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Name the major salivary glands
- 1. Parotid
- 2. Submand
- 3. Subling
Name the minor salivary glands
- 1. Palate
- 2. Lining mucosa
- 3. Tongue
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
Submand gland, duct and type of secretion?
Wharton's duct, mixed serous and mucous (65% of saliva)
Sublingual gland, duct and type of secretion?
Bartholin's duct, mostly mucous secretion
Describe the anatomy of the secretion from acinar unit?
Acinar unit<Intercalated duct<striated<excretory<collecting
Functions of saliva: (7)
- 1. Hydration
- 2. Cleansing
- 3. Lubrication
- 4. Digestion: amylase
- 5. Antimicrobial
- 6. Remineralization
- 7. Taste
Describe the antimicrobial action of saliva?
Lysozymes, lactoferrin, lactoperoxidase, cystatins, histatins, IgA
What is a mucocele? (RSGD)
rupture of a salivary gland duct & spillage of mucus in surrounding soft tissues
tx: excision w/ assoc salivary glds
Where is mucocele most freq occuring? (RSGD)
lower lip>FOM>ventral tongue
fluctuates in size
Describe mucocele microscopically? (RSGD)
cystic space lined by granulation tissue filled w/ mucus
Another name for mucocele on the ventral surface of tongue?
Cyst of Blandin Nuhn
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
Describe ranula microscop (RSGD)?
cystic space filled by granulation tissue and filled w/ mucus
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
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
What does salivary duct cyst look microscop? (RSGD)
dilated cystic space lined by epithelium (cuboidal or columnar)
Diff dx of fluid filled lesions?
- 1. mucocele
- 2. ranula
- 3. salivary duct cyst
- 4. dermoid cyst
- 5. cystic mucoepidermoid carcinoma
What is sialolithiasis (RSGD)?
calcified accretion within salivary duct
salivary calcium forms a nidus and enlarges with epithelial debris
tx: gentle massgae or excision
what is etiology for sialolithiasis?
unclear, cause by partial ductal obstruction and sialadenitis w/concen of mucus
periodic tender swelling during meal times
Where is sialoliths most freq seen?
Wharton's duct, stensen's, occasionally minor gland of upper lip
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
Describe cysts of lymphoid hyperplasia microscop?
intraparotid epithelium-lined cystic spaces surrounded by lymphoid tissue. contain lymphocytes with HIV envelope protein p24
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
What is sacoidosis? (Immune Mediated SGD)
multisystem granulomatous disease of unknown etiology
abnormal immune response to bacterial antigens
What genetic factors are assoc with sarcoidosis?
assoc w. Class I HLA-A9, B5-B8, Class II HLA-DR3
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
What is Heerfordt's syndrome?
manifestation of Sarcoidosis
includes: uveitis, parotid gland enlargement, facial paralysis, fever
What are the oral features of sarcoidosis (IMSGD)?
painless papules/nodules/ulcers (cobblestone)
bony lesions similar to perio
bilateral parotid gland enlarg
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
What blood test can be used to dx sarcoidosis?
SACE, serum angiotensin convert enzyme elevated
What kind of radiography used to dx sarcoidosis?
Chest films, look for pulmonary infiltrates with medistinal enlargment
What kind of biopsy is done for sarcoidosis dx?
bx the lesions or elective salivary gland biopsy, look for granulomatous inflamma
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
What is Sjogren syndrome (IMSGD)? another name?
predilection for females
t-cell mediated autoimmune destruction of salivary and lacrimal gland parenchyma
causes xerostomia, xerophthalmia
What is primary sjogren's syndrome?
also known as keratoconjunctivitis sicca syndrome
dry mouth and dry eyes
what is secondary sjogren's syndrome?
dry mouth, dry eyes, and any collagen vascular disease
lupus, sclerosis (scleroderma), dermatomyositis, rheumatoid arthritis, raynaud disease, polymyopathy
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
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
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
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
What are local causes of xerostomia?
- decrease mastication
- mouth breathing
what are iatrogenic causes of xerostomia?
- 1. meds
- 2. radiation therapy
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
Sjogren syndrome and effect on glands?
Tx options for sjogren's?
artifical saliva subst (pilocarpine, sialagen)
secondary sjogren tend to develop lymphoma (40 times more likely)