Salivary Gland Disorders Flashcards
salivary gland disorders
- mucocele/ranula
- sialolithiasis
- acute/chronic sialadenitis
- sialadenosis
- xerostomia
- benign lymphoepithelial lesion (BLEL)
- Sjogren syndrome
- necrotizing sialometaplasia
- sialorrhea
T/F: salivary gland neoplasia is benign
false, it is benign and malignant
mucocele
oral mucosal swelling caused by rupture of salivary gland DUCT
what does the rupture of a salivary gland duct lead to?
spillage of mucin
T/F: mucocele is common
true
who is affected by mucocele?
all ages but especially children, young adults
what is the most common site for a mucocele?
lower lip (82%)
what sites are affected by mucocele?
- lower lip
- buccal mucosa
- ventral tongue
- floor of mouth
clinical features of mucocele
- non-tender, soft swelling
- may be fluctuant or firm
- color: translucent to bluish
T/F: reoccurance does not happen with mucocele
false, may have history of repeated swelling and resolution
ranula
type of mucocele seen on the floor of the mouth
what does ranula arise from?
sublingual gland
T/F: ranula develops on the floor of the mouth to the right of midline
false, can be right or left of midline
clinical features of ranula
similar as mucocele
histopathologic features of mucocele/ranula
- extravasated mucin
2. granulation tissue with variable numbers of inflammatory cells
treatment of mucocele/ranula
- microscopic exam to rule out neoplasm
2. excision of mucous deposit including involved gland
T/F: some mucocele/ranula resolve without treatment especially superficial ones
true
T/F: treatment for ranula may include marsupialization (“unroofing”)
true
marsupialization
making incision into the lesion and suturing the edges so inner and external surfaces are continuous
prognosis of mucocele/ranula
excellent
mucocele/ranula will occasionally recur if what?
if the involved gland is not excised
sialolithiasis
deposition of calcium salts around nidus of debris in lumen
what causes sialolithiasis?
unclear but can possibly due to
- chronic sialadenitis
- partial ductal obstruction
where does sialolithiasis occur?
submandibular gland, parotid or minor glands
what percent of sialolithiasis occur in the submandibular gland?
80%
clinical features of sialolithiasis
- hard submucosal mass in soft tissue
- ± symptoms
- may have swelling prior to or during meals
radiographic features of sialolithiasis
soft tissue film shows opaque, lamellated structure
histopathologic features of sialolithiasis
- concentric laminatiosn that may surround a nidus of amorphous debris
- periductal inflammation
- acute or chronic sialadenitis of the feeding gland
if the duct associated with sialolithiasis is removed, then it often demonstrates what histopathologically?
squamous metaplasia
treatment for sialolithiasis
- gentle massage to “milk” saliva toward orifice
- sialogogues (medications which stimulate saliva)
- sour sugarless candies
- increase fluid intake to “flush”
- moist heat
- surgical removal, may include gland if significant inflammatory damage
- lithotripsy, sialendoscopy with basket retrieval (major gland)
prognosis of sialolithiasis in minor glands
good
prognosis of sialolithiasis in major glands
good, but morbidity if gland requires removal
acute/chronic sialadenitis
inflammation of the salivary gland
causes of acute/chronic sialadenitis
- bacterial
- viral
- ductal obstruction, retrograde infection
bacteria that causes acute/chronic sialadenitis
often penicillinase-producing staph
virus that causes acute/chronic sialadenitis
most often mumps
acute/chronic sialadenitis caused by ductal obstruction, retrograde infection is associated with what?
xerostomia, may follow general anesthesia
T/F: chronic may follow acute sialadenitis due to ductal damage
true
clinical features of acute/chronic sialadenitis
- diffuse
- unilateral swelling
- painful/tender, especially around meal times
- may feel warm
- overlying skin may be erythematous
- may have low-grade fever
- may have trismus
acute sialadenitis usually affects which gland?
parotid
what may be expressed in acute sialadenitis?
purulent exudate expressed from the parotid papilla
chronic sialadenitis usually affects which gland?
submandibular gland
radiographic feature of chronic sialadenitis
sialography: “sausage-link” appearance of ductal system due to ductal dilatation
histopathologic features of acute/chronic sialadenitis
- chronic inflammatory cell infiltrate
- dilated ducts
- acinar atrophy
- fibrosis
treatment of acute/chronic sialadenitis
- screening radiograph to rule-out sialolith
- antibiotic therapy - broad spectrum (i.e. tetracycline)
- culture and sensitivity if purulence
- massage (with caution)
- warm compress
- sialogogues with hydration (or sugarless lemon drops)
- ductal stenting
- sialoendoscopy with saline irrigation
- surgical drainage
- surgical removal of affected gland may be needed
T/F: antibiotics prescribed for acute/chronic sialadenitis may adjusted depending on culture and sensitivity result
true