Salivary Gland Lesions Flashcards
What causes a mucocele?
Rupture of salivary gland duct due to local trauma
Is mucocele a true cyst? Why/why not?
No. Lacks epithelial lining
What is the appearance of a mucocele?
Dome-shaped mucosal swellings ranging from 1 mm to several cm in size
Where is mucocele never found?
Upper lip
Histopathologic features of mucocele
- spilled mucin surrounded by granulation tissue
- cyst-like cavity filled with mucin, beneath the mucosal surface
- mucin-associated with granulation tissue containing foamy histiocytes
- minor salivary glands present below and lateral to spilled mucin
Treatment and Prognosis of mucocele
- Excellent prognosis
- Usually short-lived, self-resolving lesions
- Rupture on their own
- Many are chronic & need surgical excision
- Need to remove all adjacent minor salivary glands to minimize recurrence
- Occasional recurrence
What is a mucocele called that occurs on the floor of the mouth?
Ranula
Which gland is most commonly the source of spilled mucin for a ranula?
Sublingual gland. (Could also be submandibular duct or minor salivary glands on floor of mouth)
How does ranula appear clinically, and in what population does it tend to appear?
Blue, dome-shaped, fluctuant swelling on floor of mouth.
Found in children and young adults.
What is a plunging or cervical ranula?
Usually a clinical variant– spilled mucin dissects through mylohyoid muscle and produces swelling in the neck
What are the histopathologic features of ranula?
Similar to mucoceles (except for location): mucin-filled cyst-like cavity beneath the mucosal surface.
Spilled mucin elicits a graulation tissue response containing foamy histiocytes.
Ranula treatment and prognosis
Removal of feeding sublingual gland and/or marsupialization (remove roof of intraoral lesion)
Usually successful for small, superficial ranulas associated with ducts or rivini
Usually unsuccessful for larger ranulas–may need to remove entire feeding gland
What is a salivary duct cyst, and what type of tissue does it arise from?
- True epithelial-lined developmental cyst that is separate from the adjacent normal salivary ducts
- Arises from salivary gland tissue
- “Mucous Retention Cyst” -cyst-like dilation of salivary ducts also may develop secondary to ductal obstructions (mucus plug)
Salivary Duct Cyst tends to occur more often in children or adults?
Adults
Does salivary duct cyst arise within major or minor salivary glands?
Either one
Histopathological features of salivary duct cyst?
- Cyst is lined by thin cuboidal epithelium
- Excretory salivary gland duct lined by columnar epithelium adjacent to cyst
- Dilated duct lined by columnar eosinophilic oncocytes that exhibit papillary folds into the ductal lumen
Salivary duct cyst usually develops secondary to what?
Ductal obstruction
Isolated salivary duct cysts are treated how?
Conservative surgical excision
What is sialolithiasis?
Calcified structures within the salivary ductal system
How does sialolithiasis arise?
From deposition of Ca salts around a nidus of debris within the duct lumen
Formation is NOT related to any systemic derangement in Ca or P metabolism
Sialolithiasis most commonly develops in ductal system of which gland?
Submandibular gland
For minor salivary gland sialolithiasis, usually found in mucosa of what region in the mouth?
upper lip or buccal mucosa
How might sialolithiasis present on a radiograph?
Radiopaque mass visible sometimes
Symptoms of major gland sialolithiasis?
Pain or swelling of affected gland
Histopathology of sialolithiasis
Intraductal calcified mass with concentric laminations
Surround nidus of amorphous debris
Duct exhibits squamous metaplasia
Treatment of sialoliths
If small: gentle massage of gland to “milk” stone out of duct orifice
sialogogues: drugs that increase salviary flow, moist heat, increased fluid intake–promote passage of stone
Larger sialoliths may need surgical excision
Feeding gland may have to be removed
Define sialadenitis
Inflammation of the salivary gland (usually due to infection)