Salivary Glands Flashcards
Developmental
congenital
parents may or may not be affected
symmetric features, bilateral
Neoplastic
malignant vs benign
reactive
inflammatory, infectious, traumatic, autoimmune
Developmental diagnostic seive
salivary gland aplasia
traumatic diagnostic seive
mucocele, necrotizing sialometaplasia
inflammatory or infective diagnostic seive
sialoliths, sialadenitis, cheilitis, galndularis
autoimmune/systemic diagnostic seive
sjögren’s syndrome, SLE
neoplastic diagnostic seive
ploemoprhic adenoma, mucoepidermoid carcinoma
drug induced diagnostic seive
xerostomia, sialadenosis
idiopathic diagnostic seive
xerostomia
diagnostic work up
history
examination
investigations
sialolithiasis/mucous plug
calcified structures, pain, swelling
salivary duct
calcium deposition around a nidus
wharton’s duct common
sialolithiasis/mucous plug management
cannulation
endoscopic removal
surgical excision
sialadenitis
acute or chronic
infectious (staph a.)
non infectious (sjögren’s syndrome, sarcoidosis, allergies)
swelling, erythema, pus, pain
sialadenitis histopathology
acute=accumulation of neutrophils in ducal system and acini
chronic=scattered or patchy infiltration of salivary parenchyma by lymphocytes and plasma cells
atrophy of acini and duct all dilation is common
sialadenitis management
acute=antibiotics, rehydration, abscess drainage
chronic=cannulation, antibiotics
mucocele
rupture of a salivary gland duct and spillage of mucin into the surrounding tissues
result of local trauma
mucocele histopathology
granulation tissue response
numerous foamy histiocytes
mucocele treatment
surgical excision
remove feeding minor salivary glands
risk of recurrence
ranula
mucocele on the floor of mouth
ranula management
marsupialization
surgical excision
necrotizing sialometaplasis
uncommon, locally destructive inflammatory condition
result of ischemia of salivary tissue
mimics a malignant process
necrotizing sialometaplasis predisposing factors
traumatic injuries dental injections ill-fitting dentures upper respiratory infections adjacent tumors previous surgery
necrotizing sialometaplasis clinical features
developers in the palatal salivary glands (75% on posterior palate)
hard palate affect more often than the soft
appears initially as a non ulcerated swelling, associate with pain or paresthesia
2-3 weeks, tissue slough out, leaving crater like ulcer
necrotizing sialometaplasis histopathology
acinar necrosis followed by associated squamous metaplasia of salivary ducts
necrotizing sialometaplasis treatment
biopsy
if diagnosed no specific treatment is indicated or necessary
lesion resolves on own in about 5-6 weeks
salivary gland tumors
epithelial neoplasms (unilateral swelling of parotid)
9/10 tumors affect parotid, are benign, are PSAs
next common is carcinoma
salivary gland tumors types
benign (pleomorphic adenoma, warthin’s tumor)
malignant (mucoepidermoid carcinoma, adenoid cystic carcinoma)
pleomorphic adenoma
most common neoplasm
slow growing, lobulated, rubbery swelling, bluish appearance
benign but recurs if excision in inadequate
poorly encapsulated, intimate relationship with facial nerve (difficult to completely excises)
pleomorphic adenoma histopathology
originate from ductal epithelium reminiscent of connective tissue mixed tumor (myxoid or cartilage tissue) thin fibrous capsule mixture of glandular epithelium and myoepithelial cells
pleomorphic adenoma management
malignant degeneration resulting in carcinoma
malignant change is uncommon
surgery
warthin’s tumor
papillary cyst adenoma lympomatosum
parotid
found in smokers, autoimmune disease or exposed to radiation
benign
warthin’s tumor clinical features
painless nodular mass on parotid gland
firm or fluctuant
near angle of mand.
warthin’s tumor management
surgical removal
rare recurrence
monomorphic adenoma
benign encapsulated
females, upper lip and buccal mucosa
epithelial cells
mucoepidermoid carcinoma
parotid gland
a symptomatic swelling
facial nerve palsy
minor glands are clinically mistaken for a mucocele
mucoepidermoid carcinoma histopathology
mucus-producing cells and squamous cells
mucoepidermoid carcinoma management
early stage parotid treated by subtotal parotidectomy
advanced total removals of parotid
radical neck dissection
postoperative radiation
mucoepidermoid carcinoma prognosis
low-grade tumors have good prognosis
high-grade tumors is guarded (survival rate of 30-54%)
adenoid cystic carcinoma
minor salivary glands (palate)
adenoid cystic carcinoma histopathology
myoepithelial cells and ductal cells
cribriform, tubular, and solid
perineural invasion
adenoid cystic carcinoma management
local recurrence, distant metastasis
surgical excision and adjunct radiation therapy
adenoid cystic carcinoma prognosis
survival rate decreases over time, due to prone recurrence and metastasis
polymorphous low-grade adenocarcinoma
lobular
palate, lip, buccal mucosa
painless swelling, may ulcerated and bleed
variety of growth patterns within the same lesion
local excision
acinic cell adenocarcinoma
rare unilateral asymptomatic enlarging mass grayish, solid, cystic (honeycomb) surgical excision, possible post surgical radiation tx
xerostomia
oral dryness, salivary hypofunction
concurrent findings=burning mouth syndrome, candidiasis, rampant caries, perio
management with pilocarpine, cevimeline
sjögren’s syndrome
dry eyes and dry mouth
patients older than 40, female more common
over counter eye drops and sipping water
pilocarpine or cevimeline
