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Oral Diseases > Theme 10 - Disorders of salivary glands > Flashcards

Theme 10 - Disorders of salivary glands Flashcards

1
Q

What are the developmental abnormalities of salivary glands?

A

Aplasia
Hypoplasia
Ductal Atresia
Accessory salivary gland
Ectopic salivary gland

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2
Q

What is ductal atresia?

A

Absence or narrowing of salivary duct - congential malformation of 1st branchial arch. Uncommon.

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3
Q

What is the difference between an accessory salivary gland and an ectopic salivary gland?

A

Accessory - very common, tissue closely related to parotid duct and drains into this
Ectopic - form in developmental areas of 1st and 2nd branchial arches. Salivary tissue present in lymph nodes, gingivae, brain etc. Can be mistaken for metastases

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4
Q

What is a Stafnes bone cavity?

A

Occurs at angle mandible below ID canal, round, well defined, approx 1-2cm diameter

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5
Q

What are the 3 infective/inflammatory abnormalities of salivary glands?

A

Mumps/viral sialadenitis
Bacterial sialadenitis
HIV associated salivary gland disease

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6
Q

What are the predisposing factors for bacterial sialadenitis?

A
  • Reduced saliva flow
  • Dehydration secondary to radiotherapy
  • Sjogrens syndrome
  • Poor OH
  • Medication
  • Gland/duct abnormalities
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7
Q

How does bacterial sialadenitis present and what is the treatment?

A

Unilateral, intermittent painful swelling of gland, regional lymph nodes enlarged, I/O pus from parotid duct opening.
Antibiotics, hot salt maouthwash, analgesics

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8
Q

How can salivary calculi/stones be investigated?

A

DPT or lower occlusal
Sialography
Ultrasound

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9
Q

What virus is mumps caused by and how does it present?

A

Paramyxovirus
Painful swelling of parotids, bilateral

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10
Q

How does HIV associated salivary gland disease present?

A

Xerostomia, swelling of major salivary glands (bilateral), general lymphadenopathy. Dense lymphoid tissue - can develop into lymphoma

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11
Q

What are mucoceles?

A

Developmental or secondary to trauma. Rupture or dilatation of duct, fills with saliva. History of swellings that go up and down when thinking of food.

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12
Q

What is a mucous extravasation cyst?

A

Mostly affects lower lip, duct ruptures and pool of mucin interacts with fibrovascular tissue resulting in development of granulation tissue and cystic cavities lined by epithelial macrophages

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13
Q

What is a mucous retention cyst?

A

More common in ranula (FOM) where duct is dilated and swells. Double layer ductal epithelium retains saliva with mucin in middle

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14
Q

What are the effects of xerostomia?

A

Difficulty eating swallowing and speaking
Disturbance in taste
Thirst
Generalised discomfort
Increased caries and perio - esp as stimulate with sweets
Poor denture retention
Bacterial sialadenitis
Oral candidiasis

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15
Q

How can xerostomia be managed?

A

Saliva replacement (lubricants)
Stimulate residual secretory capacity (sugar free gum)
Pilocarpine (side effect = tachycardia)
Prevention : OHI, CHX, Diet advice, FV

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16
Q

What is Sjogrens syndrome? What is the epidemiology of Sjogrens syndrome?

A

Autoimmune charactered by dry eyes, dry mouth, muscle and joint pain and severe fatigue.
95% women, all ages

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17
Q

What are the 5 criteria in the ACR-EULAR classification criteria for Sjogrens syndrome (2016)?

A

Labial salivary gland with focal lymphocytic sialadenitis and focus score >1 focus/4mm2
Anti-SSA/Ro positive
Ocular staining score >5 in at least 1 eye
Schirmers test <5mm/5min in at least 1 eye
Unstimulated whole saliva flow rate <0.1ml/min

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18
Q

What are the exclusion criteria in the ACR-EULAR classification criteria when diagnosing Sjogrens syndrome?

A

Past head and neck radiaition
AIDS
Hep C infection
Sarcoidosis
Graft v Host disease
Anticholinergic drugs
Amyloidosis
IgG4-related disease

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19
Q

When a labial gland biopsy is taken for diagnosing Sjogrens Disease, what is calculated?

A

Focus score. Looking for lymphocyte infiltration >50 within normal structure SG = focal lymphocytic sialadenitis.

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20
Q

What are the 3 tests for dry eyes?

A

Schirmers test: <5mm in 5 mins
Rose bengal stain : uneven distribution
Lissamine green stain

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21
Q

What is a sialography (what does it look like in Sjogrens) and what is a scintigraphy?

A

Silography - radiographic demonstration of major salivary glands by introducing radio opaque contrast medium into ducts. Mottled.
Scintigraphy - tracer injected SG uptakes, measures secretion

22
Q

What are the oral features of Sjogrens syndrome?

A

SG swelling
Xerostomia - SMG often first affected so notice dry mouth on waking but less during day
Fungal infections
Caries
Altered taste
Difficulty swallowing
Symptoms of reflux

23
Q

What are the occular features of Sjogrens syndrome?

A

Gritty sensation
Pain
Red
Lacrimal gland swelling

24
Q

What are the skin features of Sjogrens syndrome?

A

Dry, poor circulation, cryoglobulinaemia (blood coagulates at extremities)

25
Q

What is the concern with Sjogrens syndrome patients which is why they have repeated SG reviews?
What are the risk factors?

A

Lymphomas - MALT most common
RF:
- Ro/La positive
- Recurrent or persistant SG swelling
Cryoglobulinaemia
Low C4
Palpable purpura
High focal score

26
Q

What do you expect to see on a ultrasound in terms of grey scale/echogenicity changes for Sjogrens syndrome?

A

Hyperechoic band
Indistinct gland border
Hypoechoic foci
Loss of glandular structure

27
Q

What is the management of Primary Sjogrens syndrome?

A

Prevention
Replacement e.g. saliva/tears
Immuno-modulatory
Stimulants

28
Q

What are the 4 benign epithelial salivary gland neoplasms we must know?

A

Pleomorphic adenoma
Warthin tumour
Basal cell adenoma
Canalicular adenoma

29
Q

What are the 4 maliganant epithelial salivary gland neoplasms we must know?

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Carcinoma ex pleomorphic adenoma

30
Q

What is the presentation of a pleomorphic adenoma?

A

Common. All ages affected. Parotid and palate most affected. Slow growing, mobile, smooth and painless swelling.

31
Q

What is the presentation of a Warthins Tumour?

A

Occurs in the parotid gland ages 50-70years, male predominance. Bilateral or multifocal. Slow growing, mobile, smooth and painless swelling.

32
Q

What is the presentation of a basal cell adenoma?

A

70% in parotid, 20% upper lip, 70 years. Well circumscribed and capsulated.

33
Q

What is the presentation of a canalicular adenoma?

A

Mainly in upper lip, well demarcated, overlying mucosa not ulcerated

34
Q

What are the histopathological features of a pleomorphic adenoma?

A

Well demarcated, bossellated, variably encapsulated, pleomorphic appearance, epithelial and myoepithelial cells with epithelial and mesenchymal elements.

35
Q

What are the histopathological features of a Warthins tumour?

A

Encapsulated, papillary projections into cystic spaces, lined by oncocytic epithelium, gelatinous contents, stroma made of mature lymphoid tissue

36
Q

What are the histopathological features of a basal cell adenoma?

A

Uniform basaloid cells, variety of structures

37
Q

What are the histopathological features of a canalicular adenoma?

A

Tumour expanding to subcutaneous tissue, clear space with haemorrhaging, strands of epithelial cells and delicate stroma

38
Q

Why is surgical removal of pleomorphic adenomas challenging and what is the concern with these benign tumours?

A

Can easily rupture capsule - multifocal recurrance. Must be extracapsular dissection.
Concern is malignant transformation to carcinoma ex pleomorphic adenoma

39
Q

What are the clinical presentations of malignant salivary gland neoplasms?

A

Firm fixed lump
Poorly demarcated
Rapid growth
Pain
Skin/mucosal ulceration
Parotid gland: facial nerve palsy or dysphasia
Bone invasion
Tethering
Trismus

40
Q

What is the presentation of a mucoepidermoid carcinoma?

A

Most common SG malignancy, wide age range peaking 40-50years. Parotid and palate. Slow growing, firm, fixed, painless.

41
Q

What is the presentation of an acinic cell carcinoma?

A

Wide age range peak 50-60 years. Parotid and palate. Slow growing, firm, fixed, painless swelling, neuro symptoms. More common in women

42
Q

What is the presentation of a canalicular adenoid cystic carcinoma?

A

Middle age and elderly. Slow growing fixed mass, ulceration common. Late presentation as infiltrates without fibrosis or inflammation. Pain, facial nerve palsy.

43
Q

What are the histopathological features of a mucoepidermoid carcinoma?

A

3 cell types present: epidermoid cells, mucous secreting cells, tumour cells.

44
Q

What are the histopathological features of an acinic cell carcinoma?

A

Neoplastic cells demonstrate serous acinar cell differentiation

45
Q

What are the histopathological features of an adenoid cystic carcinoma?

A

Swiss cheese pattern, basaloid tumour, epithelial cells arranged in nests, connective tissue stroma.

46
Q

What is the malignant behaviour of a mucoepidermoid carcinoma?

A

5 year survival 95%
Behaviour predicted by tumour gradeL low/intermediate/high. Low = no lymphovascular invasion), High = poorly differentiated, perineural involvement
Lymph node metastasis and distant metastasis to lungs liver bone and brain

47
Q

What is the malignant behaviour of an acinic cell carcinoma?

A

Mostly favourable. Lymph node metastasis and distant to lung. Worse survival if poorly differentiated

48
Q

What is the malignant behaviour of an adenoid cystic carcinoma?

A

High recurrence rate. Lymph node metastasis uncommon. Distant metastasis to lung brain and bone
Poor survival

49
Q

What is the treatment for malignant salivary gland tumours?

A

Wide local excision with radiotherapy.

50
Q

What are the 3 potential nerve complication when excising a submandibular gland?

A

1) Damage to lingual nerve
2) Damage to hypoglossal nerve (tongue protrusion)
3) Damage to lower part facial nerve (lower lip weakness)

51
Q

How is sarcoidosis diagnosed?

A

Serum angiotensin converting enzyme in blood test

52
Q

What are the complications of a parotidectomy?

A

Pain and swelling
Facial nerve weakness
Sialoce (localised swelling of saliva - repeated aspiration requires)
Freys syndrome (produce sweat)
Drain ( for 24 hrs)

Oral Diseases (12 decks)

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