4th year salivary gland disease Flashcards
(100 cards)
1
Q
Define mucocele
A
Mucus-filled cysts that affect minor salivary glands
2
Q
Commonality of mucoceles
A
Common
3
Q
Potential cause of mucoceles
A
Thought to be caused by trauma
4
Q
2 epidemiological features of mucoceles
A
More common in young adults/children
More common in males
5
Q
6 common features of the clinical presentation of mucoceles
A
Single
Fluctuant, dome shaped cyst
Normal or bluish coloration
Non-pulsatile
Normal overlying epithelium
1mm-1cm
6
Q
Common location of a mucocele
A
Inner aspect of lower lip
7
Q
4 locations superficial mucoceles are commonly found
A
Soft palate
Retromolar pad
Posterior buccal mucosa
Lower labial mucosa
8
Q
3 conditions associated with superficial mucoceles
A
Lichen planus
Lichenoid drug reactions
Graft versus host disease
9
Q
Give 2 histologically different types of mucus-filled cysts
A
Mucous extravasation cyst
Mucous retention cyst
10
Q
Most common mucus-filled cysts
A
Mucous extravasation cyst
11
Q
Describe 3 histological features of mucous extravasation cyst
A
Pool of extravasated mucous
Wall of compressed granulation tissue
Mixed inflammatory cell infiltrate
12
Q
Describe 4 histological features of mucous retention cyst
A
Duct stricture
Pool of mucous in cyst
Minimal inflammatory reaction
Wall of fibrous tissue lined by altered ductal epithelium
13
Q
4 managements strategies for mucoceles
A
Reassurance only
Excision biopsy
Cryosurgery
Sclerotic agents
14
Q
6 complications of active treatment for mucoceles
A
Bruising
Bleeding
Post-operative pain
Swelling and infection
Possibility of recurrence
Altered sensation
15
Q
Define ranula
A
Mucocele affecting floor of mouth involving major salivary glands
16
Q
Commonality of ranulas
A
Uncommon
17
Q
1 cause of ranulas
A
Obstruction
18
Q
4 features of the clinical presentation of ranulas
A
Unilateral
2-3cm in diameter
Soft, fluctuant, blue
Painless but may effect speech
19
Q
Define plunging ranulas
A
Ranula that extends into sublingual gland beyond the mylohyoid muscle and may cause midline swelling
20
Q
3 management strategies for ranulas
A
Aspiration
Marsupialization
Excision of the gland
21
Q
Define sialosis
A
Swelling of major salivary glands in particular parotid glands
22
Q
Commonality of sialosis
A
Uncommon
23
Q
4 factors linked to sialosis
A
Drugs
Alcohol
Endocrine conditions
Nutritional disorders
24
Q
4 features of the clinical presentation of sialosis
A
Soft, painless swelling
Gradual onset
Bilateral
Outward deflection of the ear lobe
25
Common location of sialosis
Parotid glands
26
Define necrotising sialometaplasia
Benign, necrotizing and inflammatory condition affecting the minor salivary glands
27
Commonality of necrotising sialometaplasia
Rare
28
Common location of necrotising sialometaplasia
Posterior palate
29
Cause of necrotising sialometaplasia
Trauma leading to necrosis
30
3 predisposing factors to necrotising sialometaplasia
Middle age
Male
Smokers
31
Epidemiological feature of necrotising sialometaplasia
2M:F
32
3 features of the clinical presentation of necrotising sialometaplasia
Preceded by paraesthesia
Irregular margins
Heaped up appearance
33
Management strategy for necrotising sialometaplasia
Supportive
34
Define salivary gland hypofunction
Condition where unstimulated and stimulated salivary flow is significantly reduced, measured objectively
35
2 objective measures of salivary gland hypofunction
Unstimulated salivary flow < 0.1-0.2mL per minute
Stimulated salivary flow < 0.7mL per minute
36
Define xerostomia
Subjective perception of a dry mouth (function is commonly found to be normal)
37
Prevalence of xerostomia
10-46%
38
2 epidemiological features of xerostomia
More common in the older population
More common in women
39
6 functions of saliva
Lubrication
Protection
Digestion through hydrolysis of starch (amylase)
Anti microbial and immunological defence
Wound healing
Solvent for taste substances
40
2 developmental causes of salivary gland disease
Agenesis or hypoplasia
Cystic fibrosis
41
2 inflammatory causes of salivary gland disease
Primary Sjogrens syndrome
Secondary Sjogrens syndrome
42
1 metabolic cause of salivary gland disease
Diabetes
43
2 iatrogenic causes of salivary gland disease
Drug therapy eg. antidepressants
Post irradiation damage
44
6 challacombe scale indicators of xerostomia
Lack of saliva
Frothy saliva
Mucositis
Candidal infection
Cervical caries
Red, depapillated, lobulated tongue
45
4 management strategies for salivary gland disease
Rectify underlying cause
Avoid contributing factors
Saliva replacement therapies
Enhance salivary function
46
5 contributing factors to xerostomia
Dry foods
Alcohol including alcohol containing mouthwashes
Smoking
Diuresis producing drinks e.g. tea/coffee
Dry hot environments
47
3 saliva replacement options
Saliva Orthana
Biotene
Glandosane if edentulous
48
1 salivary gland stimulant to enhance function
Pilocarpine derivatives
49
3 ways to manage increased caries risk for patients with salivary gland disease
High fluoride provision
Diet advice
Regular check ups and radiographs
50
Define Sjogren's syndrome
Systemic autoimmune disorder that affects exocrine glands, particularly the lacrimal and salivary glands and is characterised by lymphocytic infiltration
51
Define primary Sjögren's syndrome
Clinical symptoms of Sjögren's disease occurring in the absence of another systemic autoimmune disease
52
Define secondary Sjögren's syndrome
Clinical symptoms of Sjögren's disease are associated with another systemic autoimmune disease
53
4 epidemiological features of Sjögren’s syndrome
Most common systemic autoimmune disease
0.5-1.56%
9F:1M
60% of patients secondary Sjogrens
54
Potential cause of Sjogren's syndrome
Unknown, potentially oestrogen/androgen deficiency or virus related
55
4 clinical presentations of Sjögren’s syndrome
Painful mouth
Loss of taste
Thicker and opaque saliva
Enlarged and painful salivary glands
56
3 methods of diagnosing Sjogren's syndrome
2017 ACR–EULAR Classification Criteria for Primary Sjögren’s Syndrome
Ultrasound
Labial gland biopsy
57
5 indicators of primary Sjögren’s Syndrome as per the 2017 ACR–EULAR Classification Criteria
A focus score of ≥1 of minor labial salivary gland obtained on biopsy
Presence of anti-SSA antibodies
SICCA ocular staining score of ≥5
Schirmer test of ≤ 10 mm per 5 min
Unstimulated whole salivary flow of ≤0.1 ml per min
58
3 management strategies for Sjögren’s Syndrome
Supportive salivary substitutes/sialogues
Regular dental review
Monitor for complications: lymphoma, heart block
59
Describe artificial saliva replacements
Medicaments that mimic natural saliva, don’t stimulate salivary glands
60
Define salivary stimulants
Medicaments that stimulate salivary glands
61
Define salivary gland neoplasms
Tumours that form in the tissues of salivary glands
62
4 features that may indicate that a salivary gland tumour is likely to be malignant
Low in the mouth
History of pain/tenderness
Facial nerve dysfunction
Involvement of skin, fixation or ulceration
63
Common salivary glands affected by neoplasms
10x more common in major glands, usually the parotid gland
64
Define pleomorphic salivary adenoma
Benign tumour affecting salivary glands characterised by architectural diversity: ducts, sheets, strands of myoepithelium
65
2 histological features of pleomorphic salivary adenoma
Myoepithelial cells produce myxoid matrix which may resemble cartilage
Tumour often lined with thin incomplete capsule
66
3 epidemiological features of pleomorphic salivary adenoma
Commonest tumour (60%+), in both major and minor glands
Occurs at all ages
Peak 20-40 years
67
Recurrence of pleomorphic salivary adenoma
Local recurrence common, especially if ruptured
68
Describe metastasis of pleomorphic salivary adenoma
Very rarely, benign pleomorphic adenoma may metastasise, usually post-op, major glands
69
Define carcinoma ex-pleomorphic adenoma
Malignancy of longstanding and/or recurrent pleomorphic salivary adenoma lesions
70
3 features of the clinical presentation of carcinoma ex-pleomorphic adenoma
Rapid enlargement of lump
Usually major salivary glands
Peak incidence about 10 years after pleomorphic adenoma
71
2 factors affecting the prognosis of carcinoma ex-pleomorphic adenoma
Degree of invasion beyond capsule
Precise subtype
72
Define mucoepidermoid carcinoma
Malignant tumour affecting salivary glands, usually minor and parotid glands with 3 histologically distinct elements
73
3 histologically distinct elements of mucoepidermoid carcinoma
Mucous cells
Epidermoid cells
Intermediate cells
74
2 histological features of mucoepidermoid carcinoma
May be solid, cystic or both
Circumscribed but unencapsulated
75
2 epidemiological features of mucoepidermoid carcinoma
Occurs at all ages
Peak 40-50 years
76
Metastasis of mucoepidermoid carcinoma
Low-grade tumour, less than 10% metastasise
77
3 features indicative of a high-grade mucoepidermoid carcinoma lesion
Solid rather than cystic
Cytologically malignant-looking cells
Infiltrative edge
78
Define adenoid cystic carcinoma
Malignant tumour affecting salivary glands, usually minor and parotid glands
79
2 epidemiological features of adenoid cystic carcinoma
Occurs at all ages, peak 40-50 years
80
4 features of the clinical presentation adenoid cystic carcinoma
Soft
Unencapsulated
Discoloured mucosa
Nerve-related symptoms
81
Histology of adenoid cystic carcinoma
Swiss cheese appearance with deceptively bland cytology
82
3 features of metastasis of adenoid cystic carcinoma
Usually low-grade
Widespread local invasion
Haematogenous metastasis common
83
3 management strategies for malignant salivary gland neoplasms
Surgery (excision biopsy)
Radiotherapy: not particularly effective
Chemotherapy: formalin
84
3 opportunistic bacteria associated with salivary gland infections
Staphylococcus aureus
Steptococci
Anaerobes
85
2 predisposing factors to bacterial salivary gland infections
Reduced salivary gland flow
Reduction in host immunity
86
4 features of the clinical presentation of bacterial salivary gland infections
Painful gland swelling
Unilateral, involving one major gland
Pus expressed from duct
Regional lymphadenopathy
87
2 management strategies for bacterial salivary gland infections
Supportive
Antibiotic therapy: co-amoxiclav 5 day course
88
Describe salivary duct obstruction
Obstruction affecting salivary gland output
89
4 causes of salivary duct obstruction
Benign stricture
Mucus plug
Sialolith/stone
Extraductal compression
90
Clinical presentation of salivary duct obstruction
Swelling at mealtimes that resolves over the next few hours
91
Define sialoliths
Single or multiple calcification(s) of a mucus plug over time
92
Common location of sialoliths
Usually affecting submandibular gland - within salivary gland duct or deep within gland itself
93
4 management strategies for sialoliths
Supportive management
Removal in clinic using probe
Basket retrieval (sialendoscopy)
Excision
94
4 complications of bacterial salivary gland infection
Recurrence of infection
Spread of infection
Fistula formation
Compromised gland function
95
Describe sialography
Anatomical investigation of major salivary gland structure where radiopaque dye is introduced into the gland via the duct and two radiographs at 90 degrees to each other
96
Give 2 indications for sialography
Obstructive symptomatology
Sjogrens syndrome
97
Give 2 contraindications to sialography
During acute phase of salivary gland infection
Hypersensitivity to iodine
98
4 viruses commonly infecting salivary glands
Paramyxovirus
Influenza virus
Echo viruses
Epstein Barr virus
99
4 clinical features of a paramyxovirus salivary gland infection
Painful swelling of parotid glands
Bilateral
Pyrexia
Regional lymphadenopathy
100
3 systemic complications of paramyxovirus infection
Pancreatitis
Orchitis
Oophoritis
