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Oral Path 1 > Salivary Gland Lesions > Flashcards

Salivary Gland Lesions Flashcards

1
Q

Where are salivary glands located IO?

A
  • Parotid, subMN, sublingual glands
  • Hard palate: posterior lateral quadrant
  • Soft palate
  • Buccal & labial mucosa & vestibule
  • Floor of mouth
  • Tongue
  • Serous/mucous glands present in MX sinus & nasal mucosa
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2
Q

Where AREN’T there any salivary glands IO?

A
  • Gingiva & edentulous alveolar ridge mucosa
  • Midpalatine raphe
  • Hard palate anterior to PM region
  • Dorsum of the tongue
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3
Q

Ranula

A
  • Mucocele on FOM
  • Latin word rana = frog
  • Source is usually sublingual gland (but also subMN & MSG)
  • Sublingual = body of gland or along superficial ducts of Rivini
  • Most frequent in children & young adults
  • Larger than other mucoceles
  • Tx: Removal of feeding gland
  • Px: Relatively good. Plunging Ranula can be dangerous
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4
Q

Sialolithiasis

A
  • Sialolith: Calcified structure w/in salivary ductal system
  • Deposition of Ca2+ salts around a nidus of debris w/in lumen
  • Can be promoted by chronic sialadenitis & partial obstruction
  • Not related to any systemic derangement in Ca2+ metabolism
  • Clinical Features
    • Most common w/ subMN gland/duct
      • Can happen in any duct though
    • If palpable: firm/hard
    • Pain & swelling during times of increased salivation
  • Tx:
    • Small stones can be milked out of the duct
    • Sialagogues, moist heat, fluid intake promote passage
    • Larger stones need to be removed surgically
    • Entire gland may need to be removed
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5
Q

Bacterial Sialadenitis

A
  • Inflammation of the salivary glands (acute or chronic)
  • Arise as a result of ductal obstruction or decreased saliva flow
  • Allows retrograde spread of bacteria (S. aureus)
  • Blockage: sialolith, congenital stricture, adjacent tumor
  • Decreased flow: Dehydration, debilitation or medications
  • Clinical Features
    • Usually in parotid
    • Can be bilateral
    • Acute pain, swelling, lymphadenopathy
    • Sometimes fever malaise, leukocytosis
  • Tx:
    • Acute: abx & rehydrate
      • Surgical drainage may be needed
    • Chronic: ranges from conservative tx to surgery
      • Abx, analgesics, sialagogues, glandular massage
      • Removal of sialolith may be beneficial
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6
Q

Viral Sialadenitis (Mumps)

A
  • Caused by paramyxovirus, genus Rubulavirus
  • Approx 30% cases are subclinical
  • Low grade fever, headache, malaise, anorexia, myalgia
  • Swelling of salivary glands
  • Parotid most frequently involved
    • 75% of cases are bilateral
  • Dx made from clinical presentation (if epidemic)
  • Isolated cases: serological studies (mumps-specific IgG or IgM)
  • Viral isolation from saliva
  • Tx: Palliative (analgesic, antipyretic, rest)
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7
Q

Sarcoidosis

A
  • Multisystem, granulomatous disorder of unknown cause
  • Improper degradation of antigenic material
  • Formation of non-caseating granulomatous inflammation
  • 10-17x more common in AA
  • Bimodal peak of incidence: 25-35yo, 45-65yo
  • Dx based on clinical, radiographic, histopathologic features
  • Negative findings for special stains and microorganisms
  • Elevated angiotensin-converting enzyme (ACE) levels
  • 60% of cases resolve spontaneously w/in 2yr
  • Corticosteroids are 1st line
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8
Q

Sjogren’s Syndrome

A
  • Autoimmune disorder
    • Pt forms antibodies to salivary glands and other exocrine glands
    • Initial inflammation w/ progression to destruction of salivary glands
  • Xerostomia, xeropthalmia (AKA keratoconjunctivitis sicca)
  • Primary SS (sicca syndrome): xerostomia & xeropthalmia
  • Secondary SS: sicca syndrome & autoimmune disease (RA and lupus)
  • Clinical Features
    • Females predominate by ratio of 10:1
    • Xerostomia - pain, burning, erythema of oral mucosa
    • Xeropthalmia - burning, itching of eyes, blurred vision, accumulation of thick secretion
    • RA in about 1/2 of pts; lupus & scleroderma also seen
  • Lab anomalies
    • Antinuclear antibodies in the blood
    • Rheumatoid factor in blood
    • Increased erythrocyte sedimentation rate
  • Tx:
    • Supportive - artificial tears, saliva (gland tissue is destroyed, so there’s nothing we can do to cure it)
  • Px:
    • Increased risk of caries (fluoride app)
    • Secondary candidiasis
    • Chronic disease but not life threatening
    • Pts show 40x risk of developing lymphomas
      • Lymphocytes are just attacking - one mutation away from becoming malignant
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9
Q

Sialadenosis

A
  • Non-inflammatory disorder characterized by SG enlargement
    • Hypertrophy of acinar cells
  • Associated w/ underlying systemic problems
  • Diabetes, malnutrition, alcoholism, bulimia
  • Deregulate innervation of glands, causing granules accumulation
  • Management closely related to control of underlying cause
  • Mild examples may cause few problems
  • If cosmetics are a concern, surgery can be done
  • Pilocarpine may be beneficial in bulimic pts
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10
Q

Xerostomia

A
  • Refers to subjective sensation of a dry mouth
  • Frequently, but not always, associated w/ reduced saliva
  • 25% of older adults
  • Likely a result of medication use
  • 500 drugs reported to produce xerostomia
  • Clinical Findings
    • Foamy or thick and ropey saliva
    • Dry mucosa
    • Fissured tongue w/ atrophy of papilla
    • Increased prevalence of candidiasis & decay
  • Tx: Difficult & often unsatisfactory
    • Artificial saliva to make pt more comfortable
    • D/c or dose modification may be tried
    • Pilocarpine: promotes all glandular flow, which may not always be desirable
    • Freq dental visits b/c of increased caries risk
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11
Q

Sialorrhea

A
  • Excessive salivation for various causes
    • Some causes are transient & don’t req tx
  • Aphthous ulcers, ill-fitting dentures, GERD, heavy metal poisoning
  • Meds used to tx Alzheimer’s & myasthenia gravis
  • Pts w/ neurological disorders may drool but have normal saliva
  • Some pts complain of drooling, but exam is normal
  • If persistent, tx intervention may be req
    • Speech therapy: requires cooperation
    • Anticholinergic meds: unwanted side effects
    • Surgery
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12
Q

Salivary Gland Tumors: Tissue of Origin

A
  • Majority of SG neoplasms arise from epithelium, esp glandular epithelium
  • Adenomas: Benign glandular neoplasms
  • Adenocarinoma: Malignant glandular neoplasms
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13
Q

Clinical features of salivary gland adenomas

A
  • Encapsulated: Freely movable except on hard palate
    • Allows for easy removal in most cases
  • Slow growth
  • Nontender
  • Firm or compressible
  • Clinical features are similar to some of the benign mesenchymal tumors
  • Tx: Surgical excision & F/U
  • Px: Excellent w/ adequate surgery
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14
Q

Clinical features of SG adenocarcinomas

A
  • Infiltrated growth = Fixed to surrounding tissue
  • Rapid or slow growth
  • Larger, rapidly growing lesions may cause pain and/or paresthesia
  • Tx: Surgery & radiation
  • Px: Variable
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15
Q

T/F: The bigger the gland, the more likely the neoplasm will be benign. Small glands are likely to be malignant. Minor salivary glands are 50/50

A

True

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16
Q

What gland is the most common location for neoplasms?

A

Parotid

17
Q

Warthin Tumor

A
  • AKA papillary cystadenoma lymphomatosum
  • Slowly growing, painless nodular mass
  • Exclusively in the parotid gland
    • Tumor of serous cells
    • Most common in tail of parotid, near MN angle
  • Bilateral (usually metachronus)
    • One tumor that can happen bilaterally, but not at the same time
  • Assoc w/ smoking - 8x risk
  • 10:1 male to female ratio
  • Usually >40yo
  • Tx:
    • Surgical removal is the tx of choice
    • Superficial location facilitates surgery
  • Px: Recurrence is rare
18
Q

Canalicular Adenoma & Basal Cell Adenoma

A
  • Formerly known as monomorphic adenoma
  • Most common in parotid gland and minor SGs of the upper lip, but can be in any SG area
  • Upper lip = canalicular adenoma
    • Almost exclusive to minor salivary glands
    • Most or second most common tumor of the upper lip
  • Parotid = basal cell adenoma
    • Most found in the parotid gland, followed by MSG
  • Slow growing & asymptomatic
  • Tx: surgical excision
  • Px: good, recurrence is rare
19
Q

Mucoepidermoid Carcinoma

A
  • Most common malignant salivary gland tumor
    • Most common in parotid
    • MSG is second most common
      • Lower lip, floor of mouth, tongue, retromolar pad
  • Pain or nerve palsy may be present
  • Appears as asymptomatic swelling w/ sometimes a blue or red color
  • Low grade
    • Mimics benign neoplasm clinically, but is a carcinoma
    • Contains mucus pools = compressible
    • Increased mucus, more cystic
  • High grade
    • Aggressive malignant tumor
    • Epithelial component is more prominent
    • Decreased mucus, appears similar to OSCC, less cystic
  • Rarely may occur w/in jaws
  • Tx & Px
    • Tx depends on clinical & histopathological features
      • Low grade: surgery w/ relatively good px
      • High grade: surgery + radiation w/ poor px
      • Parotid: partial or total parotidectomy
      • SubMN: total removal of gland
      • MSG: surgical excision w/ safety margins
    • 5yr survival: 30-98%
20
Q

Acinic Cell Adenocarcinoma

A
  • Malignancy w/ cells that show serous acinar differentiation
  • Always in parotid gland
  • Typically slow growing and asymptomatic, i.e. low grade malignancy
  • Behaves benign
  • Tx:
    • Surgical excision
    • Partial or total parotidectomy, depending on location
    • SubMN: total removal of the gland
    • MSG: surgical excision w/ safety margins
  • Px:
    • Good, occasionally fatal
    • Best Px of any malignant SG tumor b/c it’s so low grade
21
Q

Adenoid Cystic Carcinoma

A
  • One of the most common and best recognized SG malignancies
  • 50-60% in MSG
  • Palate > parotid = subMN
  • Features
    • Sometimes behaves a high grade malignancy w/ rapid growth, local invasion, fixation, pain/parasthesia, surface ulceration
    • Other lesions have clinical features similar to benign neoplasms
    • Skip lesions traveling along the nerve
  • High propensity for neural invasion & vascular invasion
  • Tx:
    • Relentless tumor prone to local recurrence & distant metastasis
    • Wide surgical excision + radiation
  • Px:
    • Good short term; poor long term
    • May metastasize after many years
22
Q

Polymorphous Low Grade Adenocarcinoma

A
  • Almost only in MSG
    • Esp on hard & soft palate
  • Low grade: slow growth, usually nonpainful
    • Typically looks benign
  • High propensity for neural invasion
  • Tx: wide surgical excision
  • Px
    • Overall, relatively good
    • Better than other SG adenocarcinomas
    • Death from tumor is rare

Oral Path 1 (10 decks)

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