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Oral Medicine > Salivary Gland Disease > Flashcards

Salivary Gland Disease Flashcards

1
Q

Define ‘Agenesis’

A
  • Developmental abnormality
  • Where an organ fails to develop during embryonic growth
  • Due to absence of primordial tissue
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2
Q

Define ‘Atresia’

A
  • Developmental abnormality

- Where an orifice/ passage in body is closed/ absent

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3
Q

Define ‘Aplasia’

A
  • Developmental abnormality
  • Where an organ/ tissues fail to develop or function normally

e.g. ectodermal dysplasia

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4
Q

Define ‘Hypoplasia’

A
  • Developmental abnormality
  • Where an organ/ tissues are underdeveloped or incompletely developed
  • Due to reduced number of cells
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5
Q

What may results as a direct major trauma to the nerves innervating the salivary glands?

A
  • Fraye’s syndrome

- Gustatory facial sweating; instead of producing saliva in mouth

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6
Q

Which nerves of the parasympathetic division of the ANS innervates the salivary glands?

A
  • PAROTID = Glossopharyngeal n. (CN IX); otic ganglion

- SUBMANDIBULAR/ SUBLINGUAL = Facial n. (CN VII); submandibular ganglion

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7
Q

How is a ranula managed?

A
  • Fenestrate & drain

- If recurrence –> surgical removal of that damaged minor salivary gland

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8
Q

Describe the histology of a mucocele

A
  • Cystic cavity containing saliva and macrophages (foam cells; looks like soap bubbles)
  • Surrounded by granulation tissue wall to contain saliva from leaking
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9
Q

What is necrotising sialometaplasia?

A
  • Benign ulcerative vascular lesion of the hard palate
  • Usually painless and self-healing
  • Vasospasm of greater palatine vessels –> ischaemia/ infarction of minor salivary glands
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10
Q

What differentiates necrotising sialometaplasia from a carcinoma?

A
  • Bilateral and symmetrical; v few cancers present like this
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11
Q

What is the aetiology of necrotising sialometaplasia?

A
  1. Small vessel ischaemia/ infarction
  2. Smoking
  3. Trauma
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12
Q

Describe the histology of necrotising sialometaplasia

A
  1. Slough surface
  2. Hyperplasia of surface epithelium (seen as blobs further down from outer surface; ‘pseudo-epitheliomatous hyperplasia’)
  3. Squamous metaplasia of ducts
  4. Necrosis of salivary acini
  5. Inflammation

=> MAY LOOK CANCEROUS but normal cells which are hyperplastic!

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13
Q

Which medications are most associated with dry mouth?

A
  • ANTIMUSCARINICS (anti-acetylcholine drugs; synapse) = Amitriptyline (26% reduction)
  • DIURETICS = Bendroflumethiazide (10% reduction)
  • LITHIUM (bipolar)
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14
Q

Describe the histology of a MINOR salivary gland in a patient with Sjogren’s

A
  1. Focal lymphocytic sialadenitis (focal collection of lymphocytes)
    • -> each collection = 50+ lymphocytes
    • -> at least 1 collection of 4mm2
  2. Acinar loss
  3. Fibrosis
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15
Q

Describe the histology of a MAJOR salivary gland in a patient with Sjogren’s

A
  1. Lymphocytic infiltration extending into WHOLE lobule
  2. Acinar atrophy
  3. Hyperplastic ductal epithelium = MYOEPITHELIAL ISLANDS (eventually occludes duct)
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16
Q

What are some oral complications of Sjogren’s?

A
  1. Oral infections (bacterial; stapyloccocal, fungal; candidal)
  2. Increased caries risk
  3. Functional loss (speaking, chewing, swallowing)
  4. Poor denture retention
  5. Salivary lymphoma (NHL; 1-5%)
17
Q

What can be commonly found in the history of a patient with a subacute duct obstruction?

A
  • Swelling associated with meals
  • Slow and progressive growth
  • Buccal mucosa may feel like gravel
  • Mucoceles may be associated
18
Q

What are the causes of subacute duct obstructions?

A
  1. Sialoliliths (stones)

2. Mucous plugging (slowing down of mucous –> calcify)

19
Q

What investigations can be done for subacute duct obstructions?

A
  • Low dose plain XR (usually submandibular involvement —> lower true occlusal)
  • Sialography (infection free only!)
  • Isotope (if think gland is dead/ stopped functioning)
20
Q

What is the management for subacute duct obstructions?

A
  • Surgical removal of stone
  • Sialogrpahy; ‘washing’ effect (if ‘no stone’ case)
  • Gland removal (fixed swelling)
21
Q

What may a subacute duct obstruction lead to if left untreated?

A

Chronic sialadenitis (infection follows)

22
Q

What are the percentage of salivary tumours for each salivary gland?

A
  • Parotid = 80%
  • Submandibular = 10%
  • Sublingual = 0.5%
  • Minor = 10%
23
Q

What are the percentage of salivary tumours for each salivary gland that are MALIGNANT?

A
  • Parotid = 15%
  • Submandibular = 30%
  • Sublingual = 80%
  • Minor = 45%
24
Q

What are the two types of EPITHELIAL neoplasms found in salivary glands?

A
  • Adenomas

- Adenocarcinomas

25
Q

What are the two types of NON-EPITHELIAL neoplasms found in salivary glands?

A
  • Lymphomas (lymphocytes)

- Sarcomas (CT)

26
Q

Describe the clinical AND histological presentation of a pleomorphic adenoma

A
  • CLINICALLY
    • -> Swelling that is slow growing
    • -> Not fixed to other tissues
  • HISTOLOGICALLY
    • -> ‘Mixed tumour’
    • -> Benign, well-defined
    • -> ‘Duct-like’ structures; myoepithelial cells
    • -> Myxoid and condroid areas
    • -> Fibrous capsule (variable- complete/ incomplete)
27
Q

What is the treatment for a pleomorphic adenoma?

A

Wide local excision (can recur; follow up 5yrs)

28
Q

What are the complications if a pleomorphic adenoma if left untreated?

A

Malignant change –> carcinoma ex-pleomorphic adenoma

29
Q

What is an adenolymphoma?

And which gland is it most commonly associated with?

A
  • Benign cystic tumour of the salivary glands
  • Containing abundant lymphocytes
  • Parotid gland
30
Q

What is the treatment for an adenolymphoma?

A

Excision

31
Q

Describe the histology of adenolymphomas

A
  • Cystic (spaces)
  • Distinctive epithelium (oncocytic)
  • Lymphoid tissue abundant
32
Q

What is a adenoid cystic carcinoma?

A
  • Slow growing malignant neoplasm arising from glandular tissues
  • Commonly seen in minor salivary glands
  • Distinct histology
  • Spread seen = perineural, lymphoid, bone
33
Q

Describe the histology of an adenoid cystic carcinoma

A
  • 3 patterns = cribiform, tubular or solid

- -> Cribiform “swiss cheese” due to cystic spaces

34
Q

What is a mucoepidermoid carcinoma?

A
  • Painless, fixed, slowly growing neoplasm of salivary gland origin
35
Q

Describe the histology of a mucoepidermoid carcinoma

A
  • 3 types of distinct cells seen = squamous (epidermoid), glandular (mucous-secreting) and “intermediate” cells
  • Grading/ differentiation = cystic or solid

Oral Medicine (13 decks)

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