theme 10 Flashcards
developmental abnormalities of salivary glands
aplasia/hypoplasia
ductal atresia
accessory salivary gland/ectopic salivary gland
what is a sialography
involves injection of radio-opaque dye into duct
2 type of salivary gland infections
bacterial sialadenitis
viral sialadenitis - mumps
predisposing factors to bacterial sialadenitis
reduced salivary flow - medications, dehydration, radiotherapy, sjogrens, poor OH
sialolithiasis
how are submandibular gland stones easily identified compared to parotid
heavily calcified compared to parotid
2 types of bacterial sialadenitis
acute - suppurative, acute, redness, pain, swelling, lymphadenopathy
chronic - progressive destruction + fibrosis to protect gland
2 examples of chronic sialadentitis
post radiotherapy + sjogrens
virus causing mumps
paramyxovirus
features of mumps
unilateral parotid swelling
features of HIV-associated salivary gland disease
lymphoepithelial lesions within parotid, lymphocytes associated with cystic change - cysts within parotid
uncommon due to triple therapy
what are mucoceles
mucous cyst - fluid filled swelling occurs on lower lip or FOM
temporary, painless
2 types of mucoceles
extravasation - broken salivary gland duct = leakage into ST around gland
retention - blockage of salivary gland = build up of mucous
causes of dry mouth
medication - antidepressants most common dehydration diabetes renal failure radiotherapy sjogrens
how does pilocarpine work
stimulates residual secretory capacity
characteristics of sjogrens
dry eyes, dry mouth, muscle + joint pain, fatigue
causes of sjogrens
cause unknown - involves immune system mediated inflammatory mechanisms
2 categories of sjogrens
primary + secondary
causes of secondary sjogrens
RA, lupus, scleroderma, primary biliary cirrhosis
who does primary SS affect most
women
examples of objective evidence of salivary gland involvement
- unstimulated whole salivary flow - <1.5ml
- parotid sialography showing presence of diffuse sialectasis without evidence of obstruction in major ducts
- salivary scintigraphy showing delayed uptake, reduced concentration and/or delayed excretion of tracer
what must be present on SS biopsy
inflammation
focus score used
risk of which cancer with SS
lymphoma - MALT associated most common
3 components to diagnosing SS
symptoms, clinical signs, evidence of immune system disturbed
what type of scan used for salivary glands
unltrasound
doppler detect changes in pattern of blood flow
antibodies present in primary SS
anti-Ro + La
ways to manage dry mouth
good OH
stay hydrated
less sugar/coffee/alcohol
limit drug use
replacement - oralube/xerostom/biotene/water
immuno-modulatory - ciclosporins
stimulant - pilocarpine or cevimeline, sugar freee gum, lozenges, mint
also reinforce good OH
roles of saliva
mechanical washing anti-microbial activities remineralised of dental tissues buffer lubrication - mucin limited digestion - amylase
dry mouth problems
discomfort ulceration gum disase infections - fungal, ascending salivary gland infections poor denture retention alternated taste sensation speech + swallowing difficulties
most common salivary gland to suffer from malignancy
parotid
most common benign salivary gland tumour
pleomorphic adenoma
4 malignant epithelial salivary gland tumours
mucoepidermoid carcinoma
adenoid cystic carcinoma - bad prognosis
acidic cell carcinoma
adenocarcinoma
where does warthin tumour present
parotid only
type of epithelial cells on salivary glands
myoepithelial
2 layers of ductal system
luminal + alumna (basal cells)
features of pleomorphic adenoma
slow growing, mobile, smooth, painless swelling
treatment for pleomorphic adenoma
superficial parotidectomy, extracapsular dissection
risk with treating parotid gland tumours
risk to facial nerve
histopathological features of pleomorphic adenoma
pleomorphic + ep + myoep, ep + mesenchyme = chondromyxoid matrix
well demarcated, bosselated, variably encapsulated
risk of pleomorphic ademona
malignancy potential ~10-15yrs
carcinoma ex pleomorphic adenoma
tend to be very high grade, fast growing
risk factor for warthins tumour
smoking
features of warthins tumour
slow growing, mobile, smooth, painless
histopathological features of warthins tumour
encapsulated, papillary structure form cystic spaces, gelatinous contents, lined by oncocytic ep
features of basal cell adenoma
made of back to back ducts - no chondromyxoid matrix
features of canalicular adenoma
canal like systems of ep cells
decompressed bag of jelly when excised
clinical presentation of malignancy salivary gland neoplasms
firm fixed lump poorly demarcated rapid growth painless first, pain at later stage skin/mucosal ulceration face palsy if affecting nerve bone invasion
reasons for recurrent salivary gland swellings
salivary calculi/sialolithiasis
papillary obstruction
duct stricture
punctuate sialectasis
causes of persistent diffuse enlargement of salivary glands
sjogrens
sialosis
sarcoidosis
causes of nodular enlargement
neoplasm
lymph node
cyst
order for investigating salivary glands
- clinical examination/palpation
- plain radiography - FOM occlusal
- ultrasound
- sialography
- CT/MRI
8 types of salivary gland surgery
- removal of caliculi
- ductal dialtion/repositiioning
- excision of sublingual gland
- excision of submandibular gland
- parotidectomy - superficial or total
- extracapsular dissection
- excision of minor salivary gland tumours
- minimally invasive surgery
3 nerves that may be damaged in submandibular surgery
- facial nerval cervical branch
- lingual nerve
- hypoglossal nerve
complications of parotidetomy
pain/swelling
facial nerve weakness
sialocele
Freys syndrome
what is Freys syndrome
postganglionic parasympathetic fibres connect to sympathetic instead - causes person to sweat when eating instead
general rule for lip swellings
upper = malignant lower = mucocele
