Salivary Gland Disease Flashcards
What are the salivary gland diseases?
- Mucocele/Ranula
- Sialolithiasis
- Acute and Chronic Sialadenitis
- Xerostomia
- Benign Lymphoepithelial lesion (BLEL)
- Sjoren syndrome
- Necrotizing sialometaplasia
- Salivary gland Neoplasia
What is a mucocele/Ranula?
A ruptured salivary duct in which mucin spills into the surrounding tissues.
What is a common cause of oral swelling?
mucocele/ranula
Muccocele/ranula is most often seen in whom?
Children and young adults-but all ages
Where in the oral cavity is a mucocele/ranula seen?
lower lip, buccal mucosa, ventral tongue floor of mouth
Where is the most common site and how often?
- lower lip near #22,27.
- 82% of the time
What are the clinical features of a mucocele/ranula?
-non-tender, soft swelling
-flucuant or firm
-translucent to blue color
-history of repeated swelling and reslolution-superficial
mucocele erupts on own.
Where is a ranula most often located and what is the appearance compared to mucocele?
-located on anterior floor of mouth (FOM) right or left to
midline.
-It appears larger than mucocele
Histopathologically, what is its appearance?
- extravasated mucin
- granulation tissue
- variable mounts of inflammatory cells
How do you treat a mucocele/ranula?
- microscopic exam to rule out neoplasm
- some resolve with no tx
- excision of mucous deposit including involved gland
- marsupilization-unroofing
What is the prognosis for a mucocele/ranula?
- excellent
- occasionally recur if involved gland not excided
What are Sialolithiasis?
- Salivary duct stone
- calcified structures that develop within the salivary ductal system
- Deposition of calcium salts around nidus of debris in lumen
- Cause unclear,may be promoted by chronic sialadentitis and partial duct obstruction
How do Sialolithiasis appear clinically?
- Hard submucosal mas in soft tissue
- may or may not have symptoms
- May have swelling prior or during meals
What is the most common affected gland and how often?
- submandibular gland
- 80% of the time
-can also be affect the parotid or minor glands
What does sialolithiasis like radiographically?
soft tissue appears opaque and lamellated
What is the histological appearance of a sialolithiasis?
- concentric laminations surrounding nidus of amorphous debris
- if associated duct is removed, often demonstrate squamous metaplasia
- periductal inflamation
- acute or chronic sialadenitis of the feeding gland
What is the treatment for sialolithiasis?
-gentle message toward orifice
-sialogogues or sour sugarless candies
-moist heat
-“flush”-increase fluid intake
-surgical removal, may include gland if significant
inflammatory damage
-Lithotripsy, sialendoscopy w/basket retrieval (major
gland)
What is the prognosis for sialolithiasis?
-Minor glands-good
-Major glands-good, but morbidity if gland needs
removal.
What is Acute/Chronic Sialadenitis?
inflammation of the salivary gland
What infectious causes of sialadenitis?
- Bacterial - penicillanase-producing staph
- Viral - mumps
What are non-infectious causes of sialadenitis?
- Ductal obstruction, retograde infection - associated with xerostomia, may follow general anesthesia.
- Chronic may follow acute sialadenitis due to ductal damage.
What are the clinical features/ symptoms of sialadenitis?
- diffuse, painful and tender, unilateral swelling
- pain, especially around meal times
What gland is usually involved during acute sialadenitis?
parotid gland
-purulent exudate expressed from the parotid papilla
What gland is usually involved during chronic sialadenitis?
submandibular gland
Does acute sialadenitis have radiographic or histopathologic features?
No
What are the radiographic features for chronic sialadenitis?
Sialography have “sausage link” appearance due to ductal dilatation.
What are the histopathologic features for chronic sialadenitis?
- chronic inflammatory cell infiltrate
- acinar atrophy, ductal dilatation and fibrosis
What is the treatment for acute/chronic sialadenitis?
- screening radiograph
- culture and sensitivity if purulence
- adjust antibiotic depending on the culture and sensitivity result
- massage
- sialogogues w/ hydration
- ductal stenting
- sialoendoscopy w/ saline irrigation
- surgical removal of affected gland may be needed
What is the prognosis for sialadenitis?
excellent to poor if gland is removed
What is xerostomia?
“dry mouth”
What are the causes of xerostomia?
- glandular aplasia and hypofunction
- radiation therapy
- graft vs. host disease-Sjogren syndrome
- medications (antihistamines,antidepressants,sedatives/anxiolytic agents, anthypertensives)
What does Xerostomia predispose you to?
- mucosa susceptible to injury due to lack of lubrication
- oral candidiasis
- increased caries, especially cervical
How do you treat Xerostomia?
- artificial saliva/lubricants
- sialogogues, sugar-free lemon drops (Salagen-pilocarpine or Evoxac-cevimeline)
- 1% neutral sodium fluoride gel or toothpaste nightly
- antifungal therapy as needed
What salivary gland disease may represent an isolated form of or associated with Sjogren syndrome?
Benign lymphoepithelial lesion (BLEL)
The portion of BLEL that is infiltrated is what?
monoclonal and may represent a low-grade lymphoma in situ
What group of people get Benign lymphoepithelial lesion (BLEL)?
Females,middle aged, and older
What are the clinical signs of Benign lymphoepithelial lesion (BLEL)?
-Unilateral or bilateral, firm, non-tender swelling of the parotid area.
- Sialography: “blossoms on a tree”
- pattern of punctate sialectasis present
What are the histopathologic features in Benign lymphoepithelial lesion (BLEL)?
- Destruction of the normal parotid parenchyma with replacement by diffuse lymphocytic infilrate.
- Remnants of ductal epithelium. “epimyoepithelial islands”
- Epimyoepithelial islands aslo seen in lymphoma
How do you treat Benign lymphoepithelial lesion (BLEL)?
- do nothing
- Low-dose radiation
- Corticosteroid therapy
What is the prognosis for Benign lymphoepithelial lesion (BLEL)?
Good, malignant transformation of lyphoid or epithlial components have been reported.
What type of condition is Sjogren syndrome?
Autoimmune condition
- May be continuous of Benign lymphoepithelial lesion (BLEL)
- primarily in women
- wax & wane
- tx steroid condition
Sjogren syndrome has 2 conditions. T or F
True. Primary (sicca syndrome) and secondary
What is Primary (sicca Syndrome) Sjogren syndrome?
xerostomia and keratoconjunctivitis (dry eyes)
What is Secondary Sjogren syndrome?
Sicca syndrome (primary) plus any other autoimmune disease.
-Ex: rheumatoid arthritis, SLE, Hashimoto’s thyroiditis, mixed connective tissue disease
What are clinical features of Sjogren syndrome?
- middle age to older adults
- female predilection 9:1
- automimmune attackes lacrimal and salivary glands
- parotid swelling (BLEL)
- Patients complain of dry gritty feeling in eyes and dry mouth
What are oral clinical features of Sjogren syndrome?
- cervical/rampant caries
- increase prealence of oral candidiasis
- burning tongue
- angular cheilitis
- atrophy of dorsal tongue papillae
How do you diagnose Sjogren syndrome?
Labaratory: variety of autoantibodies which are characteristic but not specific.
-Nuclear autoantibiodies: Anti-SS-A(anti-Rho) and anti -SS-B (anti-La) may be found in 50% of these patients
Serology: non-specific
-Patients have elevated sedimentation rate, ANA, and polyhypergammaglobulinemia
- International classification criteria for Sjogren syndrome
- Diagnosis of autoimmune condition is a long process
- -Labial salivary gland biopsy
What is the Labial salivary gland biopsy technique for sjogren syndrome?
- lower labial mucosa, lateral midline, uninflammedW
- 1cm incision, parallel to vermilion zone
- Remove at least 5 minor glands through the incision and place them in routine 10% buffered formalin
- Exclude lobules of gland exhibiting acinar atrophy and interstitial fibrosis from the assessment, since these are non-specific features related to aging.
What are the Histopathologic features of Sjogren syndrome?
- Aggregates (foci) of >50 lymphocytes +/- plasma cells scattered throughout glandular parenchyma
- > 1 focus/4 mm consistent with the salivary compaonent of Sjogren syndrome
- (must have 4 foci in thin field of view)
What is the treatment for Sjogren Syndrome?
- artificial tears
- sialogogues-pilocarpine (salagen tablets) or cevimeline (Evoxac)
- Daily topical fluorides for natural teeth
- anti-fungal agents for candidiasis, prn
- For secondary sjogren syndrome, therapy should be given to the other autoimmune process as well
what is the prognosis for Sjogren Syndrome?
FAIR
-Patients with Sjogren Syndrome have a 44x increase in lymphoma compared to age and sex matched population
What causes Necrotizing sialometaplasia?
ischemic necrosis from:
- traumatic injury
- dental injections
- ill-fitted dentures
- eating disorders w/binge-purging
- URI
- adjacent tumor
- previous surgery
Who usually get Necrotizing sialometaplasia?
- Adults, rare in children
- Male predilection
- Most common in Posterior Hard PALATE/Anterior Soft PALATE
What are some clinical features for Necrotizing sialometaplasia?
- swelling +/- pain, paresthesia
- After 2 weeks patient reports, “a piece of my palate fell out”
- sharply demarctated ulcer, non-elevated margins
- minimal peripheral erythema
- Heals 4-6 weeks
- “Margins like the cup on a putting green”
What are the Histiopathologic features for Necrotizing sialometaplasia?
- mistaken for SCC or Mucoepidermoid carcinoma
- -Early stages only lobular ischemic necrosis
- -Pseudoepitheliomatous hyperplasia (PEH) of surface epithelium
- -Nonspecific reactive hyperplasia of stratified mucocutaneaous epithelia, which stimulates SCC
- ACINAR NECROSIS, but architecture of involved glands are preserved
- SQUAMOUS METAPLASIA of the Ductal Epithelium-confined to the normal boundaries of the gland
