Salivary glands Flashcards
where are 75% of Mucocele/Ranulas found in the mouth?
- the Lower lip
can also be found on buccal mucosa, ventral tongue, floor of mouth
clinical features of Mucoceles:
Non-tender, soft swelling, translucent to bluish to normal color depending on depth of mucus spillage
what is the difference between a Ranula and a Mucocele?
- A Ranula is a mucocele in the floor of the mouth
what microscopic features would you expect to see in a Mucocele?
extravasated mucin, granulation tissue and variable numbers of inflammatory cells
T/F: the re-occurance of Mucoceles is relatively uncommon
FALSE
Very common for them to “pop” then return later on
what are some other names for “Sialolithiasis”?
salivary calculi, or salivary stones
where would a Sialolithiasis usually be found?
Affects submandibular gland most frequently
- parotid and minor glands may be affected
What are the possible symptoms of Sialolithiasis?
- May or may not be symptomatic
- If symptomatic, patient complains of swelling of involved gland prior to or during meals
what are the clinical/radiographic findings for Sialolithiasis?
Clinical: Hard submucosal mass in soft tissue
Radiograph: Soft tissue film will show an opaque, lamellated structure
what is the treatment protocol for Sialolithiasis?
A) Surgical excision
B) If submandibular gland is involved, evaluate function to determine if gland should be removed
Acute Sialadenitis is typically caused by what agent?
Bacteria
- often penicillinase-producing staph
Acute Sialadentitis can be secondary what other condition?
xerostomia
may follow general anesthesia
T/F: Sialadentitis refers to inflammation of the salivary gland
true
clinical features of Sialadentitis:
1) Diffuse, painful and tender, unilateral swelling
2) Usually parotid gland is effected
3) Purulent exudate expressed from the parotid papilla
what is the treatment protocol for Sialadentitis?
A) Culture and sensitivity tests to determine bacteria type
B) Penicillinase-resistant penicillin initially
C) Adjust antibiotic depending on culture and sensitivity results
Chronic Sialadenitis is usually preceded by what other condition?
May follow acute sialadenitis
due to ductal damage
T/F: CHRONIC sialadentitis is often associated with sialolithiasis
True
what are the clinical signs for Chronic Sialadentitis?
Recurrent episodes of tender swelling of salivary gland, usually submandibular
Sialography (X-ray of salivary ducts) will show what results in a patient with chronic sialadentitis?
Sialography shows “sausage-link” appearance of ductal system
what is the treatment protocol for chronic sialadentitis?
- Antibiotic therapy, such as tetracycline
- Massage and sialogogues (e.g., lemon drops)
- Ductal ligation or removal of offending gland if problem fails to resolve
________ is a condition usually associated with salivary gland hypofunction
Xerostomia
what is the most common cause/form of xerostomia?
medication-related xerostomia
besides medications, what else can cause xerostomia?
1) radiation therapy with salivary glands in the field
2) Sjogren syndrome
3) graft-vs.-host disease
what classes of drugs are known to cause xerostomia?
1) Antihistamines
2) Antidepressants
3) Sedatives and anxiolytic agents
4) Antihypertensive agents
xerostomia can lead to what secondary conditions?
A) Mucosa that is susceptible to injury, due to lack of lubrication
B) Candidiasis
C) Increased dental caries
what are some treatments for xerostomia?
1) Artificial saliva/lubricants
2) Sialogogues – sugar-free lemon drops, Salagen (pilocarpine) or Evoxac (cevimeline)
3) 1% neutral sodium fluoride gel or toothpaste nightly
4) Antifungal therapy as needed
what does the acronym “BLEL” stand for?
Benign Lymphoepithelial Lesion
what conditions can BLEL be associated with?
Sjogren’s syndrome
T/F: recent research shows that BLEL may be a form of carcinoma-in-situ
True
who is at risk for BLEL? where does it usually appear?
- Female predilection, middle-aged or older
- Unilateral or bilateral, firm, non-tender swelling of the parotid area is seen
Sialography of a patient with BLEL will show what result?
A “blossoms on a tree” pattern of PUNCTUATED SIALECTIASIS is often observed
what happens to the parotid gland in a patient with BLEL?
Destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infiltrate
what characteristic histological marker must be found to diagnose a patient with BLEL?
Must identify epimyoepithelial islands, which probably represent residual ductal structures
(Epimyoepithelial islands can be seen in lymphoma as well, unfortunately)
what does the treatment for BLEL depend on?
Depends on how much the appearance of the lesion bothers the patient
what are some possible treatments for a patient with BLEL?
Varies from doing nothing to low-dose radiation or corticosteroid therapy
what is the prognosis for a patient with BLEL?
Good, but malignant transformation of both the lymphoid component or the epithelial component has been reported
