11 Salivary Gland Pathology

Question 1

mucocele

Answer 1

• 60% lower lip

- all ages

Question 2

salivary duct cyst

Answer 2

• epithelial lined cavity
• possible duct obstruction
• history of trauma, swelling, pain

Question 3

ranula

Answer 3

-mucocele in floor of mouth

Question 4

sialoliths

Answer 4

• episodic swelling, often at mealtimes
• most often in submandibular gland system
• tx with sialogogues, moist heat, fluid intake, surgical removal

Question 5

sialadenitis

Answer 5

• infectious and noninfectious causes
• mumps, staph aureus
• sjogrens, sarcoidosis, radiation therapy, allergens

Question 6

acute bacterial sialadenitis

Answer 6

• most common in parotid, 10-25% bilateral
• swollen, painful, possible trismus and fever, purulent discharge
• chronic sclerosing sialadenitis if fibrosis present
• tx with antibiotics and rehydration, drain abscess

Question 7

cheilitis glandularis

Answer 7

• rare inflammation of minor salivary glands
• swelling of lower lip and glands
• middle aged/older men
• tx with vermillionectomy
• 18-35% associated with squamous cell carcinoma

Question 8

sialorrhea

Answer 8

• excessive salivation
• local irritants, GERD, rabies, medications
• neuromuscular disorders, mental retardation, surgical resection of madible cause poor neuromuscular control
• tx with anticholinergic meds, transdermal scopolamine

Question 9

idiopathic paroxysmal sialorrhea

Answer 9

• episodic excessive salivation, 2-5 minutes

- associated with nausea or epigastric pain

Question 10

xerostomia

Answer 10

• drugs major cause
• causes thirst, caries, thick saliva, microflora shift, sleep affected
• tx with biotene products, gels, liquids, prevident, pilocarpine, saliva substitutes

Question 11

sjogren syndrome

Answer 11

• chronic, systemic autoimmune disease causing xerostomia
• mostly middle aged women
• rheumatoid arthritis associated with sjogren
• schirmer test for tear secretions

Question 12

sialadenosis

Answer 12

• noninflammatory enlargement of parotid glands caused by loss of autonomic innervation
• associated with diabetes mellitus, malnutrition, alcoholism, bulimia

Question 13

necrotizing sialometaplasia

Answer 13

• locally destructive inflammatory condition
• causes include trauma, injections, dentures, tumors, surgery
• most unilateral, posterior palate
• painful swelling sloughs leaving necrotic ulcer
• biopsy, no tx, heals in 5-6 weeks

Question 14

salivary gland tumors

Answer 14

• parotid gland most common, 15-30% malignant
• pleomorphic adenomas and warthin tumor most common benign, mucoepidermoid carcinoma most common malignant
• submandibular 35-45% malignant, pleomorphic adenomas (benign) and adenoid cystic carcinomas (malignant) most common
• sublingual rare, mostly malignant
• minor glands 50% malignant, palate, lips, buccal mucosa

Question 15

pleomorphic adenoma

Answer 15

• most common salivary gland neoplasm, benign
• ductal and myoepithelial elements
• painless, slow growing, facial nerve palsy rare
• parotid, palate
• surgical excision, recurrence risk in larger glands

Question 16

warthin tumor

Answer 16

• parotid only
• smoking association (8x over non-smokers)
• slow growing, painless, mostly unilateral near angle of mandible
• surgical removal

Question 17

monomorphic adenomas

Answer 17

• canalicular adenoma, only in minor glands of upper lip and buccal muccosa
• basal cell adenoma mostly in parotid and upper lip
• surgical removal

Question 18

mucoepidermoid carcinoma

Answer 18

• most common malignant salivary gland neoplasm, most common in parotid
• most common salivary gland tumor of kids
• graded low to high, facial nerve palsy and pain common in high grade
• surgical removal, prognosis depends on grade level

Question 19

adenoid cystic carcinoma

Answer 19

• rare in parotid, 50% in minor glands
• most common malignancy of submandibular glands
• slow growing, dull aching pain, facial nerve paralysis or bone destruction possible
• perineural invasion characteristic feature
• surgery + radiation
• prognosis poor for submandibular and maxillary sinus, metastases to lungs and bone

Question 20

polymorphous low-grade adenocarcinoma

Answer 20

• only in minor salivary glands, mostly palate, upper lip, buccal mucosa
• older adults, mostly female
• perineural invasion
• surgical removal, prognosis good