Salivary gland disease Flashcards
(145 cards)
1
Q
how many minor salivary glands are present?
A
600-1000
located in inner lips/cheek/throat/palate/pharynx
2
Q
what are the two broad categories of salivary gland disease?
A
neoplastic: benign or malignant
non neoplastic: congenital or aquired
3
Q
what is silaloithiasis ?
A
calcium rich stones deposits in the salivary glands
4
Q
what can predispose you to salivary gland stones?
A
xerostomia dehydration antihistamines antihypertensives antipsychotics
5
Q
what are the signs and symptoms of sialolithiasis?
A
painful lump in FOM
Pain worsened on eating
stone can block the glands duct partially or completely
6
Q
what can salivary stones predispose you to?
A
infection
7
Q
what is acute supparative sialadentitis?
A
this is an infection of the salivary gland usually caused by staph areus/strep viridans ,
8
Q
which poeple are commonly affected by sialadentis?
A
older people
following surgery and period of dehydration, poor OH
9
Q
what are the signs of sialadenitis?
A
tender , painful lump in cheek or under the chin
foul taste
fever and weakness
10
Q
how do you treat sialedenitis?
A
metronidazole, flucloxicillin
11
Q
which viral infections can cause salivary gland disease?
A
mumps caused by paramyxovirus
12
Q
which congenital cysts affect the salivary glands?
A
cysts in parotid gland due to problems related to the ear development before birth
13
Q
which congenital diseases of the salivary glands exist?
A
aplasia/heterotropic
Stafne defect
cysts
14
Q
what is a stafne defect?
A
congenital salivary gland disease ectopic portion of salivary gland tissue causing the bone in the mandible to remodel
15
Q
which acquired diseases of the salivary glands exist?
A
TIIINMAN vascular infective traumatic autoimmune metabolic inflamm neurological neoplastic idiopathic
16
Q
Which traumatic lesionsc an cause salivary gland disease?
A
mucoceles/ranula
nicotinic stomatitis
Ranula: 2-3cm in FOM soft blue and fluctuant mucocele from the SM or SL gland
17
Q
what is nicotinic stomatitis?
A
heat from tobacco causes hyperkeratosis of palate
can also cause inflam of the duct opening of tiny salivary glands on the palate become dialiated
18
Q
what does nictonic stomatitis look like?
A
red patches or spots on a white background
19
Q
what infections of the salivary glands can occur?
A
Sialadenitis: inflammation of the Saliavry gland and most common in parotid
bacterial: usually ascending infection from oral cavity
viral: paramyxovirus, HIV
rarely fungal
Management: hydration, AB flucloxillin and metron, analgesia
20
Q
what inflammatory diseases can affect the salivary glands?
A
irradiation
sarcoidodis
21
Q
which idiopathic diseases can affect the salivary glands?
A
saliliothiasis and sialosis/sialodenosis
22
Q
what is sialosis?
A
this is an uncommon, non-inflam, non-neoplastic recurrent swelling of the salivary glands
23
Q
Which benign neoplasms of the salivary glands are there?
A
PWC
pleiomorphic adenoma
Warthins tumour
Canalicular adenoma
24
Q
which malignant salivary gland diseases are there?
A
Mucoepidermoid
acinic cell
SCC
adenoid cystic
25
Which metabolic diseases can affect the salivary glands?
diabetes
| anaorexia
26
which autoimmune diseases can affect the salivary glands?
Sjrogens
| GvHD
27
how can a benign tumour of the parotid present?
painless slow growing lump near earlobe
28
malignant tumours typically present with which feature?
facial nerve weakness
29
which neurological diseases of the salivary glands are there?
freys syndrome
30
which vascualr lesions of the saliavry glands are there?
Necrotising sialometaplasia
31
what are the three common injuries to the parotid gland?
effusion
sialocele
external fistula
32
what is the treatment for salivary caliculi?
conservative management for small stones: promote hydration, sucking on citrus fruits, extracorpeal lithotripsy
invasive: Sialoendoscopy with basket retrieval or fragmentation, surgery
33
what surgical treatment options are there for SM glands?
gland preserving surgery, incision is made through FOM and then through the SM duct to gain access to stone when in distal duct
34
what surgical treatment is performed for parotid stone?
meatotomy this is when you excise the duct and make the opening larger to get the stone out
perfomed when stone in distal duct
35
when would you perform intra-oral surgery?
stone is not palpable I/O
36
when would you perform extracorpeal lithotripsy?
cannot see stone on US
| patients with blood dyscrasaias, pregnant or abnormal clotting, undergone stapedectomy or ossicular repair
37
what proportion of salivary gland tumours account for head and neck tumours?
3%
38
what are the long standing injuries that can occur from salivary gland trauma?
effusion
sialocele
external fistula
39
What is the demographics of necrotising sialometaplsia?
more common inmales 3:1 ratio
| occurs aged 50 and above
40
What are the clinical features of sialosis?
painless bilateral cheek swelling
| peak ages 30-60, more common in women
41
What is the aetiology behind silaosis?
hormonal disturbances: diabetes, hypothyroidism, pregnancy and lactation
malnutrition: protein defciency, alcoholics, bullimia
Drugs: iodine, antihypertensives, isoprenaline
42
How can we investigate salivary gland disease?
Intermittent swelling and persistent swelling US
intermittent swelling associates with meals consider radiography as well as US
If a mass is identified: MRI/CT following US
If a calculus or dilatation or structure identified on US then sialgography
43
which glands are calculi more common in? and at what percentages?
Submanidbular ( 83-94%, 20% have 2 or more)
parotid (4-10%)
SL (1-7%)
44
what are the causes of obstructive disease?
stone or stricture
45
When are plain films used and how useful are they?
intra oral films used to look at duct course
extra-oral films used to look at glands
Not useful and may identify unrelated disease
46
What percentage of stones are radiolucent?
40% of parotid
| 20% SM
47
What is the incidence for stones?
30-50
| 2:1 M:F
48
Which radiographic views could you consider taking for a stone?
lower 90
| olique lateral or tru lateral
49
What should be the first choice for investigating salivary gland disease?
ULTRASOUND
50
What are the indications for US?
swellings in and around salivary glands
detect stones in SM or Parotid
US guided biopsy
Lithotrotrpisy
51
What are the contra-indications to US?
NONE
52
When would you use Sialographay?
```
Following US
symptoms of obstructive disease (stone or stricture)
recurrent infection
sjrogens
prior to interventional procedure
```
53
what are the contraindiations of silaogrpahy?
allergy to iodine
Acute infection
calculus near orifice
single epiode of problems
54
What are the advanatges of a sialogram?
Excellent imaging of the ductal system
55
What are the disadvantages of sialogrpahy?
LImited infromation about the parenchymal tissue
operator dependant
radition dose
56
How much contract media is injected into the duct in sialography?
0.3-0.5ml
57
How many x ray films need to be taken when carrying out sialography?
a film to establish exposure and any radiopaque calculi
2 films after the sialgroam has been administered at 90 degrees to eachother
film to establish if contrast retained after the sialoggue has been gieven
58
what should the appearance of the main salivary duct be?
uniform dimension
59
What is the diameter of the SM duct compared with the parotid?
SM: 3-4mm
parotid: 1-2mm
60
What should the intraglandular ducts look like for the parotid gland and sm gland?
Parotid: tree in winter
SM: bush in winter
61
If there is stenosis in the salivary gland how will this affect the contrast media?
the contrast media will be slow to empty and may be reatined
62
If there is a caliculi in the gland how will this affect the contrast media?
contrast maybe retained once the sialogoue has been adminstered
63
Which obstructive disease has a filling defect in duct with proximal ductal dilatation (near gland)?
caliculi
64
Which obstructive disease has narrowing of the duct with proximal ductal dilatation?
Stenosis
65
What are the management options for stricture management?
Balloon dilatation
66
When would you use an endoscope?
TO break up the stone or to utilise with the basket
67
What is the appearance of the salivary glands radiologically in sjoregns syndrome?
Punctate sialectasis
68
what is sialodochitits?
Ductal inflammation or infection
69
How does sialodochitis appear radio graphically? what can it be associated with?
string of sausages
segmented sacculation or dialatation of the main duct
it can be associated with stenosis or caliculi
70
When would you use a MRI scan in saliavry disease?
a suspected mass identified with US
71
When would we use nucelar medicine in salivary gland disease?
rarely now
| replaced with US
72
When would we use a CT scan in salivary gland disease?
persistent mass where MRI contraindicated
73
What percentage of sialoliths occur in the distal third of duct (near orifice) SM?
50%
74
What percentage of stones occur within the SM gland?
30%
75
What percentage of stones occur within the proximal part of the duct in SM glands?
20%
76
What are the causes of silalorrhoea/ptyaliasm?
Swallowing problems: Cancer/infection blocking airway
Excessive production: RIley day syndrome
Neuromuscular dysfunction: parkinsons, muscular dystrophy, cerebral palsy, CVA
Anatomical: macroglossia/thrusting
Drugs: anticholinsterases/Clozapine/haloperiodol
77
What are the medical treatment options for excessive saliva?
Scopalamine patch (1.5mg)
Glycopyrrolate tablets (1-2mg)
Botox
oral motor training
78
What are the disadvantage of scoplalmine patches?
can lead to glaucoma
79
What are the disadvantages of glycopyrolate tablets?
Can cause constipation (antocholinergic and antimuscarinic action)
80
What are the surgical treatment options for silorrhoea?
GLand excision
Re-route the parotid duct
duct ligation
81
When would you carry out surgery for excess salivation?
when symptoms present for more than 6 months
| patients that suffer from learning difficulties
82
Which antibiotics would you normaly prescribe for acute parotitis?
flucloxacillin or metroinidzaole
83
What are the predisposing factrors for acute parotits?
```
Caliculi or strictures
dehydration
xerostomIa
diabetes
history of obstrcutive dieases
```
And recurrent parotitis of childhood
84
What are the causes of xerostomia?
iatrogenic: drugs, radiation, GvHD
Dehydration
Sjoren, Sarcoidodis, Primary biliary cirrhosis
Diabetes, cystic fribrosis, autonomic dysfunction, hyperparathyrosism
85
What investigations would you do in a patient suffering from xerostomia?
```
Haematological investigations: ESR/C reactive protein
AI immune dieaase: RF, ANA, SSA, SSB
SACE
Serum calcoum and phorphate
blood glucose
```
US
carlessen critten test (stimulated saliva)
Labial gland biopsy
86
what is the noirmal rate for unstimulated salivary flow?
0.1ml
87
What is the normal rate for stimulated saliva flow?
>1ml/min
88
What would the labial gland biopsy show in people with sjrogens?
70% have focal lymphocytic infiltration
| since there is lymphopcyte mediated destruction of salivary gland
89
which immune cell maybe lacking in people with sjorgens?>
t supressor cells
90
What is the implication of lacking t supressor cells?
B cells are able to increase which may lead to lymphpoma
91
What happens to the glandular tissue in sjrogens and what happens to the ductal tissue in sjrogens?
acina show atrophy
| ductal cells multiply and can block the duct forming epimyoepithelial islands
92
What are the causes of hallitotis?
```
Drugs: Antithyroids, Baclofen, biguanides
resp infection
periodontal diseaae
dry socket
sinusitis
periconronitis
poor OH
ulcers
```
93
What are the components of salivary glands?
Acini-serous or mucous
lipids
ducts
myoepithelial cells
94
the partoid gland is composed of which type of acini?
serous
95
The SM gland is composed of?
mixed mainly serous
96
the SL gland is composed of?
Mixed mainly mucous
97
What are the three types of mucoceless?
superfical
extravastion
rentention
98
What is the incidence of salivary cysts?
common
| 2nd-3rd decade
99
What sites do mucoceles occur on?
```
50% lower lip
cheek
tongue
FOM
rare on upper lip
```
100
Which type of salivary glands do mucoceles usually arise from? minor and major?
minor
101
what is a mucous extrvastion cyst?
younger type
| duct ruptures and leaks out into the connective tissue and becomes lined by granulation tissue and muciphages
102
What is a retention mucocele?
older type and caused by blockage of the duct by a stone for example, it is lined by epithelium
103
What are superficial mucoceles?
causes by a subepithelial or intraeputhelial blister
| they rupture and leave shallow ulcers
104
Superficial mucoceles are more common in males or females?
females
105
What is a adifferntial diagnosis for a subepithelial blister?
Pemphigoid, DH, EM, Liner IgA
106
What is a differential for intraeipthelial blisters?
pemphigus
107
What are the benign neoplasms of saliavry gland?
PWC
pleiomorphic adenoma
Warthins tumour
Canalicicluar adenoma
108
What are predisposing factors for salivary gland tumours?
link between salivary gland and breast cancer
109
What is the frequency for salivary gland tumours?
Parotid: 73%
Minor glands: 14%
SM gland: 11%
SL: 0.3%
110
What is the percentage malignancy for salivary gland tumours?
parotid: 15%
Minor: 46%
SM: 37%
SL: 86%
111
What is a pleiomorphic adenoma?
a well circumscribed tumour with a pleiomorphic (mixed) appaerance
slow growing well demarcated and smooth and mobile
112
What is special about the epithelial tissue of a pleiomorphioc adenoma?
recognisbale epithelial tissue intermignled with mucoid, myxoiud and chondroid appearance
113
What are the features of pleiomorphic adenoma?
commonest salivary gland tumour (65% of parotid)
Affects all ages
2:1 F:M
114
What site do pleiomorphic adeomas usually affect?
Palate (most common I/O site)
| can present as swelling behind the ear
115
what are the macroscopic features of a pleoimorophic adenoma?
Fibrous capsule
capsular invasion
bosselated surface
satellite nodeules
116
What are the microscopial features of a pleimorphic ademona?
Epithelial: stands, sheet and duct like
| Connective tissue: Mucoid, chondroid and fibrous
117
What complications can arise fro a pleiomorphic adenoma?
Recurrence and malignant progression
118
What are the reurrence rates for pleimorphoic adenoma?
5 years: 3.4% and 10 years 6.8%
119
Why do pleiomorphic tumours recurr?
```
diffluant nature
varibale thickness of capsule
intra-tumoural splittins
nodules bulging through capsule
low biological requirement
```
120
What is a warthins tumour?
this is a benign neoplasm of the salivary glands also known as, circumscribed, slow growing, mobile and painless
adenolymphoma
cysctic lymphadenoma
papilliary cyst adenoma lyphomatsum
121
What is a warthins tumour composed of?
cystic and glandular structures with a papilliary cystic arrnagemnt
122
What is a warthins tumour lined by?
eosinophilic epithelium
123
What is in the stroma of a warthins tumour?
lymohoid tissue with follicles
124
What percentage of parotid tumours are warthins?
14% of primary epithelial tumours
125
Who is at risk from warthins tumour? where does it affect?
50-70 year old males
smoke
5-10% are bilateral and mulitfocal
lower pole of parotid gland
126
what are the macroscopic features of a warthins tumour?
Gelatiunous contect
| cystic structures with papilliary in growth
127
What are the microscopical features of warthins tumour?
double layered, oncocytic, columnar epithelium lining the cysts
lymphoid stroma with germinal follicles
capsule and subcapsular sinus
128
Where do warthins tumour arise from?
ectopic salivary gland tissue in the intra or para parotid lymph nodes
129
What are the consequences of warthins tumour?
benign
| can infarct or become infarct
130
What is a canalicular adenoma?
```
benign
CALM
Columnar epithelial cells
anastomising bi layered strands
Loose vascular stroma and cysts
Minor glands (90% upper lip, 10% lower lip)
```
131
what is a mucoepidermoid carcinoma?
tumour which has sqaumous cells, mucus secreting type cells and cells of an intermdiate type
132
What is the clincal behaviour of a mucoepidermoid carcnima?
variable
Low grade presents as PA
High grade: rapid growth, pain, nerve fixation, unlceration, metastases
133
What is the prevelance of mucoepidermoid carcinomas? which age group does it affect?
5-10% of all salivary gland tumours
15% of minor glands
can affect any age
134
What are the microscopial features of a low grade mucoepidermoid carcinoma?
large number of mucous cells, small number of epidermoid cells, cysts which rupture, cause inflammation and lead to fibrosis
135
What are the microscopical featurs of high grade mucoepidermoid cancrinoma?
Large number of epidermoid cells, small number of mucous cells, solid and causes necrosis
136
What is acinic cells carinoma?
cells similar to cerous cells which from solid sheets
| small to large cystic spaces
137
What percentage of parotid tumours are affected by acinic cells carcinoma?
2%
138
What are the complications of acincic cells carcinoma?
they may recurr and metastasise locoregionally
139
what is an adenoid cystic carcinoma?
infiltrative malignant tumour which is a cribiforom appearance.
the tumour cells are two types: duct lining cells and myoepthelial cells
140
what are the clinical features of adenoid cystic carcinoma?
middle aged to eldery people
| slow growing, fixation , ulceration and pain, causes facial nerve palasy and bone destruction
141
What percentage of adenoid cystic carcinomas are seen in parotid gland?
3%
142
what percentag of adenoid cystic carcinomas are seen in minor salivary glands?
palate
| 10-15%
143
what are the microscopical features of adenoid cystic carinomas?
non encapsulated
surface mophology can be: Cribiform, tubular, solid
Perineural involvment
144
what are the behavioural characteristics of adenoid cystic carcinomas?
local invasion (extensive)
peri and intra neural spread
lymoh node invilvement
distant spread to lungs bone and brain
145
what is the 5 and 15 year surival rate for adenoid cystic carcinoma?
5 years: 75%
| 15 years : 13%
