Salivary glands

Question 1

where are 75% of Mucocele/Ranulas found in the mouth?

Answer 1

• the Lower lip

can also be found on buccal mucosa, ventral tongue, floor of mouth

Question 2

clinical features of Mucoceles:

Answer 2

Non-tender, soft swelling, translucent to bluish to normal color depending on depth of mucus spillage

Question 3

what is the difference between a Ranula and a Mucocele?

Answer 3

• A Ranula is a mucocele in the floor of the mouth

Question 4

what microscopic features would you expect to see in a Mucocele?

Answer 4

extravasated mucin, granulation tissue and variable numbers of inflammatory cells

Question 5

T/F: the re-occurance of Mucoceles is relatively uncommon

Answer 5

FALSE

Very common for them to “pop” then return later on

Question 6

what are some other names for “Sialolithiasis”?

Answer 6

salivary calculi, or salivary stones

Question 7

where would a Sialolithiasis usually be found?

Answer 7

Affects submandibular gland most frequently

• parotid and minor glands may be affected

Question 8

What are the possible symptoms of Sialolithiasis?

Answer 8

• May or may not be symptomatic

- If symptomatic, patient complains of swelling of involved gland prior to or during meals

Question 9

what are the clinical/radiographic findings for Sialolithiasis?

Answer 9

Clinical: Hard submucosal mass in soft tissue

Radiograph: Soft tissue film will show an opaque, lamellated structure

Question 10

what is the treatment protocol for Sialolithiasis?

Answer 10

A) Surgical excision

B) If submandibular gland is involved, evaluate function to determine if gland should be removed

Question 11

Acute Sialadenitis is typically caused by what agent?

Answer 11

Bacteria

- often penicillinase-producing staph

Question 12

Acute Sialadentitis can be secondary what other condition?

Answer 12

xerostomia

may follow general anesthesia

Question 13

T/F: Sialadentitis refers to inflammation of the salivary gland

Answer 13

true

Question 14

clinical features of Sialadentitis:

Answer 14

1) Diffuse, painful and tender, unilateral swelling
2) Usually parotid gland is effected
3) Purulent exudate expressed from the parotid papilla

Question 15

what is the treatment protocol for Sialadentitis?

Answer 15

A) Culture and sensitivity tests to determine bacteria type

B) Penicillinase-resistant penicillin initially

C) Adjust antibiotic depending on culture and sensitivity results

Question 16

Chronic Sialadenitis is usually preceded by what other condition?

Answer 16

May follow acute sialadenitis

due to ductal damage

Question 17

T/F: CHRONIC sialadentitis is often associated with sialolithiasis

Answer 17

True

Question 18

what are the clinical signs for Chronic Sialadentitis?

Answer 18

Recurrent episodes of tender swelling of salivary gland, usually submandibular

Question 19

Sialography (X-ray of salivary ducts) will show what results in a patient with chronic sialadentitis?

Answer 19

Sialography shows “sausage-link” appearance of ductal system

Question 20

what is the treatment protocol for chronic sialadentitis?

Answer 20

• Antibiotic therapy, such as tetracycline
• Massage and sialogogues (e.g., lemon drops)
• Ductal ligation or removal of offending gland if problem fails to resolve

Question 21

________ is a condition usually associated with salivary gland hypofunction

Answer 21

Xerostomia

Question 22

what is the most common cause/form of xerostomia?

Answer 22

medication-related xerostomia

Question 23

besides medications, what else can cause xerostomia?

Answer 23

1) radiation therapy with salivary glands in the field
2) Sjogren syndrome
3) graft-vs.-host disease

Question 24

what classes of drugs are known to cause xerostomia?

Answer 24

1) Antihistamines
2) Antidepressants
3) Sedatives and anxiolytic agents
4) Antihypertensive agents

Question 25

xerostomia can lead to what secondary conditions?

Answer 25

A) Mucosa that is susceptible to injury, due to lack of lubrication

B) Candidiasis

C) Increased dental caries

Question 26

what are some treatments for xerostomia?

Answer 26

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

Question 27

what does the acronym “BLEL” stand for?

Answer 27

Benign Lymphoepithelial Lesion

Question 28

what conditions can BLEL be associated with?

Answer 28

Sjogren’s syndrome

Question 29

T/F: recent research shows that BLEL may be a form of carcinoma-in-situ

Answer 29

True

Question 30

who is at risk for BLEL? where does it usually appear?

Answer 30

• Female predilection, middle-aged or older

- Unilateral or bilateral, firm, non-tender swelling of the parotid area is seen

Question 31

Sialography of a patient with BLEL will show what result?

Answer 31

A “blossoms on a tree” pattern of PUNCTUATED SIALECTIASIS is often observed

Question 32

what happens to the parotid gland in a patient with BLEL?

Answer 32

Destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infiltrate

Question 33

what characteristic histological marker must be found to diagnose a patient with BLEL?

Answer 33

Must identify epimyoepithelial islands, which probably represent residual ductal structures

(Epimyoepithelial islands can be seen in lymphoma as well, unfortunately)

Question 34

what does the treatment for BLEL depend on?

Answer 34

Depends on how much the appearance of the lesion bothers the patient

Question 35

what are some possible treatments for a patient with BLEL?

Answer 35

Varies from doing nothing to low-dose radiation or corticosteroid therapy

Question 36

what is the prognosis for a patient with BLEL?

Answer 36

Good, but malignant transformation of both the lymphoid component or the epithelial component has been reported