7salivarydisease.txt

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Grant32
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191300
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7salivarydisease.txt
Updated:
2013-01-03 20:15:44
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Oral Pathology lecture 7
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  1. Causes for salivary gland obstruction
    • 1. Stone (sialoliths)
    • 2. Muocous plugs
    • 3. Scars
    • 4. Tumors
    • 5. Infections (bacterial/viral)
  2. Causes for inflammation
    • 1. Infection (bacterial/viral)
    • 2. Autoimmune (ex: Sjogrens)
  3. Where do sialoliths occur most often?
    80% occur in the submandibular gland
  4. What portion of submandibular stones are radiopaque?
    • 80% of submandibular stones
    • 50% of parotid stones
  5. What is the history of obstructions
    • Intermittent swelling, usually associated with meals
    • *Sialoliths are the most common cause
  6. How do we treat sialolithiasis?
    • Palpation to pass the stone
    • Dilation of the duct (stone too large to pass)
    • Surgical excision
    • Gland removal
  7. How is a mucocoele created?
    Saliva is produced by a minor gland but can't escape
  8. What is a ranula?
    • "marsupialized" pouch
    • Extravasation of the lingual gland
    • Can also be from a problem in whartons duct
  9. Mumps infection
    • 70% bilateral
    • Swelling and pain with eating
    • Resolves in ~1 week
    • Labs: increased lymphocyte count and amylase
    • Orchitis in 20% of adult males
  10. Bacterial Salivary Gland Infections
    • Secondary to obstruction or dehydration
    • Mostly unilateral
    • Often strep, sometimes staph (parotid)
  11. Sjogren's Syndrome
    • Xerostomia, Keratoconjunctivitis sicca, RA
    • Lymphocytic destruction of exocrine glands
    • Bilateral parotid enlargement
    • Schirmer test, blood test, minor gland biopsy
  12. Non-inflammatory infiltrative processes of salivary glands
    • Iodine toxicity
    • Malnutrition
    • Alcoholism
    • Diabetes Mellitus
    • Amyloidosis
  13. Firm localized swelling
    • 1. Lymph node (metastatic tumor or infection)
    • 2. Primary tumor (malignant or benign)
  14. Fluctuant localized swelling
    • 1. Abscess
    • 2. Cyst
  15. Salivary gland lymphadenopathy
    • Involved with infections of H/N region (TB, AIDS, etc)
    • Especially malignant melanoma and SCCA
    • Metastatic tumors of scalp, ear, cheek, eyelid, etc.
  16. How are tumor incidence and gland size related?
    larger glands directly proportional to the tumor incidence
  17. Relation of tumor malignancy and gland size
    • Inversely proportional
    • Smaller glands more likely to have malignancies (submand>parotid)
  18. Which primary salivary gland tumor is the most common?
    Pleiomorphic adenoma
  19. The most common malignant tumor of the parotid glands and submandibular glands
    Mucoepidermoid carcinoma
  20. Pleomorphic adenoma
    • Frequently occurs in the parotid gland (superficial lobe)
    • most common salivary gland tumor
    • high recurrence rate after enucleation
    • Composed of epithelial cells and mesenchymal component
  21. Warthin's tumor
    • Papillary cystadenoma lymphomatosum
    • Second most common benign parotid tumor
    • single or multiple masses, non-tender
  22. malignant salivary gland tumors
    • Firm, rubbery mass
    • More likely fixed to over/underlying strucures
    • In parotid can cause facial paralysis
  23. Mucoepidermoid carcinoma
    • 1/3 of all malignant salivary gland tumors
    • Most common malignancy of the parotid
    • Variable grades of malignancy
  24. necrotizing sialometaplasia
    • Vascular insufficiency
    • Necrosis of lobules of minor salivary glands
    • mimics a malignancy clinically and histologically
    • Raised area with necrotic center on palate
    • heals over time, can take weeks
  25. Adenoid Cystic Carcinoma
    • Most common malignancy of the submandibular gland
    • Slow growing
    • Tendency for early hematologic metastasis
    • Invades nerves

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