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Flashcards in Chapter 11 Deck (120):
1

Describe the saliva composition of the submandibular, sublingual, and parotid glands

Sublingual - mucous

Submandibular - mostly serous with some mucous

Parotid - serous

2

Which salivary gland is more likely to have a mass (benign)? Why?

Parotid gland because it is a large gland with lymph nodes embedded in it.

3

Where in the oral cavity are minor salivary glands found? Where are they not found?

Found in hard palate, soft palate, labial and buccal mucosa, ventral tongue

Not found in anterior hard palate (rugae), attached gingiva, dorsal tongue

4

What is the definition of a neoplasm?

New growth with unlimited growing potential. Tumors and neoplasms aren't necessarily the same things

5

What is a mucocele?

Spillage of mucin/saliva into the soft tissues due to rupture of a salivary gland duct, usually caused by trauma

6

What population are mucoceles most common in? Why?

Children and young adults because they are more prone to injury

7

What is the most common location for mucoceles?

Lower lip (83%)

Other common locations are the FOM, anterior ventral tongue, and buccal mucosa

8

Why is it important to remove the adjacent minor salivary gland when treating a mucocele?

So that the mucocele doesn't reoccur

9

Clinical mucoceles of the upper lip are more likely to be a ___ than an actual mucocele.

Salivary gland tumor

10

Mucoceles of the retromolar region are distinctly unusual. Most clinical mucoceles in this region will prove to be _____

Mucoepidermoid carcinoma

11

What is a mucocele in the FOM called?

A ranula

12

Where are ranulas found? They are associate with the rupture of the ____ duct.

FOM

Lateral to midline


Sublingual gland duct

13

You can treat ranulas by surgical excision or marsupialization. What is marsupialization?

Removal of the roof of the intraoral lesion

14

Why are ranulas a serious medical concern?

They can get big enough that it could go through the mylohyoid muscle and elevate the tongue and obstruct the airway

15

What is a mucus extravasation phenomenon called?

A mucocele

16

What is another name for a salivary duct cyst?

Mucus retention cyst

17

True or false... salivary duct cysts are most commonly found in children

False. Occurs mostly in adults

18

What is a salivary duct cyst?

An epithelium-lined cavity that arises from saliavary gland tissue

19

What is a plunging ranula?

Spilled mucin dissects through the mylohyoid and is dangerous

20

Where are salivary duct cysts typically found?

Usually in the parotid gland but also common in FOM, buccal mucosa, lips


may be in any major or minor salivary glands

21

If you find a mass on the hard palate, what should you assume it is?

A mass on the hard palate is considered a neoplasm until proven otherwise

22

What is the coloring of a salivary duct cyst?

Bluish (may be normal or yellowish)

Soft fluctuatant swelling

23

What is the treatment of a salivary duct cyst?

Surgical excision

24

What are sialoliths?

Salivary stones

These are calcifications that develop in salivary ducts

25

Where is the most common location for sialoliths? Why?

Submandibular gland because it has a long and tortuous duct with thick secretions

May also be found in the upper lip and buccal mucosa

26

What are the symptoms of a sialolith?

Pain or swelling especially at meal time

You can diagnose it by radiographs, sialography, ultrasound, CT

27

What is the treatment for a sialolith?

Gentle massage, increase fluid intake, moist heat, sialogogue, surgery

28

What are some things that slows or inhibits salivary flow through the duct system which may predispose to development of stones?

Mucous plug
Bacterial colonies
Chronic duct blockage phenomena

Normal ductal anatomy (Wharton's duct (submandibular duct)

Xerostomia (typically are not associated with elevated serum calcium levels)

29

What is another name for mumps?

Epidemic parotitis

30

Mumps is caused by a ___ infection primarily affecting the salivary glands. Some complications associated with mumps are ___, ___, and ___.

Paramyxovirus

Epididymoorchitis (swollen testes)

Oophoritis

Mastitis


Diagnosis is based on clinical findings, viral culture, serological tests

31

What are anesthesia mumps? How long does it take for this to spontaneously resolve?

Rare complication after general anesthesia (due to allergic reaction)

Swelling of parotid or submandiublar glands after surger

Spontaneously resolves in hours to a few days

32

What is sialadenosis? (Sialosis)

Non inflammatory asymptomatic* salivary gland enlargement

33

Where does sialadenosis typically occur?

Parotid gland. Hypertrophic of acini

34

What are some underlying systemic conditions that could lead to sialadenosis?

Endocrine disorders: diabetes*, hypothyroidism, pregnancy

Malnutrition: general malnutrition, alcoholism*, anorexia, bulimia*

Drugs: anti-hypertensive drugs, psychotropic drugs

35

What is the clinical presentation of sialenosis?

Parotid swelling

Usually slowly evolving

Usually bilateral

could have pain

36

What is adenomatoid hyperplasia of the minor salivary glands?

Minor glands, often on hard or soft palate.. localized sessile painless swelling that mimics a neoplasm.

Pathogenesis is unknown but possibly due to trauma

Hyperplasia of normal gland

**remember that you must biopsy to rule out neoplasm because swelling on the hard palate is considered a neoplasm until proven otherwise.

37

What is necrotizing sialometaplasia? What is it caused by?

Locally destructive inflammatory condition of the salivary glands

Due to ischemia

Some factors that can cause ischemia are traumatic injuries, dental injections (too fast too close to bone), ill-fitting dentures, upper respiratory infections, adjacent tumors, previous surgery

38

Where does necrotizing sialometaplasia typically occur?

Palate. Unilateral

39

Necrotizing sialometaplasia is a non-ulcerated swelling, pain and paraesthesia leading to necrotic tissue sloughs out, ulcer heals in __-__ weeks

5-6 weeks

40

You must biopsy necrotizing sialometaplasia to rule out ___

Malignancy.

It mimics malignancy clinically (except too acute onset) and histologically

41

What is sialadenitis?

Inflammation of the salivary glands

42

What are the infectious and non infectious causes of sialadenitis?

Infection: mumps (viral). Bacterial

Non-infectious: sjogren syndrome. Sarcoidosis, radiation induced, recent surgery, allergic reaction, obstruction of the salivary duct.

43

What is chelitus glandularis?

Swelling and version of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands

44

Although the cause of chelitus glandularis is unknown, what.are some possible causes?

Sun damage, tobacco, syphilis, poor hygiene, heredity

45

What is the clinical presentation of cheilitis glandularis

Swelling and pain, typically lower lip

Eversion of the lip

Red dots indicate duct orifices

Weeping mucopurulent secretions often are seen

46

What population is cheilitis glandularis most commonly found in?

Middle aged to older males

47

What does the histology of cheilitis glandularis look like?

Chronic sialentitis and ductal dialation

48

Cheilitis glanduaris can sometimes look like ___. It is important to determine which it is because ___ may be ___.

Actinic chelosis

Actinic chelosis may be premalignant

(Cheilitis glandularis still has a well defined vermillion border)

49

What is sialorrhea?

Excess salivation

50

What are some things that can cause sialorrhea?

Local irritations (apthous ulcers, ill fitting dentures)

GERD

Rabies, heavy metal poisoning (hat makers and wood words are prone to metal poisoning)

Medications

Idiopathic paroxysmal sialorrhea

Drooling

51

What are some things that can cause drooling (leading to sialorrhea), why?

Down syndrome (macroglossia)

Neurological disorder (cerebral palsy)

52

What is the treatment of sialorrhea?

Treat the underlying cause

Anticholinergic medications, scopolamine transdermal patch (not for children)

Surgery: relocation of the salivary ducts to tonsillar fossa, tympanic neurectomy

53

How common is xerostomia?

Xerostomia is subjective sensation of a dry mouth common in 25% of older adults

54

What are 3 complications with xerostomia?

Candidiasis (due to changes in oral microflora)

Prone to cervical and root caries

Alteration of taste

55

What are some common causes for xerostomia?

Medications

Caffeine/alcohol

Smoking

Radiation therapy to head and neck

Sjögren's syndrome

Diabetes mellitus

Sarcoidosis (noncaeseating granulamouts inflammation)

Surgery of salivary glands

56

How do you manage xerostomia?

Elimination of alcohol, smoking, caffeine

Drug modification, if possible. (Sleep aids are really bad about causing xerostomia

Sugarless gum/candies

Oral lubricants (mouthwash, biotene, spray)

57

What does xerostomia look like intraorally?

Fissured tongue

With dry glove, wipe hard palate, it will stick

Prone to angular cheilitis

Rampant caries

58

What is another name for Sjögren's syndrome (if they also have dry eyes)?

Sicca syndrome

59

SS mainly affects what population?

Women

60

What is the difference between primary and secondary SS?

Primary SS - no other autoimmune disease

Secondary SS - associated with other autoimmune diseases (rheumatoid arthritis)

61

In order to be diagnosed with SS, you must have 2 out of the 3 criteria. What are the three criteria?

Positive serum anti-SSA or and SSB

Ocular staining score of 3 or greater. (Sum of fluorescein staining of cornea 0-6 and lissamine green staining of both nasal and temporal bulbar conjunctiva (0-3)

Presence of focal lymphocytic sialadenitis with a focus score of one or greater/4mm^2 in labial salivary gland biopsy samples

62

What are the exclusion criteria for SS?

Past head and neck radiation treatment

Hep. C infection

AIDS

Preexisting lymphoma

Sarcoidosis

Graft vs. host disease

Use of anticholinergic drugs

63

A lymphocytic focus has at least how many lymphocytes?

50 or more lymphocytes

64

What is the treatment for SS?

Management of xerostomia.. which includes.. sugarless gum, dry mouth products, sialogauges, emphasize oral hygiene, monitor lymphoma

65

Name two sialogauges used to treat SS?

Pilocarpine (salagen)

Cevimeline (evoxac)

66

Patients with SS are ___ times more likely for a certain type of lymphoma called ___

40 times

MALT lymphoma (marginal zone lymphoma)

67

What does a salivary neoplasm look like?

Smooth surfaced

Dome shaped

Non-ulcerated

68

What is the incidence of salivary neoplasms?

4/100,000 people

69

Where are the most common locations for salivary neoplasms? Give the percentage of incidence for each location.

Parotid gland (70%)

Minor glands (25%)

Submandibular (~5%)

Sublingual (<1%)

70

Sublingual neoplasms have the highest likelihood of being malignant. What percentage of sublingual neoplasms are malignant?

70-90%

71

What is the most common site for minor salivary gland neoplasms? What percentage of minor salivary gland neoplasms occur here?

Palate

50% especially on the lateral hard or soft palate*

72

What percent of all major salivary gland neoplasms are benign, what percent is malignant?

Benign 66%

Malignant 34%

73

What percentage of parotid salivary gland neoplasms are benign, what percent are malignant?

Benign - 70%

Malignant - 30%

74

What percentage of submandibular gland neoplasms are benign, what percent are malignant?

Benign - 60%

Malignant - 40%

75

What percentage of sublingual neoplasms are benign, what percent are malignant?

Benign - 30%

Malignant - 70%

76

What percentage of minor salivary glands are malignant for the following locations...

All minor glands
Upper lip
Lower lip
Palate
Tongue
Cheek
Retromolar pad

Malignant...

All minor glands - 50%
Retromolar pad - 90%
Tongue - 85%
Lower lip - 60%
Cheek - 50%
Palate - 50%
Upper lip - 20%

77

Salivary gland neoplasms are more common in the ___ lip than the __ lip

More common in upper lip than lower lip

78

Upper lip neoplasms are mostly __ whereas lower lip neoplasms are mostly ___

Benign

Malignant

79

What percentage of neoplasms in the retromolar area are malignant?

90%

80

What s the most common neoplasm?

Pleomorphic adenoma (benign)

81

What is the most common malignant neoplasm?

Mucoepidermoid carcinoma

82

Name four different benign salivary gland neoplasms

Canalicular adenoma

Pleomorphic adenoma

Warthin tumor (papillary cystadenoma lymphomatosum)


Oncoctyoma

83

What is another name for a warthin tumor?

Papillary cystadenoma lymphomatosum

84

What is a canalicula adenoma?

A type of monomorphic adenoma

It is slow growing, painless mass, blue or normal color, may be multifocal

85

Where do canlicular adenoma typically occur?

Exclusively in minor salivary glands of the upper lip (75%) and buccal mucosa

86

Only a ___ is found more commonly in the upper lip than a canalicular adenoma

Pleomorphic adenoma

87

If you find a neoplasm in the upper lip. It is likely a pleomorphic adenoma if the patient is of the age ___. It is likely a canalicular adenoma if the patient is of the age ___.

<50

>60


Canalicular adenomas are found in older age groups (7th decade peak), with a slight female predominance

88

What is another name for a pleomorphic adenoma?

Benign mixed tumor


*note that this is the most common salivary neoplasm

89

~60% of parotid tumors (superficial lobe), and ~55% of submandibular tumors are what kind of neoplasm?

Pleomorphic adenoma

90

What kinds of cells are pleomorphic adenomas made out of?

Mixture of ductal and myoepithelial cells

(Remarkable microscopic diversity accounts for the name)

91

Name, in order, the most common sites for minor gland pleomorphic adenomas.

Palate

Upper lip

Buccal mucosa

92

True or false.. pleomorphic adenomas can grow to grotesque proportions if untreated.

True

93

Which salivary neoplasm is encapsulated? How is it encapsulated?

Pleomorphic adenomas are encapsulated.

They are well-circumscribed and have a firm fibrous tissue lining. This allows you to basically peel the growth out.

94

Which tumor is a benign tumor of oncocytes?

Oncocytoma

95

What is an oncocyte?

Cell that went through metaplastic processes that made mitochondria fill up the cell.

96

What is the second most common benign parotid tumor?

Warthin's tumor (papillary cystadenoma lymphomatosum)

These occur almost exclusively in the parotid gland and may be bilateral

97

What population is warthin's tumor predominately found in?

Older men

Smokers

98

Smokers have a __ times greater risk of developing a warthin's tumor

8

99

While a pleomorphic adenoma is typically found in the superior tail of the parotid gland, where are warthin's tumors typically found?

Posterior inferior tail of the parotid

100

Name 5 malignant salivary neoplasms

Mucoepidermoid carcinoma

Acinic cell adenocarcinoma

Adenoid cystic carcinoma

Polymorphous low-grade adenocarcinoma

Malignant mixed tumor

101

What is the most common malignant salivary neoplasm?

Mucoepidermoid carcinoma

102

Where is the most common location for mucoepidermoid carcinomas?

Parotid gland

They most common is minor glands (remember that the palate is the most common minor gland neoplasm site)

103

True or false... benign tumors are typically unuclerative while malignant tumors are ulcerative

True

104

True or false... prognosis of mucoepidermoid carcinoma solely depends on the clinical stage.

False. It depends on the histopathologic grade and clinical stage

105

True or false... mucoepidermoid carcinoma has a better prognosis in the submandibular gland the parotid gland.

False... the submandibular gland tumors are associated with a poorer prognosis than in the parotid gland

106

What is the pathogenesis of intraosseous mucoepidermoid carcinoma?

Ectopic salivary gland tissue that was developmentally entrapped within the jaw

Odontogenic epithelium, mucous metaplasia

107

Where are the most common locations of intraosseous mucoepidermoid carcinoma in middle aged adults?

Mandible>maxilla>molar-ramus region

108

True or false... intraosseous mucoepidermoid carcinoma has a survival rate of 90%

True

109

What is an acinic cell adenocarcinoma?

Low-grade malignant neoplasm showing serous acinar differentiation

Slow growing mass with pain

110

Where are the most common locations for acinic cell adenocarcinoma?

Parotid gland (85% of cases) > minor glands > submandibular

111

What is the second most common malignant neoplasm?

Acinic cell adenocarcinoma

112

What is the local recurrence, metastasis, and survival rate of acinic cell adenocarcinoma?

Local recurrence: 1/3

Metastasis: 10-15%

Survival: 80-94%

113

What is the most common malignant salivary gland tumor of the submandibular gland?

Adenoid cyst carcinoma

114

True or false.. adenoid cystic carcinomas are more commonly found in minor glands than in the parotid gland or submandibular glands

True

115

Which tumor is slow-growing, widely infiltrative, has a tendency for perineural spread, surrounds nerves to cause pain and facial nerve paralysis, and most commonly affects middle aged adults?

Adenoid cystic carcinoma

116

Which salivar gland tumor almost exclusively occurs in minor glands, and is found in older adults, and exhibits different growth patterns histologically?

Polymorphous low-grade adenocarcinoma (terminal duct carcinoma)

117

What is another name for a malignant mixed tumor?

Carcinoma ex pleomorphic adenoma

118

Malignant mixed tumors are most commonly found in ___ glands

Major glands.

119

Malignant mixed tumors result from malignant transformation of the ___ cells. Mass presents for many years but a recent rapid growth with pain and/or ___

Epithelial cells

Ulceration

120

What is a carcinosarcoma?

A type of malignant mixed tumor. It has carcinomatous and sarcomatous components. (Epithelial and mesenchymal components)