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BDS4 Oral Medicine > Salivary Gland Enlargement > Flashcards

Salivary Gland Enlargement Flashcards

1
Q

What are the different causes of salivary gland swelling/enlargement

A
  • viral sialadenitis
  • secretion retention
  • gland hyperplasia
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2
Q

What viruses can cause salivary gland enlargement

A
  • paramyxovirus (mumps)
  • HIV
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3
Q

What virus causes mumps

A

paramyxovirus

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4
Q

How is mumps transmitted

A
  • direct contact with infected saliva
  • droplet spread
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5
Q

What are the symptoms of mumps

A
  • fever
  • malaise
  • swelling of salivary glands
  • involvement of other organs possible
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6
Q

What is the typical salivary gland presentation in mumps

A
  • bilateral swelling
  • parotid always almost effected
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7
Q

What is the incubation period of mumps

A
  • 2-3 wks
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8
Q

What organs may mump effect other than the salivary glands

A
  • testes in males
  • pancreas - usually older px
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9
Q

What is HIV-associated salivary gland disease characterized by

A
  • xerostomia and/or swelling of the major glands
  • usually the parotid
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10
Q

What is the cause of the HIV-associated salivary gland disease

A
  • lymphoproliferative enlargement
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11
Q

What should you consider testing for when you see unexplained salivary gland swelling

A
  • HIV testing
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12
Q

What are causes of secretion retention

A
  • mucocele
  • subacute obstruction
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13
Q

What is a mucocele

A

‘cystic’ lesion of minor salivary glands
filled with saliva

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14
Q

What aer the types of mucoceles

A
  • mucous extravasation cyst/extravasation mucocele
  • mucous retention cyst/retention mucocele
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15
Q

What are the features of extravasation mucoceles

A
  • no epithelial lining - not really a cyst
  • most common type
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16
Q

Where is the most common area for a extravasation mucocele

A
  • lower lip
  • v rare in upper lip
  • if you see a lump in the upper lip, be suspicious of a salivary tumour
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17
Q

What is the clinical presentation of a mucous extravasation cyst

A
  • blue/translucent submucosal swelling
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18
Q

What is the usual cause for a mucous extravasation cyst

A
  • rupture of a duct
  • usually history of trauma
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19
Q

What are the features of a retention mucocele

A
  • lined with ductal epithelium
  • rare in lower lip
  • usually older px
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20
Q

What causes retention mucoceles

A
  • obstruction of gland
  • duct dilates and becomes filled with saliva resulting in swelling
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21
Q

What is a ranula

A
  • mucous retention cyst in FOM
  • resembles frogs belly
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22
Q

Describe the histology of a mucous extravasation cyst

A
  • mucin filled cavities/pools of mucin
  • no epithelial lining
  • extravasated mucus evokes a chronic inflammatory response
  • macrophages have vacuolated cytoplasma containing phagocytosed mucin
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23
Q

This is a slide of a extravasation mucocele, what are H, I, J

A

neutrophils

24
Q

This is a slide of a extravasation mucocele, what is g

A

mucin

25
Q

This is a slide of a extravasation mucocele, what is c

A

vascular granulation tissue

26
Q

This is a slide of a extravasation mucocele, what is b

A

minor salivary gland structure

27
Q

This is a slide of a extravasation mucocele, what is a

A

lip epithelium

28
Q

This is a slide of a extravasation mucocele, what are e and f

A

macrophages that have ingested mucin

29
Q

This is a slide of a extravasation mucocele, what is d

A

macrophages

30
Q

Why do mucous retention cysts have little chronic inflammation

A
  • mucous is contained within the duct
31
Q

What is the presentation of subacute obstruction

A
  • swelling associated with meal times due to increased salivary flow
  • swelling reduces after flow reduces
  • eventually swelling can become fixed due to complete obstruction
  • commonly effects submandibular gland
  • painful
32
Q

What is the usual cause of submandibular duct obstruction

A

duct blockage

33
Q

Why is the submandibular gland more prone to blockage

A
  • The concentration of calcium in saliva produced by the submandibular gland is twice that of the saliva produced by the parotid gland
  • The submandibular gland saliva is relatively alkaline and mucous.
  • The submandibular duct (Wharton’s duct) is long, meaning that saliva secretions must travel further before being discharged into the mouth
  • The duct possesses two bends, the first at the posterior border of the mylohyoid muscle and the second near the duct orifice
  • The flow of saliva from the submandibular gland is often against gravity due to variations in the location of the duct orifice
  • The orifice itself is smaller than that of the parotid
  • These factors all promote slowing and stasis of saliva in the submandibular duct, making the formation of an obstruction with subsequent calcification more likely.
34
Q

What is the most common cause of duct obstruction in the parotid duct

A
  • duct stricture
35
Q

What are the different causes of duct obstruction

A
  • sialoliths
  • mucous plugs
  • duct stricture/dilitation
36
Q

What are the symptoms of sialolith duct obstruction

A
  • pain
  • swelling (mealtimes)
  • reduction in salivary flow - predisposed to infection and chronic sialadenitis
  • may be palpable
37
Q

What is the pathogenesis of sialoliths

A
  • deposition of calcium salts around an organic nidus
  • original nidus may consist of: altered salivary mucin, desquamated epithelial cells and micro-organisms
38
Q

This is a slide of a sialolith, what is e

A
  • stratified squamous epithelium
39
Q

Why is the presence of stratified squamous epithelium strange in the salivary duct

A
  • the normal duct epithelium is columnar
  • change due to trauma
40
Q

What is a change in epithelium type called

A

metaplasia

41
Q

This is a slide of a sialolith, what is c

A

normal duct epithelium

42
Q

This is a slide of a sialolith, what is h

A

salivary calculi
white bits are due to mineral being lost in slide

43
Q

This is a slide of a sialolith, what is b

A

inflammatory cells present within normal acinar tissue

44
Q

What are mucous plugs

A
  • similar symptoms to sialoliths
  • made of mucus
  • no findings on x-ray
45
Q

If the obstructions are not removed, what can occur

A
  • stagnation of saliva
  • predisposition to chronic infection
  • chronic infection leads to scarring
46
Q

What are different investigations that can be done for suspected obstruction

A
  • low dose plain radiography
  • sialography
  • isotope scan
  • ultrasound assessment of duct system
47
Q

What radiographs are taken for obstruction

A
  • true occlusal for submandibular
  • PA film in cheek - parotid
48
Q

What is the preferred investigation for obstruction

A

radiography
ultrasound

49
Q

When is sialography useful

A
  • mucous plugs- cant be detected on x-ray. both an investigation and tx as washes it out
  • need to be infection free
50
Q

When are isotope scans useful

A
  • when gland is damaged and function uncertain
  • helps see glands ability to secrete
51
Q

What is ductal dilatation

A
  • defect which prevents normal emptying
  • microorganisms can grow and lead to persistant and recurring sialadenitis
  • this results in gland function being lost
  • may follow childhood recurrent parotitis
  • the acinra tissue is lost and replaced with fibrous scar tissue
52
Q

What is the management of subacute obstruction

A
  • reformation of stone/obstruction
  • deformity of duct - infection
  • gland damage - reduced salivry flow and ascending infection
53
Q

What are causes of hyperplasia of the glands

A

sialosis
sjogrens

54
Q

What is sialosis

A

characterized by non inflammatory non-neoplastic recurrent bilateral swelling of the glands

55
Q

What glands are usually effected by sialosis

A

parotid
bilateral
mimics mumps

56
Q

What is the cause of sialosis

A
  • no obvious cause
  • some associations: alcohol abuse, liver cirrhosis, diabetes, drugs
57
Q

What investigations do we want to do for sialosis

A
  • bloods
  • MRI
  • ultrasound
  • labial gland biopsy
  • tear film

BDS4 Oral Medicine (17 decks)

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