Salivary Glands

Question 1

Developmental

Answer 1

congenital
parents may or may not be affected
symmetric features, bilateral

Question 2

Neoplastic

Answer 2

malignant vs benign

Question 3

reactive

Answer 3

inflammatory, infectious, traumatic, autoimmune

Question 4

Developmental diagnostic seive

Answer 4

salivary gland aplasia

Question 5

traumatic diagnostic seive

Answer 5

mucocele, necrotizing sialometaplasia

Question 6

inflammatory or infective diagnostic seive

Answer 6

sialoliths, sialadenitis, cheilitis, galndularis

Question 7

autoimmune/systemic diagnostic seive

Answer 7

sjögren’s syndrome, SLE

Question 8

neoplastic diagnostic seive

Answer 8

ploemoprhic adenoma, mucoepidermoid carcinoma

Question 9

drug induced diagnostic seive

Answer 9

xerostomia, sialadenosis

Question 10

idiopathic diagnostic seive

Answer 10

xerostomia

Question 11

diagnostic work up

Answer 11

history
examination
investigations

Question 12

sialolithiasis/mucous plug

Answer 12

calcified structures, pain, swelling
salivary duct
calcium deposition around a nidus
wharton’s duct common

Question 13

sialolithiasis/mucous plug management

Answer 13

cannulation
endoscopic removal
surgical excision

Question 14

sialadenitis

Answer 14

acute or chronic
infectious (staph a.)
non infectious (sjögren’s syndrome, sarcoidosis, allergies)
swelling, erythema, pus, pain

Question 15

sialadenitis histopathology

Answer 15

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

Question 16

sialadenitis management

Answer 16

acute=antibiotics, rehydration, abscess drainage

chronic=cannulation, antibiotics

Question 17

mucocele

Answer 17

rupture of a salivary gland duct and spillage of mucin into the surrounding tissues
result of local trauma

Question 18

mucocele histopathology

Answer 18

granulation tissue response

numerous foamy histiocytes

Question 19

mucocele treatment

Answer 19

surgical excision
remove feeding minor salivary glands
risk of recurrence

Question 20

ranula

Answer 20

mucocele on the floor of mouth

Question 21

ranula management

Answer 21

marsupialization

surgical excision

Question 22

necrotizing sialometaplasis

Answer 22

uncommon, locally destructive inflammatory condition
result of ischemia of salivary tissue
mimics a malignant process

Question 23

necrotizing sialometaplasis predisposing factors

Answer 23

traumatic injuries
dental injections
ill-fitting dentures
upper respiratory infections
adjacent tumors
previous surgery

Question 24

necrotizing sialometaplasis clinical features

Answer 24

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

Question 25

necrotizing sialometaplasis histopathology

Answer 25

acinar necrosis followed by associated squamous metaplasia of salivary ducts

Question 26

necrotizing sialometaplasis treatment

Answer 26

biopsy if diagnosed no specific treatment is indicated or necessary lesion resolves on own in about 5-6 weeks

Question 27

salivary gland tumors

Answer 27

epithelial neoplasms (unilateral swelling of parotid) 9/10 tumors affect parotid, are benign, are PSAs next common is carcinoma

Question 28

salivary gland tumors types

Answer 28

benign (pleomorphic adenoma, warthin’s tumor) | malignant (mucoepidermoid carcinoma, adenoid cystic carcinoma)

Question 29

pleomorphic adenoma

Answer 29

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)

Question 30

pleomorphic adenoma histopathology

Answer 30

``` originate from ductal epithelium reminiscent of connective tissue mixed tumor (myxoid or cartilage tissue) thin fibrous capsule mixture of glandular epithelium and myoepithelial cells ```

Question 31

pleomorphic adenoma management

Answer 31

malignant degeneration resulting in carcinoma malignant change is uncommon surgery

Question 32

warthin’s tumor

Answer 32

papillary cyst adenoma lympomatosum parotid found in smokers, autoimmune disease or exposed to radiation benign

Question 33

warthin’s tumor clinical features

Answer 33

painless nodular mass on parotid gland firm or fluctuant near angle of mand.

Question 34

warthin’s tumor management

Answer 34

surgical removal | rare recurrence

Question 35

monomorphic adenoma

Answer 35

benign encapsulated females, upper lip and buccal mucosa epithelial cells

Question 36

mucoepidermoid carcinoma

Answer 36

parotid gland a symptomatic swelling facial nerve palsy minor glands are clinically mistaken for a mucocele

Question 37

mucoepidermoid carcinoma histopathology

Answer 37

mucus-producing cells and squamous cells

Question 38

mucoepidermoid carcinoma management

Answer 38

early stage parotid treated by subtotal parotidectomy advanced total removals of parotid radical neck dissection postoperative radiation

Question 39

mucoepidermoid carcinoma prognosis

Answer 39

low-grade tumors have good prognosis | high-grade tumors is guarded (survival rate of 30-54%)

Question 40

adenoid cystic carcinoma

Answer 40

minor salivary glands (palate)

Question 41

adenoid cystic carcinoma histopathology

Answer 41

myoepithelial cells and ductal cells cribriform, tubular, and solid perineural invasion

Question 42

adenoid cystic carcinoma management

Answer 42

local recurrence, distant metastasis | surgical excision and adjunct radiation therapy

Question 43

adenoid cystic carcinoma prognosis

Answer 43

survival rate decreases over time, due to prone recurrence and metastasis

Question 44

polymorphous low-grade adenocarcinoma

Answer 44

lobular palate, lip, buccal mucosa painless swelling, may ulcerated and bleed variety of growth patterns within the same lesion local excision

Question 45

acinic cell adenocarcinoma

Answer 45

``` rare unilateral asymptomatic enlarging mass grayish, solid, cystic (honeycomb) surgical excision, possible post surgical radiation tx ```

Question 46

xerostomia

Answer 46

oral dryness, salivary hypofunction concurrent findings=burning mouth syndrome, candidiasis, rampant caries, perio management with pilocarpine, cevimeline

Question 47

sjögren’s syndrome

Answer 47

dry eyes and dry mouth patients older than 40, female more common over counter eye drops and sipping water pilocarpine or cevimeline