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2013-10-27 13:49:00
salivary glands

OBIO Exam 2
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  1. Name the major salivary glands
    • 1. Parotid
    • 2. Submand
    • 3. Subling
  2. Name the minor salivary glands
    • 1. Palate
    • 2. Lining mucosa
    • 3. Tongue
  3. Parotid gland, duct and type of secretion?
    Stensen's duct, serous acini, 25% secretion

    nerves of VII pass through (Marginal branch, cervical, buccal, zygomatic, and temporal)

    arteries: Superfic temporal, transverse facial
  4. Submand gland, duct and type of secretion?
    Wharton's duct, mixed serous and mucous (65% of saliva)
  5. Sublingual gland, duct and type of secretion?
    Bartholin's duct, mostly mucous secretion
  6. Describe the anatomy of the secretion from acinar unit?
    Acinar unit<Intercalated duct<striated<excretory<collecting
  7. Functions of saliva: (7)
    • 1. Hydration
    • 2. Cleansing
    • 3. Lubrication
    • 4. Digestion: amylase
    • 5. Antimicrobial
    • 6. Remineralization
    • 7. Taste
  8. Describe the antimicrobial action of saliva?
    Lysozymes, lactoferrin, lactoperoxidase, cystatins, histatins, IgA
  9. What is a mucocele? (RSGD)
    rupture of a salivary gland duct & spillage of mucus in surrounding soft tissues

    tx: excision w/ assoc salivary glds
  10. Where is mucocele most freq occuring? (RSGD)
    lower lip>FOM>ventral tongue

    fluctuates in size
  11. Describe mucocele microscopically? (RSGD)
    cystic space lined by granulation tissue filled w/ mucus
  12. Another name for mucocele on the ventral surface of tongue?
    Cyst of Blandin Nuhn
  13. What is a ranula (RSGD)?
    large mucocele occuring on FOM, similar pathogenesis

    occassionaly plunges through mylohyoid muscle

    tx: surgical removal of the feeding sublingual gland or marsupialization
  14. Describe ranula microscop (RSGD)?
    cystic space filled by granulation tissue and filled w/ mucus
  15. What is an antral pseudocyst (RSGD)?
    collectiong of inf exudate (serum) under max sinus mucosal membrane, causes dome shaped sessile elevation in sinus floor

    could be irritation or allery related or from tooth

    diff sinus mucocele

    no tx unless assoc w. infection
  16. What is a mucous retention cyst (salivary duct cyst)? (RSGD)
    true cyst arising from salivary gland

    unknown cause (some by obstruction by mucous plug or stone)

    tx: surgical excision
  17. What does salivary duct cyst look microscop? (RSGD)
    dilated cystic space lined by epithelium (cuboidal or columnar)
  18. Diff dx of fluid filled lesions?
    • 1. mucocele
    • 2. ranula
    • 3. salivary duct cyst
    • 4. dermoid cyst
    • 5. cystic mucoepidermoid carcinoma
  19. What is sialolithiasis (RSGD)?
    calcified accretion within salivary duct

    salivary calcium forms a nidus and enlarges with epithelial debris

    tx: gentle massgae or excision
  20. what is etiology for sialolithiasis?
    unclear, cause by partial ductal obstruction and sialadenitis w/concen of mucus

    periodic tender swelling during meal times
  21. Where is sialoliths most freq seen?
    Wharton's duct, stensen's, occasionally minor gland of upper lip
  22. What is cystic lymphoid hyperplasia of the parotid (RSGD)? another name?
    HIV-assoc lymphoepithelial cysts

    develop bilaterally in the intraparotid LNs

    tx: combination antiretroviral therapy
  23. Describe cysts of lymphoid hyperplasia microscop?
    intraparotid epithelium-lined cystic spaces surrounded by lymphoid tissue. contain lymphocytes with HIV envelope protein p24
  24. What is necrotizing sialometaplasia (NSM) (RSGD)?
    acinar necrosis, acute inflama, squamous metaplasia or salivary ducts

    may mimic SCC, mucoepidermoid carcinoma

    tx: biopsy to confirm, no tx debride and mouth rinse, resolves 5-6 weeks
  25. What is sacoidosis? (Immune Mediated SGD)
    multisystem granulomatous disease of unknown etiology

    abnormal immune response to bacterial antigens
  26. What genetic factors are assoc with sarcoidosis?
    assoc w. Class I HLA-A9, B5-B8, Class II HLA-DR3
  27. What are the clinical features of sarcoidosis (IMSGD)?
    blacks 10 times more affected


    20-40yr of age

    COPD, chest pain, fever, dural thickening, lupus pernio

    skinviolaceous indurated plaques ("Erythema Nodosum)

    uveitis and 2nd glaucoma
  28. What is Heerfordt's syndrome?
    Uveoparotid Fever

    manifestation of Sarcoidosis

    includes: uveitis, parotid gland enlargement, facial paralysis, fever
  29. What are the oral features of sarcoidosis (IMSGD)?
    painless papules/nodules/ulcers (cobblestone)

    bony lesions similar to perio

    bilateral parotid gland enlarg

    granulomatous gingivitis
  30. What skin test is used to dx sarcoidosis?
    Kveim test (intradermal inj of sarcoidal antigen)

    4-6 weeks nodules appear at site of inj, 50-85% accurate
  31. What blood test can be used to dx sarcoidosis?
    SACE, serum angiotensin convert enzyme elevated
  32. What kind of radiography used to dx sarcoidosis?
    Chest films, look for pulmonary infiltrates with medistinal enlargment
  33. What kind of biopsy is done for sarcoidosis dx?
    bx the lesions or elective salivary gland biopsy, look for granulomatous inflamma
  34. Tx options for sarcoidosis?
    spontaneous resolution in 60-80%

    systemic corticosteroids eff in 20%

    10% of pt do not respond to steroids, live with disease

    4-10% die from complications in lung, heart, CNS
  35. What is Sjogren syndrome (IMSGD)? another name?
    Autoimmune sialadenitis

    predilection for females

    t-cell mediated autoimmune destruction of salivary and lacrimal gland parenchyma

    causes xerostomia, xerophthalmia
  36. What is primary sjogren's syndrome?
    also known as keratoconjunctivitis sicca syndrome

    dry mouth and dry eyes
  37. what is secondary sjogren's syndrome?
    dry mouth, dry eyes, and any collagen vascular disease

    lupus, sclerosis (scleroderma), dermatomyositis, rheumatoid arthritis, raynaud disease, polymyopathy
  38. What is the san diego criteria for sjogren syndrome, ocular dryness?
    • ocular dryness
    • 1. schirmer's test <8mm wetting in 5mins
    • 2. rose-bengal staining of cornea to demonstrate keratoconjunctivitis sicca
  39. What is the san diego criteria for sjogren syndrome, dry mouth?
    • 1. decreased parotid flow using Lashley cups
    • 2. adnormal biopsy of minor salivary glands
  40. What is the san diego criteria for sjogren syndrome, serologic evidence?
    • 1. elevated RF>1:320
    • 2. elevated ANA (antinuclearantibody) >1:320
    • 3. anti-SS-A (Ro) or anti-SS-B (La) antibodies
  41. What is additional criteria to primary sjogren found in secondary sjogren's syndrome?
    rheumatoid arthritis, lupus, biliary cirrhosis

    rule out: sarcoidosis, lymphoma, HIV, hep b or C, fibromyalgia etc
  42. What are local causes of xerostomia?
    • decrease mastication
    • smoking
    • mouth breathing
  43. what are iatrogenic causes of xerostomia?
    • 1. meds
    • 2. radiation therapy
  44. What are some systemic diseases that cause Xerostomia?
    • 1. sjogren
    • 2. diabetes mellitus, insipidus
    • 3. sarcoidosis
    • 4. HIV
    • 5. graft vs. host disease
    • 6. psychogenic disorders
  45. Sjogren syndrome and effect on glands?
    77% parotid

    20% submand
  46. Tx options for sjogren's?
    no specifics

    artifical saliva subst (pilocarpine, sialagen)

    secondary sjogren tend to develop lymphoma (40 times more likely)