Salivary Gland Disorders, Pathology And Presentation Flashcards
Aplasia of salivary glands
Failure to develop normally.
Very rare, may occur as an isolated event of as part of a hereditary syndrome (e.g. Down syndrome)
Atresia of ducts
Failure to be tubular.
Very uncommon, submandibular duct most often affected when it does occur.
Salivary mucocoeles
A cystic cavity filled with mucus.
Two types:
Extravasation or retention
Extravasation mucocoele clinical features
Blueish/transparent swelling
Minor glands especially in lower lip
Occurs over a wide age range but most common in young people.
Asymptomatic
Discharges—> reforms
Trauma associated
Caused by ruptured duct with leakage of saliva into surrounding CT —> inflammatory reaction.
Why might a mucous extravasation cyst not be classes as a true cyst?
No epithelial linging
Treatment of extravasation mucocoele
Removal of all of the mucocoele together with the associated ruptured duct and gland where possible to prevent recurrrence.
Mucous retention cyst
Similar but less common than a extravasation cyst
Rare on lower lip
Major and minor glands effected
Represents cystic dilation of a duct typically due to obstruction.
Less inflammation
Cyst lining is epithelial lining of the duct.
Treatment: excision
Ranula
Painless soft bluish swelling in FOM
Unilateral
2-3cm
Arises from sublingual gland - uncommon
Plunging ranula
Ranula treatment
Drainage of the cystic cavity and removal of sublingual gland.
Sialadenitis
Inflammation of salivary glands (bacterial or viral infection)
Acute bacterial sialadenitis
Parotid most often affected.
Decreased salivary flow is major predisposing factor.
Pain, swelling, tenderness, exudation of pus, redness overlying the skin.
Staphy. Aureus infection
Acute bacterial sialadenitis treatment
Appropriate antibiotics after culture/sensitivity testing
Chronic bacterial sialadenitis
Secondary to duct obstruction (by stones etc)
Submandibular gland most affected
Typically unilateral
Asymptomatic (or random burst of pain associated with mealtimes)
Salivary calculi
Submandibular gland (most commonly affected)
Adults affected
Mineralisation of phosphates from supersaturated saliva being deposited around a central nidus of cell debris.
Forms within ducts in the gland or in the main excretory duct.
Yellowish
Bacteria grow on the stone surface eliciting an inflammatory response.
Salivary calculi
May be possible to remove or breakdown some stones. Alternatively it may be necessary to remove the gland, especially if it has become very damaged.
What is this?
Chronic sialadenitis
Note the marked atrophy of salivary acini
Salivary duct appear dilated
Inflammation
Treatment for chronic bacterial sialadenitis
- The gland may recover from mild sialadenitis if the associated obstruction can be removed.
- If more extensive sialadenitis, the obstruction and gland requires to be excised.
Viral sialadenitis
Mumps
Acute, contagious by paramyxovirus
Spreads via saliva
Painful swelling of parotid glands
Fever, headache, malaise
HIV-associated salivary gland disease
- May be the first clinical sign of HIV infection
- Swelling of major glands
- Painful and soft to palpate
- Multiple cysts are seen on imaging of the glands
- Histopathology glands show multiple large cysts and dense lymphoid tissue.
(The features are suggestive but not definitively diagnostic).
Necrotising sialometaplasia features
More common in males
Older/smoker
Minor salivary glands (hard palate)
Painful
Slow to heal (weeks)
Aetiology of necrotising sialometaplasia
Ischaemia or infarction secondary to trauma
Can be mistaken for cancer
Treatment of necrotising sialometaplasia
None required, it slowly resolves itself. Biopsy is usually curative.
Sjögren’s syndrome
Autoimmune disease of unknown cause characterised by lymphocytic infiltration and acinar destruction of lacrimal and salivary glands ( and other exocrine glands).
