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BDS4 Oral Medicine > Salivary Gland Enlargement > Flashcards

Salivary Gland Enlargement Flashcards

1
Q

What are the different causes of salivary gland swelling/enlargement

A
  • viral sialadenitis
  • secretion retention
  • gland hyperplasia
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2
Q

What viruses can cause salivary gland enlargement

A
  • paramyxovirus (mumps)
  • HIV
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3
Q

What virus causes mumps

A

paramyxovirus

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4
Q

How is mumps transmitted

A
  • direct contact with infected saliva
  • droplet spread
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5
Q

What are the symptoms of mumps

A
  • fever
  • malaise
  • swelling of salivary glands
  • involvement of other organs possible
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6
Q

What is the typical salivary gland presentation in mumps

A
  • bilateral swelling
  • parotid always almost effected
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7
Q

What is the incubation period of mumps

A
  • 2-3 wks
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8
Q

What organs may mump effect other than the salivary glands

A
  • testes in males
  • pancreas - usually older px
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9
Q

What is HIV-associated salivary gland disease characterized by

A
  • xerostomia and/or swelling of the major glands
  • usually the parotid
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10
Q

What is the cause of the HIV-associated salivary gland disease

A
  • lymphoproliferative enlargement
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11
Q

What should you consider testing for when you see unexplained salivary gland swelling

A
  • HIV testing
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12
Q

What are causes of secretion retention

A
  • mucocele
  • subacute obstruction
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13
Q

What is a mucocele

A

‘cystic’ lesion of minor salivary glands
filled with saliva

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14
Q

What aer the types of mucoceles

A
  • mucous extravasation cyst/extravasation mucocele
  • mucous retention cyst/retention mucocele
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15
Q

What are the features of extravasation mucoceles

A
  • no epithelial lining - not really a cyst
  • most common type
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16
Q

Where is the most common area for a extravasation mucocele

A
  • lower lip
  • v rare in upper lip
  • if you see a lump in the upper lip, be suspicious of a salivary tumour
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17
Q

What is the clinical presentation of a mucous extravasation cyst

A
  • blue/translucent submucosal swelling
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18
Q

What is the usual cause for a mucous extravasation cyst

A
  • rupture of a duct
  • usually history of trauma
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19
Q

What are the features of a retention mucocele

A
  • lined with ductal epithelium
  • rare in lower lip
  • usually older px
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20
Q

What causes retention mucoceles

A
  • obstruction of gland
  • duct dilates and becomes filled with saliva resulting in swelling
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21
Q

What is a ranula

A
  • mucous retention cyst in FOM
  • resembles frogs belly
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22
Q

Describe the histology of a mucous extravasation cyst

A
  • mucin filled cavities/pools of mucin
  • no epithelial lining
  • extravasated mucus evokes a chronic inflammatory response
  • macrophages have vacuolated cytoplasma containing phagocytosed mucin
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23
Q

This is a slide of a extravasation mucocele, what are H, I, J

A

neutrophils

24
Q

This is a slide of a extravasation mucocele, what is g

25
This is a slide of a extravasation mucocele, what is c
vascular granulation tissue
26
This is a slide of a extravasation mucocele, what is b
minor salivary gland structure
27
This is a slide of a extravasation mucocele, what is a
lip epithelium
28
This is a slide of a extravasation mucocele, what are e and f
macrophages that have ingested mucin
29
This is a slide of a extravasation mucocele, what is d
macrophages
30
Why do mucous retention cysts have little chronic inflammation
* mucous is contained within the duct
31
What is the presentation of subacute obstruction
* swelling associated with meal times due to increased salivary flow * swelling reduces after flow reduces * eventually swelling can become fixed due to complete obstruction * commonly effects submandibular gland * painful
32
What is the usual cause of submandibular duct obstruction
duct blockage
33
Why is the submandibular gland more prone to blockage
* The concentration of calcium in saliva produced by the submandibular gland is twice that of the saliva produced by the parotid gland * The submandibular gland saliva is relatively alkaline and mucous. * The submandibular duct (Wharton's duct) is long, meaning that saliva secretions must travel further before being discharged into the mouth * The duct possesses two bends, the first at the posterior border of the mylohyoid muscle and the second near the duct orifice * The flow of saliva from the submandibular gland is often against gravity due to variations in the location of the duct orifice * The orifice itself is smaller than that of the parotid * These factors all promote slowing and stasis of saliva in the submandibular duct, making the formation of an obstruction with subsequent calcification more likely.
34
What is the most common cause of duct obstruction in the parotid duct
* duct stricture
35
What are the different causes of duct obstruction
* sialoliths * mucous plugs * duct stricture/dilitation
36
What are the symptoms of sialolith duct obstruction
* pain * swelling (mealtimes) * reduction in salivary flow - predisposed to infection and chronic sialadenitis * may be palpable
37
What is the pathogenesis of sialoliths
* deposition of calcium salts around an organic nidus * original nidus may consist of: altered salivary mucin, desquamated epithelial cells and micro-organisms
38
This is a slide of a sialolith, what is e
* stratified squamous epithelium
39
Why is the presence of stratified squamous epithelium strange in the salivary duct
* the normal duct epithelium is columnar * change due to trauma
40
What is a change in epithelium type called
metaplasia
41
This is a slide of a sialolith, what is c
normal duct epithelium
42
This is a slide of a sialolith, what is h
salivary calculi white bits are due to mineral being lost in slide
43
This is a slide of a sialolith, what is b
inflammatory cells present within normal acinar tissue
44
What are mucous plugs
* similar symptoms to sialoliths * made of mucus * no findings on x-ray
45
If the obstructions are not removed, what can occur
* stagnation of saliva * predisposition to chronic infection * chronic infection leads to scarring
46
What are different investigations that can be done for suspected obstruction
* low dose plain radiography * sialography * isotope scan * ultrasound assessment of duct system
47
What radiographs are taken for obstruction
* true occlusal for submandibular * PA film in cheek - parotid
48
What is the preferred investigation for obstruction
radiography ultrasound
49
When is sialography useful
* mucous plugs- cant be detected on x-ray. both an investigation and tx as washes it out * need to be infection free
50
When are isotope scans useful
* when gland is damaged and function uncertain * helps see glands ability to secrete
51
What is ductal dilatation
* defect which prevents normal emptying * microorganisms can grow and lead to persistant and recurring sialadenitis * this results in gland function being lost * may follow childhood recurrent parotitis * the acinra tissue is lost and replaced with fibrous scar tissue
52
What is the management of subacute obstruction
* reformation of stone/obstruction * deformity of duct - infection * gland damage - reduced salivry flow and ascending infection
53
What are causes of hyperplasia of the glands
sialosis sjogrens
54
What is sialosis
characterized by non inflammatory non-neoplastic recurrent bilateral swelling of the glands
55
What glands are usually effected by sialosis
parotid bilateral mimics mumps
56
What is the cause of sialosis
* no obvious cause * some associations: alcohol abuse, liver cirrhosis, diabetes, drugs
57
What investigations do we want to do for sialosis
* bloods * MRI * ultrasound * labial gland biopsy * tear film

BDS4 Oral Medicine (17 decks)

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