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Oral Medicine > Salivary Gland Disorders > Flashcards

Salivary Gland Disorders Flashcards

1
Q

What does aplasia mean?

A

a birth defect where an organ, tissue, or body part doesn’t develop normally, or is missing entirely

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1
Q

What hereditary syndrome may salivary gland aplasia occur?

A

Down syndrome

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2
Q

What is salivary gland atresia mean?

A

congenital blockage or absence of the orifice of a major salivary gland duct or part of the duct itself

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3
Q

What salivary duct is atresia most common in?

A

submandibular duct

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4
Q

What is heterotopic salivary tissue?

A

When salivary tissue is found in abnormal locations in the body/head and neck

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5
Q

what is a mucocoele?

A

a cystic cavity filled with mucous

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6
Q

What are the 2 types of mucocoele?

A
  • Extravasation mucocoele (mucous extravasation cyst)
  • Retention mucocoele (mucous retention cyst)
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7
Q

What causes a extravasation mucocoele?

A

caused when the salivary duct is ruptured causing saliva to leak into surrounding connective tissue
- typically history of trauma associated with this lesion
- most common in the lower lip

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8
Q

Where does extravasation mucocoele most commonly affect?

A

most commonly affects minor glands especially in the lower lip
- most frequently seen in children and young adults

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9
Q

Why is a mucous extravasation cyst not classed as a true cyst?

A

because it has no epithelial lining

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10
Q

What type of mucocoele is this?

A

extravasation mucocoele
- saliva leaked into connective tissue
- no epithelial lining

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11
Q

What is the treatment for an extravasation mucocoele?

A

Removal of all the mucocoele by excision together with the associated ruptured duct and gland where possible to prevent recurence

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12
Q

What is a mucous retention cyst?

A

the mucin
pooling is confined within a dilated excretory duct or
cyst,

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13
Q

What is more common a mucous retention cyst or a extravasation cyst?

A

mucous extravasation cyst

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14
Q

How does a mucous retention cyst appear histologically?

A
  • the mucin is retained within a dilated duct
  • the cyst lining is epithelial lining of the duct
  • as saliva is retained within the duct and doesnt escape, there is much less inflammation
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15
Q

What is a ranula?

A
  • an uncommon form of the mucous extravasation cyst arising from the sublingual gland
  • planless soft bluish swelling on the floor of the mouth
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16
Q

What is a plunging ranula?

A

A cyst in the salivary gland that forms when mucus escapes from the sublingual gland and herniates into the submandibular space
Can cause swelling in the neck

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17
Q

What is this?

A

Ranula - caused by leaked saliva from the sublingual gland

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18
Q

What type of cyst has caused this swelling in the neck?

A

Plunging ranula

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19
Q

What is the treatment for a ranula?

A

Drainage of the cystic cavity and removal of the sublingual gland

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20
Q

What is the name for inflammation of salivary glands?

A

sialadentitis

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21
Q

What are the most common causes of sialadentitis?

A

bacterial or viral infections

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22
Q

What salivary gland does acute bacterial sialadentitis most commonly affect?

A

parotid gland

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23
Q

What are the clinical features of acute bacterial sialadnetitis?

A

Patients present with pain, swelling, tenderness, exudation of pus, and there may be redness of the overlying skin
Decreased salivary flow is the major predisposing factor

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24
What bacteria is associated with acute bacterial sialadentitis?
Staph aureus, streptococci and oral anaerobes
25
What is the treatment for acute bacterial sialadentitis?
Appropriate antibiotics after culture and sensitivity testing
26
What is causing this?
Acute bacterial sialadentitis affecting the parotid gland
27
What is chronic bacterial sialadentitis?
a condition that causes recurrent episodes of swelling and pain in the salivary glands. It's usually caused by obstruction, such as calculi or stricture.
28
What salivary gland does chronic bacterial sialadentitis most commonly affect?
submandibular gland
29
Chronic bacterial sialadentitis is usually secondary to (caused by) what?
obstruction of the duct by stones, salivari calculi, mucous plugs (parotid)
30
Salivary calculi (sialoliths/stones) most commonly affect what salivary gland?
submandibular
31
what causes salivary calculi?
caused by mineralised of phosphates from supersaturated saliva being deposited around a central nidus of cell debri - dry mouth, dehydration predisposes to stones
32
What is the histopathology of chronic bacterial sialadentitis?
- the salivary acini become atrophic and are replaced by fibrous scar tissue - the salivary ducts within the gland become dilated and there is often hyperplasia of the duct epithelium - chronic inflammatory inflitrate with predominantly plasma cells and lymphocytes is seen within the gland
33
what can progressive chronic bacterial sialadentitis result in ?
may result in almost complete replacement of salivary parenchyma by fibrous tissue this can result in a firm mass within the gland which may be mistaken for a neoplasm
34
what is the treatment for chronic bacterial sialadentitis?
- the gland may recover from mild sialadentitis is the associated obstruction can be removed - if more extensive sialadentitis, the obstruction and gland requires to be excised
35
What viral infections can cause painful swelling of the parotid and other exocrine glands?
mumps and HIV
36
Is necrotising sialometaplasia more common in males or females?
males
37
What salivary gland does necrotising sialometaplasia most commonly affect?
minor salivary glands, especially those in the hard palate?
38
how does necrotising sialometaplasia present?
as a large deep ulcer, may be painful, slow to heal (often takes several weeks)
39
What is this?
Necrotising sialometaplasia
40
The aetiology of necrotising sialometaplasia is uncertain, what is it thought to be likely caused by?
It is thought to be caused by ischemic necrosis (death of tissue due to lack of blood supply) of minor salivary glands in response to trauma.
41
What features of necrotising sialometaplasia often get it mistaken for cancer?
- slow healing deep ulcer - The histopathological features include necrosis of salivary acini, inflammation and hyperplasia/metaplasia of salivary ducts. The changes in the duct epithelium can be mistaken for cancer too!
42
What causes sjogrens syndrom?
the immune system - autoimmune disease unknown cause
43
what is sjogrens syndrome?
lymphocytic infiltration and acinar destruction of lacrimal and salivary glands (and other exocrine glands). - affects areas of the body that produce fluids, such as tears and saliva
44
What are the two forms of sjorgrens syndrome?
primary sjorgrens syndrome - patients have dry eyes and/or a dry mouth with no associated connective tissue disease secondary sjorgrens syndrome - patients have dry eyes and/or a dry mouth AND a connective tissue disease e.g. rheumatoid arthritis
45
Does sjorgrens syndome more commonly affect males or females?
females much more commonly affected
46
What are the symptoms of sjogrens syndrome?
systematic symptoms include - fatigue, joint pain, peipheral neuropathy dry eyes dry mouth - dental problems dry skin there may be swelling of salivary glands
47
patients with primary sjogren's syndrome have an increased risk of developing what in affected g;and?
lymphoma
48
Give an example of 1 Sjogrens syndrome diagnostic test
Labial gland biopsy - taken from the lower lip - aims to sample 5-8 minor glands - biopsy is examined, in particular noting focal periductal collections of 50 or more lymphocytes - the number of foci of one or more focus of 50>lymphocytes in 4mm of salivary tissue is counted - a score of one or more is suggestive of sjogrens syndrome - results must be interpreted in context and with other investigations
49
Describe management techniques for sjogren's syndrome
- Systemic symptoms (e.g. joint pain, fatigue) are normally assessed and managed by rheumatology - Ophthalmology for eye symptoms - Dry mouth - stimulation or replacement - Caries prevention
50
What may be prescribed by specialists to stimulate saliva production in patients with Sjogren's?
The systemic acetyl choline esterase inhibitor pilocarpine
51
What saliva gland does sialadenosis predominantly affect?
the parotid gland
51
What is Sialadenosis?
- A non-inflammatory, non-neoplastic, bilateral symmetrical swelling of salivary glands - painless
52
What other conditions is sialedenosis associated with?
Malnutrition, anorexia, bulimia, alcoholism, diabetes, certain drugs and hormonal disturbances
53
What causes sialedenosis?
Hypertrophy of serous acini - not entirely understood but changes likely due to salivary gland intervation problem secondary to peripheral autonomic neuropathy
54
What would this likely to be? - painless - bilateral swelling of the parotid gland
Sialedenosis
55
Are tumour of salivary glands more common in major or minor glands?
major
56
What major salivary gland, accounts for 90% of major gland tumours?
Parotid
57
55% if minor salivary gland tumours arise where?
in the palate
58
Are salivary gland tumours of the upper or lower lip more common?
upper (accounts for 20% of minor salivary gland tumours)
59
The proportion of carcinomas (malignant epithelial tumours) is higher in major or minor salivary glands?
Minor salivary glands
60
What are the methods for obtaining tissue to confirm a definitive diagnosis or salivary gland tumours?
- fine needle aspiration (FNA) - a needle is used to aspirate cells from the lesion and the cell features examined - Core biopsy - a larger hollow needle is used to remove a core of tissue - Open biopsy - a surgical incision is made then an incisional biopsy of the lesion taken - Excision - all of the tumour is removed for diagnosis and treatment
61
Why is it that frequently ALL of salivary gland tumours are required to be examined histologically to reach a definitive diagnosis
they are often hetergoeneous
62
What are the 5 categories of WHO classification of salivary glands?
- malignant tumours - benign tumours - non-neoplastic epithelial lesions - benign soft tissue lesions - haematolymphoid tumours
63
What is the most common of the 22 primary epithelial salivary gland malignant tumours in the WHO classification?
Mucoepidermoid carcinoma
64
What salivary gland is most commonly affected by mucoepidermoid carcinoma
parotid gland
65
80% of mucoepidermoid carcinomas, have what gene fusions?
MIAML2 gene fusions
66
Mucoepidermoid carcinomss consist of variable proportions of what 3 types of tumour cells?
- mucous-secreting cells - epidermoid (squamoid) cells - intermediate cells
67
Mucoepidermoid cells with high numbers of epidermoid (squamoid) cells tend to present how?
- tend to be more solid and often more aggressive
68
What is the treatment for mucoepidermoid carcinomas?
complete excision of the tumour
69
What is the most common type of all salivary gland tumours?
Pleomorphic adenomas - benign epithelial tumour
70
What accounts for 60% of all parotid gland tumours?
pleomorphic adenomas
71
Most Pleomorphic adenomas are associated with what gene rearramgements?
PLAG1 or HMGA2

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