Salivary Gland Disease Flashcards
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
mucocele/ranula (frog’s belly)
where are mucocele/ranula commonly found?
lower lip (82%), buccal mucosa, ventral tongue, floor of mouth
what does a mucocele/ranula look like?
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
where does a ranula arise from?
sublingual gland
-floor of mouth to the right or left of midline
what do you see microscopically with mucocele/ranula?
- 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
salivary gland stone that most often affects the submandibular gland and may or may not be symptomatic
sialolithiasis
if a sialolithiasis is symptomatic, what does the pt complain of?
swelling of involved gland prior to or during meals
what is the cause of sialolithiasis?
cause is unclear, may be prompted by chronic sialadentis and partial duct obstruction
what does a radiograph of a sialolithiasis show?
hard submucosal mass in soft tissue
-soft tissue film will show an opaque lamellalted structure
what is the tx of sialolithiosis
- 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
what are the causes of ACUTE sialadenitis?
- infectious/non-infectious causes
- bacterial, often penicillinase-producing staph
- viral, most often mumps
- ductal obstruction, retrograde infection
- —associated with xerostomia, may follow GA
what are the clinical features of acute sialadenitis?
- 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.
what is the treatment of ACUTE sialadenitis?
- culture and sensitivity if purulence
- penicillinase-resistant penicillin initially
- adjust antibiotic depending on culture and sensitivity
- HYDRATION, HYDRATION, HYDRATION
May follow ACUTE sialdenitis, due to ductal damage
-often associated with sialolithiasis and has multiple subtypes
CHRONIC sialodenitis
what are the clinical features of CHRONIC Sialodenitis?
- recurrent episodes of tender swelling of salivary gland, usually submandibular
- sialography shows “sausage - link” appearance of ductal system
what is the treatment of chronic sialodenitis subtype juvinile recurrent parotitis?
-sialoendoscopy and irrigation can help reduce the number of episodes to manage the condition until it resolves around puberty
what is the tx of chronic sialodenitis subtype subacute necrotizing sialodenitis
self limiting, resolves in two weeks
what is the tx of overall CHRONIC sialodenitis?
- antibiotic therapy (tetracycline)
- short-term corticosteroids (analgesics)
- massage and sialoloues
- sialoendoscopy with saline irrigation
- ductal stenting
- surgical removal of offending gland
what is xerostomia associated with?
glandular hypofunction
-other causes include meds, radiation therapy with salivary glands in the field, sjogren syndrome, and graft vs host disease
what is the most common cause of xerostomia in the US?
meds (esp polypharmacy)
what are 4 main meds that cause xerostomia?
- antihistamines
- antidepressants
- sedatives and anxiolytic agents
- antihypertensive agetns
what does xerostomia dryness result in?
- mucosa that is suseptible to injury due to lack of lubrication
- candadiasis
- inc dental caries
what is the tx for xerostomia
- artificial saliva/lubricants
- sialologues - sugar free lemon drops (salagen or evoxac)
- 1% neutral sodium fluoride gel or toothpaste nightly
- antifungal therapy as needed
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
Benign lymphoepithelial lesion (BLEL)
who is most likely to get BLEL?
-females, middle aged or older
where is BLEL usually found?
-unialteral or bilateral firm, non-tender swelling of the parotid area is seen
what does a sialography of BLEL look like?
a “blossoms on a tree” pattern of punctate sialectasis os often observed
destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infilltrate
BLEL
what do you need to identify BLEL?
epimyoepithelial islands which probably represent residual ductal structures
*can be seen in lymphoma as well unfortunately
what is the tx for BLEL?
- varies from doing nothing to low-dose radiation or corticosteroid therapy
- depends on how much the appearance of the lesion bothers the pt
what is the px of BLEL?
good, but malignant transformation of both the lymphoid component or the epithelial component has been replaced
has been thought of as continuation of BLEL and exists in two forms (primary and secondary)
sjogren syndrome
what is primary sjogren syndrome?
- “sicca syndrome”
- xerostomia and keratoconjunctivitis sicca
what is secondary sjogren syndrome?
sicca syndrome plus and other autoimmune disease such as:
- rheumatoid arthristis
- SLE
- hasimoto’s thyroiditis
- dermatomyositis
- mixed connective tissue disease
who does sjogren’s syndrome usually affect
- middle aged and older adults although some cases have been reported in children
- more females than males
what type of disease is sjogren’s syndrome
autoimmune process affects salivary and lacrimal glands
what are the clinical signs of sjogren’s syndrome?
- 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
how do you dx sjogren’s syndrome?
- no universally accepted criteria
- salivary flow and lacrimal function (schirmer test and rose bengal staining)
- laboratory (autoantibodies)
- labial salivary gland biopsy
what is the labial salivary gland biopsy technique?
- 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
what should you exclude during labial salivary gland biopsy for sjrogen syndrome?
lobules of gland exhibiting acinar atrophy and interstitial fibrosis form the assessment, since these are non-specific features related to aging
what is the typical serology for sjrogen syndrom?
- most of the time it is relatively non-specific
- pts tentd to have an elevated aedimentation rate, elevated levels of ANA and polyhypergammaglobulinemia
what is the managment of sjogrens syndrome?
- 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
what is the px of sjogren syndrome?
- fair
- patients with sjogren’s syndrome have a 44x increase in lymphoma compared to age-related and sex matched population
lesions that usually begin as a swelling may have pain, paresthesia but can be painless
necrotizing sialometaplasia
what is the etiology of necrotizing sialometaplasia
ischemic necrosis
who is necrotizing sialometaplasia more common in
adults (rare in children)
is necrotizing sialometaplasia more common in men or women?
men
where is the most common location for necrotizing sialometaplasia
post hard palate / anterior soft palate
what usually are the clinical course of necrotizing sialometaplasia?
usually lasts approx two weeks, after which time the pt often reports “a piece of my palate fell out”
how long does is take for necrotizing sialometaplaisa to heal?
4-6 weeks
what are the margins like for necrotizing sialometaplasia?
like the cup on a putting green
what is necrotizing sialometaplasia often mistaken for?
mucoepidermoid carcinoma or SSC
what are the histo features of necrotizing sialometaplasia?
- 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
what is the tx for necrotizing sialometaplasia?
- do nothing
- biops for definitive dx
what is the px for necrotizing sialometaplasia?
excellent, but make sure the infarction isn’t due to an invading malignancy in the area
