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Oral Medicine & Disease > Salivary gland disease > Flashcards

Salivary gland disease Flashcards

1
Q

function of saliva

A 
clearance
taste - zinc/mucin
remineralisation - phosphate
acid buffeing 
antimicrobial
antifungal
digestion - amylase
lubrication
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2
Q

local causes of dry mouth

A 
mouth breathing
drugs - inhalers for asthma
alcohol
smoking
candidosis
cancer therapy - chemo
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3
Q

systemic causes of dry mouth

A
  • drugs - diuretics/antihypertensive/antidepressants/antipsychotic/benzodiazepines/opiod analgesics/anticonvulsants/ litium/ antimuscarinics (amitriptyline)
  • MH - diabetes/sarcoidosis/sjogren’s syndrome/CF/alzheimer’s/haemochromatosis/HIV/hep C
  • dehydrated
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4
Q

xerostomia - clinical features

A 
jacob's cracker sign - swallowing issues
food stuck to palate
shiny mucosa
>caries
denture control issues
oral malodour
clicking speech
altered taste
oral candidosis
ascending inf of salivary glands
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5
Q

how to assess xerostomia

A
  1. dry mouth - produce unstimulated saliva <1.5ml in 15min
  2. associated tear production issue - schirmer paper in 5 min
  3. bloods - antibodies (ro/la/ana), random blood glucose - esr/crp and FBC
  4. other inv - MRI/ultrasound/chest Rg
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6
Q

what is the challacombe scale of clinical oral dryness

-name the 10 signs

A

additive score of 1-10 - symptoms not progress in order but score up (can be used to monitor)

    1. mirror sticks to buccal mucosa
    1. mirror sticks to tongue
    1. frothy saliva
  • 4.no saliva pooling at FoM
  • 5.generalised shortening of tongue papillae
  • 6.altered gingival architecture
  • 7.glassy appearance of mucosa (palate)
  • 8.tongue fissured/lobulated
  • 9.cervical caries
    1. debris on palate
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7
Q

what is a ranula

A

large FoM mucous extravasation cyst (sublingual)

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8
Q

what is a necrotising sialometaplasia

  • cause
  • most likely patient
  • signs
  • diff diagnosis
  • histological apearance
A

small vessel ishaemia and resultant infarction

  • smoker/trauma/LA
  • Swelling and ulceration. Painless and self limiting
  • -Sq cell carconoma/salivary gland carcinoma
  • Surface slough and hyperplasia of surface ep
  • squamous metaplasia of ducts and necrosis of salivary acini
  • inflamation
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9
Q

systemic disease that can cause dehydration

  • chronic
  • acute
A

Chronic - diabetes mellitus / diabetes insipidus / addison’s disease / renal failure
acute - persistent vomiting/haemorrhage

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10
Q

somatisation symps

A

oral dysaesthesia / headache / neck and back pain

TMD pain/ fibromyalgia / dyspepsia

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11
Q

criteria for sjogren’s

A

subjective dry mouth - >3mth/frequent liquid sip
subjective dry eye - >3mth/tear replacement 3xd
objective dry mouth - unstimulated <1.5ml in 15min
objective dry eyes - schirmer test 5min
histopathology findings (labial minor gland biopsy)
autoimmune findings - anti la/ro

4/6 for diagnosis

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12
Q

positive histopathological findings of salivary gland disease

  • minor
  • major
A

-minor - focal lymphocytic sialadentits/acinar loss/fibrosis
focal collection of lymphocytes >50 lymphocytes,
>1 collection/4mm squared
-major - lymphocytic infiltrate/ epithelial hyperplasia/ atrophy of acina
ductal epithelium hyperplasia eventually occulding duct=myoepithelial islands

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13
Q

sjogren’s syndrome complications

A 
caries
oral candidosis
infection
function loss
denture retention
salivary lymphoma - non hodgkins lymphoma
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14
Q

xerostomia management

A 
alternative drug - liase with GP
regular sips of water
chew sugar free gum
salivary replacement 
stop smoking 
moderate caffiene intake
monitorblood sugar levels
change to SLS free toothpaste
refer if mouth breathing during sleep
drink more water

Prevention - high F conc toothpaste

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15
Q

name 2 types of hypersalivation

A

true - stroke/ degenerative CNS disease - MS/parkinson’s/alzheimers
perceived.

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16
Q

saliva substitutes

A
  • sprays - xerotin/saliveze (pH neutral) glandosane (pH5.75)
  • lozenges - saliva orthana/salivix/saliva stimulating tablets
  • saliva stimulants - pilocarpine
  • oral care systems - biotene oralbalance
17
Q

drugs that cause HYPERsalivation

A

haloperidol/anticholinesterases/clonazepam/clozapine/nicardipine

18
Q

causes of hypersalivation

A 
swallowing failure (anxiety/stroke/MND/MS)
postural drooling - cerbral palsy
19
Q

subacute obstruction - associated with what symps

  • cause
  • inv
A

swelling associated with meals - submandibular.
slowly progressing
eventually fixed and painful
=duct obstruction
-INV - plain Rg low true occ, ultrasonography, sialography (inf free)

20
Q

treating excess saliva

A
  • deal with anxiety
  • drugs to reduce salivation - antimuscarinics
  • biofeedback training - swallowing control
  • surgery = duct reposition/gland removal
21
Q

reasons for a change in gland size

A
  • secretion retention - mucocele/duct obstruction
  • chronic sialadenitis
  • gland hyperplasia - sialosis/sjogren’s
  • salivary neoplasm
22
Q

salivary gland infection

  • viral
  • bacterial
  • why are these more likely to happen
A

viral - paramyxovirus(mumps) - uni/bilateral
common in childhood

bacterial - underlying cause
dehydration/flow reduction
diabetes mellitus
immune suppression
abnormal anatomy
recurrent patotitis of childhood
23
Q 
management of a subacute obstruction
-surgical
-viral
-bacterial
outcomes
A

-surgical - sialolith removal
no stone - sialography (washing)
-gland removal - if fixed swelling
reformation of stone/duct deformity/gland damage
viral - supportive/fluids and analgesia
bacterial - supportive/fluids/analgesia and antibiotics
ascending oral microorganisms = amoxicillin with/out metronidazole

24
Q 
chronic sialadenitis
-aetiology
=submand
=parotid
what follows
A

obstruction
submand - stone
parotid - stricture
-infection follows = acinar atropy, fibrosis and inflammation

25
Q

salivary tumours
-major gland
-neurological change due to?
symps

A

major - localised swelling
facial n branches withing parotid - n disturbance
-painless, slow growing, well defined

26
Q

aetiology of salivary gland tumours
-of h&n neoplasms
what % are benign overall

A

3% of h&n neoplasms

75% benign overall

27
Q

clinical features of

  • major gland neoplasms
  • minor gland neoplasms
A
  • major = lump in affected gland, asymmetry, obstruction, pain/facial palsy (later)
  • minor= junction of h&s, palate, upper lip/cheek, ulcerate (late) = malignant
28
Q

gland percentages - % of all tumours and % malignant

  • parotid
  • submand
  • subling
  • minor
A

parotid - 80% all, 15% malignant

submand - 10% all, 30% malignant

subling - 0.5% all, 80% malignant

minor - 10% all, 45% malignant

29
Q

diagnosis of salivary gland neoplasm

A

FNA, core biopsy, incisional biopsy

30
Q

what issues can arise from diagnosis

A 
many tumour types
variation in tissue (pathology complex)
common features between types
not all tumours fit class
immunohistochemistry needed to differentiate
31
Q

Pleomorphoc adenoma

  • how common
  • where most common
  • growth rate
  • histological features
A

-75% all tumours
- PAROTID
vsried histology = duct epithelium, myoepithelial cells, myxoid and chondroid areas

32
Q

treatment of pleomorphic adenoma
issue?
progression to carcinoma %

A

wide local incision
recurrence (multifocal)
5% carcinoma progression

33
Q

Warthin’s tumour

  • % of all tumours
  • where found mostly
  • histology
  • treatment
A

15% all tumours
PAROTID
cystic, distinct ep, lymphoid tissue

treated by excision

34
Q

adenoid cystic carcinoma

  • % of tumours
  • where found
  • patterns
  • local spread to?
  • late spread
  • treatment
A

-5% of tumours
-cribriform or tubular/solid
-local spread - nerves and bone
-difficult to treat, recurrence = poor prognosis at 20yr
metastisis by blood to lung

Highly invasive – muscle/nerve
Sensory symps – facial weakness, 
Poor Prognosis, Slow growing
Diag – FNA/Biopsy/excision
Lymphnode metastasis - unusual
35
Q

histology of warthin’s tumour

A

oncocytic epithelium (pink)
cystic spaces
lymphoid tissue

36
Q

Most common salivary gland neoplasms in order of incidence

  • pleomorphic adenoma
  • adenoid cystic carcinoma
  • warthin’s tumour
  • acinic cell carcinoma
  • mucal epidermoid carcinoma
A 
Pleomorphic adenoma
Warthin’s tumour
Adenoid cystic cell carcinoma 
Mucal epidermoid carcinoma
Acinic cell carcinoma
37
Q

Mucoepidermoid carcinoma

  • histology
  • grading
  • behaviour
  • lymphatic spread
A 
2 cell types - 
squamous (epidermoid)
glandular (mucous)
Unpredictable behaviour
Lymphatic spread - rare

Oral Medicine & Disease (9 decks)

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