomia

A
  • artificial saliva/lubricants
  • sialologues - sugar free lemon drops (salagen or evoxac)
  • 1% neutral sodium fluoride gel or toothpaste nightly
  • antifungal therapy as needed
24
Q

if alone, may represent an isolated from of Sjogren Syndrome, or it may be associated with sjrogen syndrome
-recent data suggests that a portion the infiltrate is monoclonal, perhaps representing low grade lymphoma in situ

A

Benign lymphoepithelial lesion (BLEL)

25
Q

who is most likely to get BLEL?

A

-females, middle aged or older

26
Q

where is BLEL usually found?

A

-unialteral or bilateral firm, non-tender swelling of the parotid area is seen

27
Q

what does a sialography of BLEL look like?

A

a “blossoms on a tree” pattern of punctate sialectasis os often observed

28
Q

destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infilltrate

A

BLEL

29
Q

what do you need to identify BLEL?

A

epimyoepithelial islands which probably represent residual ductal structures

*can be seen in lymphoma as well unfortunately

30
Q

what is the tx for BLEL?

A
  • varies from doing nothing to low-dose radiation or corticosteroid therapy
  • depends on how much the appearance of the lesion bothers the pt
31
Q

what is the px of BLEL?

A

good, but malignant transformation of both the lymphoid component or the epithelial component has been replaced

32
Q

has been thought of as continuation of BLEL and exists in two forms (primary and secondary)

A

sjogren syndrome

33
Q

what is primary sjogren syndrome?

A
  • “sicca syndrome”

- xerostomia and keratoconjunctivitis sicca

34
Q

what is secondary sjogren syndrome?

A

sicca syndrome plus and other autoimmune disease such as:

  • rheumatoid arthristis
  • SLE
  • hasimoto’s thyroiditis
  • dermatomyositis
  • mixed connective tissue disease
35
Q

who does sjogren’s syndrome usually affect

A
  • middle aged and older adults although some cases have been reported in children
  • more females than males
36
Q

what type of disease is sjogren’s syndrome

A

autoimmune process affects salivary and lacrimal glands

37
Q

what are the clinical signs of sjogren’s syndrome?

A
  • parotid swelling (BLEL) may or may not be dramatic
  • most pts will complain of dry, gritty feeling in their eyes and a dry mouth (usually associated with rampant cervical caries)
  • inc prevalence of oral candadiasis
38
Q

how do you dx sjogren’s syndrome?

A
  • no universally accepted criteria
  • salivary flow and lacrimal function (schirmer test and rose bengal staining)
  • laboratory (autoantibodies)
  • labial salivary gland biopsy
39
Q

what is the labial salivary gland biopsy technique?

A
  • lower labial mucosa, lateral to midline, uninflamed
  • 1cm incision, parallel to vermillion zone
  • remove at least 5 minor glands through the incision and place them in routine 10% buffered formalin
40
Q

what should you exclude during labial salivary gland biopsy for sjrogen syndrome?

A

lobules of gland exhibiting acinar atrophy and interstitial fibrosis form the assessment, since these are non-specific features related to aging

41
Q

what is the typical serology for sjrogen syndrom?

A
  • most of the time it is relatively non-specific

- pts tentd to have an elevated aedimentation rate, elevated levels of ANA and polyhypergammaglobulinemia

42
Q

what is the managment of sjogrens syndrome?

A
  • artificial tears and artificial saliva
  • sialogogues
  • daily topical fluorides for natural teeth
  • antifungal agents for candadiasis
  • if secondary, appropriate therapy should be given the other autoimmune process as well
43
Q

what is the px of sjogren syndrome?

A
  • fair

- patients with sjogren’s syndrome have a 44x increase in lymphoma compared to age-related and sex matched population

44
Q

lesions that usually begin as a swelling may have pain, paresthesia but can be painless

A

necrotizing sialometaplasia

45
Q

what is the etiology of necrotizing sialometaplasia

A

ischemic necrosis

46
Q

who is necrotizing sialometaplasia more common in

A

adults (rare in children)

47
Q

is necrotizing sialometaplasia more common in men or women?

A

men

48
Q

where is the most common location for necrotizing sialometaplasia

A

post hard palate / anterior soft palate

49
Q

what usually are the clinical course of necrotizing sialometaplasia?

A

usually lasts approx two weeks, after which time the pt often reports “a piece of my palate fell out”

50
Q

how long does is take for necrotizing sialometaplaisa to heal?

A

4-6 weeks

51
Q

what are the margins like for necrotizing sialometaplasia?

A

like the cup on a putting green

52
Q

what is necrotizing sialometaplasia often mistaken for?

A

mucoepidermoid carcinoma or SSC

53
Q

what are the histo features of necrotizing sialometaplasia?

A
  • pseudoepitheliomatous hyperplasia of surface epi
  • acinar necrosis, but overall architecture of the glands is preserved
  • squamous metaplasia of the ductal epi, confound to the normal boundaries of the gland
54
Q

what is the tx for necrotizing sialometaplasia?

A
  • do nothing

- biops for definitive dx

55
Q

what is the px for necrotizing sialometaplasia?

A

excellent, but make sure the infarction isn’t due to an invading malignancy in the area

Oral Pathology #2 (4 decks)

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