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xD3 Oral Surgery Ex2 > Salivary Gland Disease (Deluke) > Flashcards

Salivary Gland Disease (Deluke) Flashcards

1
Q

What are 3 major categories of salivary gland pathology?

A
  1. Cystic-like
  2. Inflammatory
  3. Tumors
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2
Q

What are the most common categories of salivary gland pathology?

A
  1. Cystic-like

2. Inflammatory

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3
Q

What is a cystic like lesion of the minor salivary glands, common in young males, often due to trauma?

A

Mucocele

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4
Q

What is a cystic like lesion of the sublingual gland, (a mucocele on the floor of the mouth)?

A

Ranula

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5
Q

What is the difference between a Ranula and a Plunging Ranula ?

A
  1. Ranula is in the floor of the mouth and above the mylohyoid
  2. Plunging ranula is in the neck and below the mylohyoid
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6
Q

What are 3 cytsic lesions found in the Parotid ?

A
  1. Parotid duct cyst
  2. Retention cyst
  3. Lymphoepithelial cyst
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7
Q

Of the 3 cystic lesions of the Parotid, which one is bilateral and common in pts with HIV: parotid duct cyst, retention cyst, or lymph epithelial cyst?

A

Lymphoepithelial cyst

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8
Q

When pt complains of decreased saliva production or decreased saliva flow, what salivary gland pathology should be considered first: cystic like, inflammatory, or tumor?

A

Inflammatory

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9
Q

What are causes of inflammatory salivary gland lesion?

A
  1. Primary infection
  2. Autoimmune disease
  3. Sialadenosis
  4. Possibly a retrograde infection
  5. Stones
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10
Q

Which gland produces the most saliva as well as being prone to the most stones as it is tortuous, gravity is pulling on it, and its secretions have a higher mineral content?

A

Submandibular gland

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11
Q

What is an idiopathic inflammatory salivary gland lesion that is common in teenagers and will not usually have an obstruction, e.g. a stone?

A

Sialadenosis

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12
Q

What are 3 delineations to make when diagnosing an inflammatory disease?

A
  1. Acute vs chronic
  2. Suppurative vs nonsuppurative
  3. Adult vs juvenile
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13
Q

What is most commonly used X-ray to detect for salivary gland stones, now moving to CBCT?

A

Occlusal radiograph

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14
Q

Whenever one stone is seen on an image, what should you look for?

A

Another salivary duct stone

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15
Q

What is a common cause of decreased salivary duct flow?

A

Sialothiasis

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16
Q

A sialolith in the submandibular gland will be radiopaque or radiolucent?

A

Radiopaque

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17
Q

A sialolith in the Parotid gland will be radiopaque or radiolucent?

A

Radiolucent

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18
Q

Which is a more common sialolith location: submandibular gland or parotid?

A

Submandibular

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19
Q

What is a rare cause of decreased slivery flow?

A

Congenital ductal malformation e.g. juvenile chronic recurrent parotitis

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20
Q

If a submandibular gland sialolith is distal to the mylohyoid(if it is away from the gland), is it retrievable or does it require gland removal?

A

Retrievable

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21
Q

If a submandibular gland sialolith is proximal to the mylohyoid (if it is close to the gland), is it retrievable or does it require gland removal?

A

Requires gland removal

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22
Q

If a parotid sialolith is proximal to the duct (close to the gland) is the stone retrievable or is gland removal indicated?

A

Gland removal indicated

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23
Q

For a parotid sialolith proximal to the gland indicating gland removal, must the entire parotid be removed?

A

No, normally just the superficial lobe

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24
Q

What is the landmark for the parotid gland?

A

Masseter muscle

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25
Q

What are 3 causes of decreased saliva production (note this is not decreased salive flow)?

A
  1. Malnutrition
  2. Alcoholism
  3. Long-term dehydration (as with a surgery patient)
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26
Q

What its the most common bacterial cause of salivary gland infection?

A

Staphylococcus

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27
Q

What is the most common viral cause of bilateral parotid swelling?

A

Mumps

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28
Q

Coxsackie and CMV infections in the salivary glands are commonly seen in what patient type?

A

Immunosuppressed

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29
Q

What are 3 autoimmune syndromes that can affect salivary glands?

A
  1. Sjogren’s or Sicca syndrome
  2. Sarcoidosis
  3. Heerfordt’s syndrome
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30
Q

Having Sjogren’s syndrome increases a pt’s risk for what cancer?

A

Non-hodgkin’s lymphoma

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31
Q

What is the most common place to biopsy for sarcoidosis?

A

Labial biopsy (inside of lower lip)

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32
Q

Sarcoidosis is a multisystem granulomatous disorder of unknown cause. What clinical syndrome associated with acute sarcoidosis involves the patient presenting with parotid enlargement, anterior uveitis of the eye, facial paralysis, and fever?

A

Heerfordt’s syndrome

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33
Q

What is the most common salivary gland to have a neoplasm?

A

Parotid

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34
Q

n general, how does the prognosis of a salivary gland neoplasm go based on location in the mouth?

A

Prognosis decreases as get lower in the mouth and more minor glands

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35
Q

What percentage of parotid neoplasms are benign?

A

80%

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36
Q

What percent of submandibular gland neoplasms are benign?

A

20%

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37
Q

What percent of sublingual / minor salivary gland neoplasms are benign?

A

40%

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38
Q

What are 2 theories of neoplasm etiology?

A
  1. Bicellular

2. Multicellular

39
Q

What is the general idea for the bicellular theory of salivary gland neoplasm etiology?

A

Breaks gland into 2 sections and determines which of the 2 areas is contributing cells

40
Q

In the multicellular theory of salivary gland neoplasm etiology, what neoplasm arises from striated ducts?

A

Oncocytic tumors

41
Q

In the multicellular theory of salivary gland neoplasm etiology, what neoplasm arises from acinar cells?

A

Acinic cell carcinoma

42
Q

In the multicellular theory of salivary gland neoplasm etiology, what neoplasm arises from excretory ducts?

A

Squamous cell and mucoepidermoid carcinoma

43
Q

In the multicellular theory of salivary gland neoplasm etiology, what neoplasm arises from intercalated duct and myoepithelial cells?

A

Pleomorphic tumors

44
Q

Is xerostomia a common complaint with salivary gland tumors?

A

No, because contralateral gland will still contribute saliva

45
Q

What imaging is the gold standard for salivary gland tumor diagnosis?

A

CT scan and MRI

46
Q

What is the name of the procedure in which a thin hollow needle is inserted into a mass for sampling cells, then immediately examined under a microscope?

A

Fine Needle Aspiration (FNA)

47
Q

What is a limitation with the FNA (fine needle aspiration)?

A

Can only tell if malignant or benign, not what type of tumor it is

48
Q

What is indicated if a salivary gland tumor is determined malignant at FNA?

A

Biopsy and plan further treatment accordingly

49
Q

What percentage of FNA is accurate(free from error, exact, precise)?

A

84%-97%

50
Q

What percentage of FNA is sensitive (proportion of actual positives which are correct)?

A

54%-95%

51
Q

What percentage of FNA is specific (ability to identify patient without the disease)?

A

86%-100%

52
Q

What are the 2 most common benign salivary gland tumors, commonly found in Parotid?

A
  1. Pleomorphic adenoma

2. Warthin’s tumor

53
Q

What is the most common of all salivary gland neoplasms?

A

Pleomorphic adenoma

54
Q

Where does a pleomorphic adenoma commonly grow in the parotid gland of 40-60 year old females?

A

Superficial lobe near tail of the gland

55
Q

Will pleomorphic adenoma be quick-growing and painful or slow growing and painless?

A

Slow-growing, painless

56
Q

What is the treatment for pleomorphic adenoma?

A

Complete surgical excision with facial nerve preserved and avoid enucleation and tumor spill

57
Q

What is a benign salivary gland tumor that is almost exclusive to the parotid (seen commonly in older, caucasian male smokers)

A

Warthin’s tumor

58
Q

What percentage of Warthin’s tumors will be bilateral or multi centric?

A

10%

59
Q

What percentage of Warthin’s tumors that are attributed to smoking?

A

10%

60
Q

What ist he more likely diagnosis of a palpable mass arising in a salivary gland, associated with pain, and / or nerve paralysis?

A

Malignant salivary gland tumor

61
Q

Which is more suggestive of salivary gland malignancy, episodic pain or constant pain?

A

Constant pain. Episodic pain, on the other hand, is consistent with obstruction.

62
Q

If a patient complains of trismus, cervical adenopathy, fixation, numbness, loose dentition, or bleeding associated with an enlarged salivary gland, what should be considered?

A

Malignancy

63
Q

Why is it important to stage a salivary gland tumor that is malignant?

A

Guides if neck dissection is indicated

64
Q

With respect to histology, the less well defined the histology, the better or worse the prognosis?

A

Worse

65
Q

Can the histologic type of the tumor define the grade?

A

Yes, salivary duct carcinoma is higher grade than basal cell adenoma

66
Q

What is the most common salivary gland malignancy?

A

Mucoepidermoid carcinoma

67
Q

What age does mucoepidermoid carcinoma peak?

A

Fifth decade
Females > males
Caucasians > African Americans

68
Q

A high-grade mucoepidermoid carcinoma will present with what symptoms?

A

Rapid enlargement and pain

69
Q

What could a mucoepidermoid carcinoma in the minor salivary glands be mistaken for?

A

Inflammatory process, hemangioma, papilloma, tori

70
Q

What is the treatment for Stage I or II mucoepidermoid carcinoma?

A

Wide local excision

71
Q

What is the treatment for Stage III or IV mucoepidermoid carcinoma?

A

Radical excision
Neck dissection
Possible post op radiation therapy

72
Q

Which has a better rate of 10 yr free of disease Low grade or High grade mucoepidermoid carcinoma?

A

Low grade (80% vs 42%)

73
Q

Which has a higher rate of local recurrence within 10 yrs Low grade or High grade mucoepidermoid carcinoma?

A

Low grade (10% vs 6.4%)

74
Q

With respect to mucoepidermoid carcinoma, if one is in the parotid gland and one is in the submandibular gland, and both tumors have the same histopathologic grade, which location has the better prognosis?

A

Parotid gland

75
Q

What is the 2nd most common salivary gland malignancy?

A

Adenoid cystic carcinoma

76
Q

What is the most common salivary gland malignancy in the submandibular, sublingual, and minor salivary glands?

A

Adenoid cystic carcinoma

77
Q

An Adenoid Cystic Carcinoma has high recurrence rate and pt presents with facial weakness/paralysis due to what?

A

Tumor invades the nerve (neurotropism)

78
Q

Where does Adenoid Cystic Carcinoma commonly recur after surgical and radiation treatment?

A

The base of the skull due to neurotropism

79
Q

Due to neurotropism of Adenoid Cystic Carcinoma, what is usually sacrificed during complete local excision?

A

Facial nerve

80
Q

What is the post op treatment for adenoid cystic carcinoma?

A

Post op radiation therapy with neutron beam

81
Q

Where does the adenoid cystic carcinoma commonly have a distant metastasis?

A

Lung

82
Q

What is the short=term versus long-term survival rate with adenoid cystic carcinoma?

A

High 5 year survival rate (75%)

Low 20 year survival rate (13%)

83
Q

Would an osteosarcoma require neck dissection and why or why not?

A

No, because an osteosarcoma spreads by blood, not lymph

84
Q

aving a node involved in the neck associated with a malignant salivary gland tumor, whether in the parotid or submandibular gland, decreases the 5 year survival to what percent?

A

9%

85
Q

f the malignancy is considered high grade, or advanced stage tumor due to size, or histology is high risk (showing undifferentiated), what is there an increase risk of?

A

Occult neck metastasis

86
Q 
The following are all indications for what treatment?
High grade malignancy
Advanced primary tumor stage (T3-T4)
High risk histology
Tumor size >3cm
Patient > 54 yrs old
Facial paralysis
Extracapsular, perilymphatic spread
A

Neck dissection

87
Q

What are 2 advantages of neck dissection?

A
  1. Pathologic staging

2. Improved counseling and prediction of prognosis

88
Q

What are 2 disadvantages of neck dissection?

A
  1. Longer operating room time (and associated increased costs)
  2. Increased complications (functional deficits, cosmetic effects)
89
Q

A parotid gland malignancy would direct neck dissection to what levels?

A

II to IV

90
Q

A submandibular gland malignancy would direct neck dissection to what levels?

A

I-III

91
Q

What is an advantage of treating the neck with radiation versus dissection?

A

Avoids surgical sequelae

92
Q

What are 2 disadvantages of treating the neck with radiation versus dissection?

A
  1. Radiation effects on normal tissue

2. Radiation induced malignancies

93
Q

What are 2 cosmetic concerns when performing surgery on the parotid gland?

A
  1. Design incision as with a facelift

2. Monitor facial nerve during procedure to preserve

94
Q

What is the relationship of the lingual nerve to the submandibular gland?

A

Gland is more lateral in the distal and more medial as it gets into the oral cavity

xD3 Oral Surgery Ex2 (6 decks)

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