Salivary gland diseases Flashcards
inflammation of salivary glands aka
sialadenitis
sialadenitis breakdown
viral infection
- mumps
- HIV
bacterial infection
sarcoid sialenditits
mumps cause
paramyxovirus
incubation of mumps
14-21 day incubation
acute onset - within 2 weeks
mumps onset, location and prediclition to
usually in children
- bilateral or unilaeal parotid gland enlargment
low grade fever
high grade fevers with mumps
suggestive of metastatic orchitis - in 25 % of males or meningitis
diagnosis of mumps
enlargmentof parotid
isolate in saliva
uses RT- PCR
paired serum IgG IgA / IgM – acute vs convalescent serum
- 4 fold rise in mumps antibody titers
IgM raised in early stage
histopathology of mumps
biopsy is not customarily to diagnose
treatment of chldren in mumps
self limiting in 1-2 weeks
- hydration, rest, isolation
nno specific therapy is given other than bed rest, analgesic and hydration
rare deaths occur from meningitis progressing to encephalitis
mumps vaccine when
15 months second to 4-6 years
with the MMR – mumps-measles-rubella
dont give vaccination of mumps to who
immunocompromised or those allergic to eggs or neomycin
HIV infection manifestations
salivary gland enlargment of unknown etiolgy – but viruses are the suspected cause
parotid is involved 98% of the time and disease is bilateral in 60% of the cases
more common in children than adults
HIV parotitis
fluid filled cysts of all sizes together with a diffuse inflammation,
thin epithelial lining with sever inflammation
CD 8 lymphocytes
NOT CD4
cytomegalovirus associated with
human herpes 5 – with the HIV parotitis
tx of the HIV parotitis
remove cyst and the surrounding gland tissue
can supplement
bacterial infection lovation
usually UNILATERAL
- VS viral = bilateral
bacterial infection in salivary glands?
actinomycosis - sulfur granules
actinomycosis ?
if occurs in the salivary glands – accompanied by SULFUR granules in the purulent discharge
tx in acute suppurative sialadenitis
must be treated aggresssively
surgical drainage more imp than medications
sarcoid sialadenitis
sarcoidosis is a multisystem granulomatous disease with lympho- proliferation
systemic disease
cause of sarcoidosis
atypical mycobacterial infection or an altered reaction to mycobacterial tuberculosis
clinical features of sarcoid sialadenitis
BILATERAL DIFFUSE ENLARGMENT OF THE PAROTID GLANDS – indicates an early involvment in sarcoidosis
diagnosis of sarcoidosis
ESR elevated
CBC – leucopenia and or eosinophilia
diagnosis of sarcoidosis
ESR elevated
CBC – leucopenia and or eosinophilia
hypercalcemia – in advanced stages of disease he range of 50-80 mmHg
arterial hypoxema PaO2 in t
biopsy of sarcoid
incisional parotid gland biopsy
but if it has all 4 clinical signs – do not need to biopsy - then just follow
tx for sarcoidosis
those with certain organ involvments or disease manifestations require corticosteroid therapy –like prednisone
sialoliths form around..**
a nidus in CONCENTRIC layers – suggesting that some event
- inflammation
- bacterial colonization
- foreign body
- sloughed cells
precedes their formation *
the presence of tumors can initiate stone formation
name for submandibular and parotid glands
sialocele
ranula
sublingual
mucocele
minor salivary gland
tx of mucocele
remove completely
ranula results of
from extravasation of saliva from any one of the 20 ducts that arise from t he sublingual gland, initiated by ductal injury or inflammation created by sialoliths of the whartons ducts
large 3-6 cm and form a blue, tense vesicle in the floor of the mouth
treated by excision of the fibrous capsule and the entire sublingual gland from which it arises
superficial mucocele where
formed after a duct rupture in the subepithelial location of the palate and retromolar areas as small yellow or gray vesicles
difficult to find entire gland
treatment for ranula
excision of the fibrous capsule and the ENTIRE sublingual gland from which it arises
dry mouth causes
drug induced radiation plummer inson syndrome diabetes HIV subjective dry mouth - exclude any other possible causes
normal daily secretion of saliva
1 and 1.5 L
1 drug that causes dry mouth
2 = azathioprine
antidepressant medication
trcyclic antidepressants cause morme of these side-efffects than the newer biocyclic and tetracyclic agents
azathioprine
immunosuppressive medication commonly used for renal transplantaion and RA may cause dry mouth during the t
radiation induced dry mouth
2 years after
local side effect
only with radation that is covering the gland area
can get severe mucositis and xerostmia
plummer vinsom syndrome
manifestation of iron-deficiency anemia
particulary in females
estimated that between 5 and 30 ercent of woman in US are iron deficient – while in some parts of the world is 50%
clinical features of plummer vincon syndrome
dry mouth
cracks and fissures at the corners of the mouth
smooth red and painful tongue
atrophy of the upper alimentary tract – high risk of gastric cancer – atrophic change of gastric mucosa – can go to cancer
lab
low serum iron
low red blood cell count
no megaloblasts typical of pernicious anemia
lower hemociderin
sjogren syndrome
autoimmune destruction of salivary and lacrimal glands that produces the clinical manifestations of dry mouth and dry ees and in more than 50% of cases - parotid enlargment
insulin dependent diabetes
dry mouth and candidiasis can be common
HIV patient and dry mouth?
yes + erythmatous candidiasis
1. side effect of anti viral medication
+ there is involvment of the parotid
erythema – because immunocompromised
infiltration of what in sjorgren
lymphocytes
hallmark of sjorgens
lymphocytic infiltratino of glands is the hallmark of sjorgens histopathology
punctate sialectasis
think sjorgen’s
tear test
schirmer tear function test
asymptomatic mass
salivary gland neoplasm is on your dx
largest number of salivary gland tumor is located
parotid gland
benign and malignant
% of tumors in parotid that are benign
80%
if mass found in ___ more likely to be malignant
sublingual gland – as it is an uncoomon site for neoplasms so majority are malignant
most common tumore in both major and minor
pleomorphic adenoma
which tumors have strong prediliction for warthin tumor
warthin tumor, basal cell adenomas, onocytomas, acinic cell carcinoma, and sebaceous tumor
prediliction for minor salivary glands
pleomorphic low grade adenocarcinoma
most intraoral salivary gland tumors favor what
favor the palate
benign malignant ratio is minor salivary gland tumors is
1:1
palate with normal epitheium mass nodular - no symptoms
ddx
- minor salivary gland tumor should be on
free margin of surgical removal
adequate resection of pleomorphic adenoma
extracapsular stuff could be left behind
if do not have enough margin – will come back
clinical margins
1-1.5 cm including the full palatal thicckness of muscosa and periosteum
granulation of palate will occur in
after 2 weeks – can remove the splint
2 months
