Salivary Glands: Inflammatory Disorders & Neoplasms Flashcards
(187 cards)
1
Q
What are the three types of salivary glands?
A
Parotid, submandibular and sublingual
2
Q
What kind of saliva is secreted out of parotid glands?
A
Mainly serous saliva
3
Q
Parotid Gland Duct
A
Stensen’s Duct/Parotid Papilla
4
Q
Submandibular Gland Saliva Type
A
Mixture of serous and mucinous saliva
5
Q
Submandibular Gland Duct
A
Wharton’s Duct; sublingual caruncles on either side of the lingual frenum
6
Q
Sublingual Gland Saliva Type
A
Mainly mucinous saliva
7
Q
Sublingual Gland Ducts
A
8-20 excretory ducts
8
Q
Smaller Sublingual Gland Ducts; where do they exit?
A
Ducts of Rivinus; exit into the floor of the mouth
9
Q
Major Sublingual Glands; where do they exit?
A
Duct of Bartholin; exits through the submandibular duct (wharton’s duct)
10
Q
How many minor salivary glands are there?
A
600+ of them
11
Q
Are minor salivary glands encapsulated?
A
No
12
Q
Where are minor salivary glands located?
A
Labial mucosa, buccal mucosa, palate, tongue
13
Q
Describe Minor salivary glands located on tongue
A
Anterior and posterior
Von Ebner’s Glands produce serous saliva surrounding circumvallate papillae
14
Q
Where are minor salivary glands not located?
A
Anterior hard palate and gingiva except retromolar pad
15
Q
Salivary Glands are composed of what three structures?
A
Secretory component+ ducts+ myoepithelial cells
16
Q
Salivary Gland Structure: Describe what makes up secretory component
A
Serous, mucous or both serous and mucous saliva
17
Q
Salivary Gland Structure: Describe serous cells
A
Protein secreting, from acinar structures, think less saliva
18
Q
Salivary Gland Structure: Describe mucous cells
A
Secrete mucin, usually tubular strcuture rather than acini, think more viscous saliva
19
Q
Salivary Gland Structure: Describe serious demilunes
A
Mixed serous and mucous acinus, serous cells surrounding mucous acinus
20
Q
Salivary Gland Structure: Describe duct system
A
Intercalated duct -> striated duct -> excretory duct
21
Q
Salivary Gland Structure: Describe myoepithelial cells
A
Surround acini and intercalated ducts, contract to help move secretory products
22
Q
List Salivary Gland DIsorders
A
Mucocele Ranula Salivary Duct Cyst Necrotizing Sialometaplasia Sialolithiasis Sialadenosis Sialadenitis Sjogren's Syndrome
23
Q
Mucocele Clinical Presentation
A
Dome-shaped swelling, compressible, non-painful (frequently) blush
24
Q
Mucocele Etiology
A
Trauma to a salivary gland duct causing extravasation of mucin into adjacent tissue
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Mucocele Location
Lower labial mucosa >> floor of mouth (ranula) > anterior ventral tongue, buccal mucosa, palate, retromolar pad
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In what oral site will a mucocele never occur?
Gingiva
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Mucocele Population
Any age, but usually younger patients as a results of increased prevalence of trauma
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Mucocele Histology
Mucous surrounded by granulation tissue wall
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Mucocele Treatment
Conservative excision of lesion+ surrounding minor salivary gland lobules
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Mucocele Excision Techniques
Elipse, Enucleation, laser ablation
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Muocele Recurrence
Remove adjacent minor salivary gland lobules to prevent recurrence
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Mucocele: Clinical Variant
Superficial Mucocele
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Superficial Mucocele Common Sites
Soft palate, retromolar pad, posterior buccal mucosa
34
Superficial Mucocele Treatment
Ruptures and leave shallow painful ulcers -> do not require excision
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Superficial Mucocele may develop in associate with what other conditions?
Lichen Planus, lichenoid drug eruption, or GVHD
36
Describe a Ranula
Mucocele of the floor of the mouth
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Where do Ranulas occur?
Sublingual gland
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Ranula Treatment
Marsupialization
| Removal of lesion along with the sublingual gland
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Why may marsupialization not be successful with ranulas?
Larger lesions
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Ranula Clinical Variant & Significance
Plunging Ranula (cervical ranula)
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What occurs with a plunging ranula (cervical ranula)?
Spilled mucin dissects through the mylohyoid muscle
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What may plunging ranula be present as?
Only a neck swelling
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What is used to diagnose plunging ranula?
MRI/CT
44
Plunging Ranula Radiographic Hallmark
Tail Sign
45
Define Tail Sign
Extension of the lesion into the sublingual space on imaging
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Salivary Duct Cyst: Clinical Presentation
Typically soft, mucosal swelling
| Color: Ranges from bluish to amber
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Salivary Duct Cyst: Etiology
Ductal obstruction from sialolith or mucous plug
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Salivary Duct Cyst: Location
- Any major or minor salivary glands
- Major: Parotid most common
- Minor: FOM>Buccal mucosa> lip
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Salivary Duct Cyst: Population
Adults
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Components of a Salivary Duct Cyst
- Lumen
- Fibrous Connective Wall
- Epithelium
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Salivary Duct Cyst Treatment
- Conservative Excision
| - Should not recur
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Necrotizing Sialometaplasia Clinical Presentation
Swelling (1 week) -> ulceration (2 weeks) -> healing (5-6 weeks)
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Necrotizing Sialometaplasia: Etiology
Ischemia, local infarction from trauma and dental injections
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Necrotizing Sialometaplasia:Location
Almost always on the palate (75%)
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Necrotizing Sialometaplasia: Population
Adults, male (2:1)
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Necrotizing Sialometaplasia: Histology
- Acinar necrosis
| - Squamous metaplasia
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Describe squamous metaplasia
Cuboidal epithelium of ducts changes to squamous epithelium
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Necrotizing Sialometaplasia: Treatment
- Self limiting
- Follw up and ensure complete resoultion
- If the lesion does not resolve in typical 5-6 week span you must biopsy
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Sialolithiasis aka
Salivary Stones
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Sialolithiasis Clinical Presentation
Episodic pain and/or swelling
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Sialolithiasis Etiology
Deposition of calcium salts around a nidus of debris within the lumen of a salivary gland duct
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SIalolithiasis Location
Any salivary gland (duct or within the gland itself)
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Sialolithiasis: Most common major gland site; why?
Submandibular gland; long tortuous upward path
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Sialolithiasis: most common minor gland site
Upper lip, buccal mucosa
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Sialolithiasis Population
Most common in young and middle-aged adults
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Sialolithiasis: Treatment for Minor gland stone
Excision of stone and associated minor gland
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Sialolithiasis: Treatment for Major Salivary Gland Stone
- Promote passage of stone by massage of gland, moist heat+ increased salivary flow (increased fluid intake, sour candy)
- Surgical Excision: May require partial or complete excision of the gland in some cases
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Define "Sial"
Denoting saliva or salivary glands
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Define "-adenitis"
Inflammation of a gland
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Define "-adenosis"
Non-inflammatory enlargement of glands
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Sialadenosis: Define
Non-inflammatory salivary gland enlargement
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Sialadenosis: Clinical Presentation
Slowly evolving enlargement of the salivary glands
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Sialdenosis: Etiology
Underlying systemic condition
- Diabetes Mellitus
- Bulimia
- Alcoholism
- Malnutrition
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Sialadenosis: Location
parotid gland> submandibular > minor salivary glands
| Usually bilateral
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Sialadenosis: Population
Any age/demographic
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Sialadenosis: Diagnosis
Sialography finding: leafless tree
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Sialadenosis: Treatment
- Control of underlying cause
| - Partial parotidectomy for esthetic purposes
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Define Sialadenitis
Inflammation of the salivary glands
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Sialadenitis Clinical Presentation
Variable: Asymptomatic to pain/swelling/purulence
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Sialadenitis: Etiology
Infectious causes, non-infectious causes, idiopathic
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Sialadenitis: What are some infectious etiologies?
Viral: Mumps, HIV, CMV
Bacterial: Decreased salivary flow and/or ductal obstruction allows for retrograde spread of bacteria
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Sialadenitis: What are some non-infectous etiologies?
Sjogren syndrome, sarcoidosis, radiation therapy, surgical mumps
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Sialadenitis: What are some idiopathic causes?
- Juvenile recurrent parotitis
| - Subacute nectrotizing sialadenitis
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Sialadenitis: Location
Any salivary gland
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Sialadenitis: Population
Any
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Sialadenitis: Three Clinical Highlights
- Acute bacterial sialadenitis
- Mumps
- Surgical mumps
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Describe Acute bacterial sialadenitis site & characteristics
- Most commonly affects parotid gland
| - Characteristic Finding: purulent discharge from parotid papilla
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What is mumps
-Paramyxovirus
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What is the most common viral cause of sialadenitis
Mumps
90
Mumps Site
Parotid glands (may be unilateral) but can affect other major salivary glands
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Why is mumps infrequent in the US?
Vaccination
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Describe what causes surgical mumps
Acute parotitis following a recent surgery
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Surgical Mumps Etiology
patient without food or fluids leading up to surgery and given atropine to decrease saliva production during surgery
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Sialadenitis: Treatment
Treatment is based on the underlying cause
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Sialadenitis: Treatment with presence of purulence
Culture and appropriate antibiotic therapy
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Sialadenitis: Treatment for self limiting viral infection
Monitor for resolution
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Sjogren Syndrome: Clinical Features
- Xerostomia
- Xerophthalmia
- 1/3 to 1/2 of patients exhibit enlargement of the major salivary glands
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Describe features of xerostomia
Altered taste, dysphagia, atrophy of tongue papillae, increased caries risk
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Describe features of xerophtalmia
Scratchy, gritty sensation
100
Describe sicca syndrome
Xerostomia+ xerophthalmia
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Sjogren Syndrome: Etiology
Autoimmune disorder
102
Sjogren Syndrome: Population
Middle aged adults; Female; 9-1
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Sjogren Syndrome: Diagnosis
Criteria (2 out 3 necessary for diagnosis)
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Sjogren Syndrome: First criteria
Positive antibodies to Ro(SS-A) and/or La(SS-B) antigens; OR positive RF and ANA (antinuclear antibody)
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Sjogren Syndrome: Second criteria
Labial salivary gland biopsy with focus score equal to or greater than 1 focus/4 mm^2
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Sjogren Syndrome: Third cteria
Keratoconjuctivitis Sicca with ocular staining score equal to or greater than 3
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Sjogren Syndrome: Describe Keratoconjunctivitis Sicca
Terminology for xerophthalmia+ pathologic changes to the ocular surface
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Describe Primary Sjogren Syndrome
Sicca Syndrome only
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Describe secondary sjogren syndrome
Sicca syndrome+ another associated autoimmune disorder like SLE, RA, systemic sclerosis
110
Describe Diagnostic tools for Sjogren Syndrome
- Labial salivary gland biopsy by harvesting 5-7 lobules
| - Sialography
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Sjogren Syndrome Histology
- Chronic sialadenitis
| - benign lympoepithelial lesions
112
Sjogren Syndrome: What is seen on sialography
Fruit-laden, branchless tree
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Sjogren Syndrome: Treatment
- Mostly palliative
- Regular opthalmologist visits
- Hydration/Coating products
- Sialogogue medications
- Increased preventative dental care for xerostomia-related caries
- Increased prevalence of oral candidiasis
- Significantly increased lifetime risk for lymphoma
114
What are two medications used to treat Sjogren Syndrome
Cevimeline or Pilocarpine
115
Who should we avoid use of cevimeline or pilocarpine with?
Patients with uncontrolled respiratory disease, significant cardiac disease, narrow-angle glaucoma
116
How are effects limited with cevimeline or pilocarpine?
Effect is limited by amount of remaining functional salivary gland tissue
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Side Effect of cevimeline or pilocarpine
Significant sweating
118
What are the three most common benign salivary gland tumors?
- Pleomorphic adenoma
- Warthin Tumor
- Monomorphic adenoma
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Another name for Pleomorphic adenoma
Benign mixed tumor
120
Another name for Warthin tumor
Papillary cystadenoma lymphomatosum
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Two other names for monomorphic adenoma
Canalicular adenoma, basal cell adenoma
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Four most common malignant salivary gland tumors
- Mucoepidermoid carcinoma
- Acinic cell carcinoma
- Adenoid cystic carcinoma
- Carcinoma ex pleomorphic adenoma
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Define Adenoma
A benign tumor formed from glandular structures in epithelial tissue
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Define Carcinoma
A malignant tumor of epithelial origin
125
Where is epithelium present in the body?
Covering of body surfaces (skin, mucosa), lining of body cavities, major tissue in glands
126
Define adenocarcinoma
Generic term for a cancer of glandular origin
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Most common salivary gland tumor
Pleomorphic adenoma
128
Most common benign salivary gland tumor
Pleomorphic Adenoma
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Most common malignant salivary gland tumor
Mucoepidermoid carcinoma
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Most common benign salivary gland tumor in children
Pleomorphic adenoma
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Most common malignant salivary gland tumor in children
Mucoepidermoid carcinoma
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Describe Pleomorphic Adenoma
Benign, most common salivary gland tumor
133
Pleomorphic adenoma Clinical Features
- Painless, slow-growing firm mass
| - Can be present for months or years before pt seeks a diagnosis
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Pleomorphic adenoma site
Parotid> submandibular > minor (palate> upper lip> buccal mucosa)
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Pleomorphic adenoma population
Age: 30-60 years old
Sex: Slight female predilection
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Pleomorphic adenoma Treatment
Complete surgical excision; may be difficult due to facial nerve placement
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Pleomorphic adenoma: Prognosis
- Excellent, cure rate more than 95%
| - Can undergo malignant transformation if left untreated for a prolonged amount of time
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Malignant amount of pleomorphic adenoma
Carcinoma
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Describe Warthin Tumor
Benign, second most common tumor of the parotid gland behind the pleomorphic adenoma
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Warthin Tumor Etiology
- Possible heterotopic salivary tissue within the parotid lymph nodes
- Smokers have a 8x greater chance of developing this tumor
141
Warthin Tumor Clinical Features
- Slow growing, painless mass
| - 5-7% bilateral
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Warthin Tumor Site
Almost exclusive to the parotid
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Warthin Tumor Age
60-70 years old
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Warthin Tumor Sex
Equal or slight male predilection
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Warthin Tumor Treatment
Surgical excision (though in some cases clinicans can observe/monitor)
146
Warthin Tumor Prognosis
2-6% recurrence rate
| Malignant transformation is exceedingly rare
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Two types of monomorphic adenoma
Canicular adenoma and basal cell adenoma
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Describe canalicular adenoma
Benign
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Canalicular Adenoma Site
```
Almost exclusive to minor salivary glands.
Upper lip (75%)> buccal mucosa
```
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Canalicular adenoma age
Older, patients in 70's
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Canalicular Adenoma Sex
Female predilection
152
Canalicular Adenoma Treatment
Excision
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Canalicular Adenoma Prognosis
Recurrence is rare
154
Describe Basel Cell Adenoma
Benign
155
Basal cell adenoma site
75% occur in the parotid
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Basal cell adenoma Age
Middle aged-older adults
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Basal cell adenoma Sex
Female predilection
158
Basal cell adenoma treatment
Excision
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Basal cell adenoma prognosis
- Recurrence is rare
| - Malignant transformation to bassal cell adenocarcinoma is rare
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Describe mucoepidermoid carcinoma
Most common salivary gland malignancy
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Mucoepidermoid carcinoma Clinical Features
- Most commonly an asymptomatic swelling present for a year or less
- High grade variants can cause pain or parasthesia and/or grow more rapidly
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Mucoepidermoid carcinoma site
Parotid gland> minor salivary glands of the palate
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Mucoepidermoid carcinoma age
Wide Range 10-60 years old
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Mucoepidermoid Carcinoma Treatment
Depends on location, grade, stage
- Early stage tumors of the parotid can be treated with subtotal parotidectomy
- Late stage in parotid my mean total parotidectomy with facial nerve
- Possible neck dissection
- Post op radiation
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Mucoepidermoid carcinoma Low grade prognosis
-Good prognosis
| 90-98% cure rate
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Mucoepidermoid carcinoma high grade prognosis
Guarded
| 30-54% survival
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Mucoepidermoid carcinoma:
| Prognosis if in Submandibular gland
Poorer prognosis compared to parotid
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Mucoepidermoid carcinoma: prognosis if in oral minor salivary glands
Good prognosis
169
Mucoepidermoid carcinoma: prognosis if present in tongue and floor of the mouth
Less predictable, more aggressive
170
Describe Acinic cell carcinoma
Low grade malignant salivary gland neoplasm
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Acinic cell carcinoma clinical features
Slow growing, painless mass
172
Acinic cell carcinoma site
Parotid (85-90%)
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Acinic Cell Carcinoma: Age
Mean age mid 40's to early 50's
174
Acinic Cell Carcinoma Treatment
- Partial parotid lobectomy (total parotidectomy if indicated)
- Lymph node dissection only if evidence of spread, radiation indicated for uncontrolled disease
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Acinic Cell Carcinoma Prognosis
Considered non-aggressive, good prognosis
176
Acinic Cell Carcinoma Local recurrence rate
10-20%
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Acinic Cell Carcinoma Metastasis Rate
8-11%
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Acinic Cell Carcinoma Death Rate
10%
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Describe Adenoid Cystic Carcinoma
Malignant salivary gland neoplasm
180
Adenoid cystic carcinoma Clinical features
Slow growing, painful immediately, parasthesia, dull aching
181
Adenoid Cystic Carcinoma Site
50% occur in minor salivary glands with the palate being most common site
182
What is the most common malignancy of the submandibular gland?
Adenoid cystic carcinoma
183
Adenoid Cystic Carcinoma Age
Middle aged adults, rare under 20
184
Adenoid Cystic Carcinoma: Sex
Slight Female Predilection
185
Adenoid Cystic Carcinoma: Treatment
Resection
| +/- radiation
186
Adenoid cystic carcinoma prognosis
- "Relentless tumor": local recurrence and metastasis (typically distant metastasis, meaning regional lymph node less likely site of met)
- Good five year prognosis, but 35-53% 20 year survival rate
- Metastasizes in 35% of patients -> common met sites include lungs, brain, and bone
187
Biopsy techniques for suspected salivary gland tumors
-Refer: hospital based ENT/head and surgeon
Typical procedure: fine-needle aspiration
-In office punch biopsy
