SALIVARY GLAND PATHOLOGY

Etiology of acute sialadenitis

Specific?

Bacterial -> Penicillinase producing staph

What kind of infection is acute sialadenitis?

Associated with wat?

May follow what?

Retrograde

Xerostomia

General anesthesia

What gland does acute sialadenitis usually affect?

Parotid

Diffuse, painful, tender unilateral swelling with purulent exudate expressed from partotid papilla

acute sialadenitis

Treatment for acute sialadenitis

Examples?

Penicillinase resistant penicillin initially

Oxacillin, cloxacillin, methicillin dicloxacillin

Sausage link radiographic apperance of ductal system

Chronic Sialadenitis

What two things can chronic sialadenitis come from

Acute sialadenitis or sialolithiasis (stones)

Autoimjune exocrinopathy common in middle aged females

Sjorgrens Syndrome

Primary Sjogren's Syndrome Name?

Symptoms?

Sicca Syndrome

Salivary and lacrimal glands

(xerostomia and xeropthalmia)

Clinical Features of Sjogrens:

Dry mouth disposes to what

2 other teeth related

Candidiasis (oral burning or angular chelitis)

Cervical Caries and Crown amputation

What is secondary sjogrens

Primary with another AI condition

Swelling of parotid and lacrimal glands and dry eyes

Sjogrens

On the schirmer Tear test, what indicates dry eye?

<5mm in 5 mins

Sialography with Branchless, fruit laden tree like appearance

Sjogrens

Sialography with Cherry blossom like appearance

Sjogrens

Sjogrens has a _____ clearance in sialography

Slow

Diagnosis of Sjogrens:

Test?

Stain?

Autoantibodies?

Biopsy of what?

Schirmer

Rose Bengal

SS-A and SS-B

Labial Salivary Gland

Describe the labial gland biopsy technique

What is it used to diagnose?

1 cm incision, parallel to vermillion zone

Remove atelast 5 minor glands

Sjogrens

More than 50 mononuclear cells in aggregate

What kind of cells

Focus

plasma cells and lymphocytes

What is a focus score

Number of foci in a 4 square millimeter area of salivary tissue

What focus score suggests sjogren's syndrome

>1

Management of Sjogrens:

________

______ for natural teeth

_____ for candidiasis

Secondary?

Sialogogues

Topical fluoride

Antifungals

Treat other AI problems

Sjogrens has a possible development of _____ which occurs at a frequency ____x compared to that of an age and sex matched population

___-___% lifetime

Lymphoma

20

5-15

Where are mucoceles most common

Lower lip (75%)

The color of mucoceles depend on what

What is it?

Depth of Mucus spillage

Translucent to bluish

What is a ranula

Mucocele in FOM (sublingual gland affected)

Sialolithiasis most frequently affect what gland

Where else can they occur

Submandibular

Parotid and minor glands

Are sialolithiasis symptomatic?

May or may not be

If yes -> Swelling of involved gland prior to or during meals

Soft tissue film that shows an opaque, lamellated structure

Sialolithiasis

What causes Necrotizing Sialometaplasia

Unknown but Probably due to ischemic injury to salivary tissue

Why is Necrotizing Sialometaplasia important?

What is it mistaken for

Malignancy

SCC or Mucoepidermoid Carcinoma

Where does Necrotizing Sialometaplasia occur

What does it look like

What happens after 2-3 weeks

Posterior hard palate

Sharply marginated ulcer

Perforation (small hole in palate)

Histopathologic features of Necrotizing Sialometaplasia

Ischemic Necrosis of minor salivary gland lobules

Squamous metaplasia of ductal epithelium

Is Necrotizing Sialometaplasia malignant

NO

What is significant about cancers occuring in the sublingual gland

Least common site of involvment (<1%) but when they do occur there, 70-90% are malignant

Most common salivary tumor

Benign or malignant

Pleomorphic Adenoma

Benign

What % of pleomorphic adenomas have a risk of malignant transformation if untreated

5%

Canalicular Adenomas have a predilection for what location

In who?

Age?

Upper lip

Older adults - 70s

Upper lip, multifocal

Canalicular Adenoma

Most common salivary gland malignancy

Mucoepidermoid Carcinoma

Most common salivary gland malignancy in children

Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma:

______ tinge if near surface, and producing ______

May be ______

Bluish

Intraosseous (jaw bone)

Histology of Mucoepidermoid Carcinoma:

What stain is used

For what

Epidermoid and mucous cells

Mucicarmine - Mucous cells

What tumor has constant pain as an early finding

ADENOID CYSTIC CARCINOMA

Swiss cheese like tumor island

ADENOID CYSTIC CARCINOMA

What kind of invasion is noted in Adenoid cystic carcinoma

Perineural

erythema migrans; __ tongue, ?

anterior 2/3, 1.3 with fissured

most common cause of death in lupus

renal failure

scl-70 topomiaerase I:

scleroderma (sclerosing)

premalignatn condition associated with high freqinecy of oral and esophageal squamous cell carcinoma

• what else associated?

• __

plummer vinson

• iron defioceincy anemia

  • koilonychia: spoon shaped nails, brittle

primary hyperthyroid: manifestation (4)

• painful bones

• renal stones

• abdomninal grows

• physchic moans

pth

increase CA2 levels

primary vs secondary hyperparathy

• primary: gland

  • level of kidney or duct, secondary to renal failure

loss of lamina dura and ground glass trabeuclar pattern: __ tumor

hyperparathryoidism: brown tumor

promiment enlargement of jaws: due to>

renal osteodydrophy, diabetes associated renal failure

cushing + addisons

• hypercortisol: cushing

  • hypo: addisons

hypercortisol: increased levels of?

cushing disease: due to ? increase

glucocorticosteroids

endogenous

• pituriaty adenoma: adrenal tumor

moon face and buffolo hump

cushing syndrome

primary vs secondary addisons

Primary: autoimmune, infection, tumors

secondary: pituitary dysfucntion (decreaesd production)

manifestations of addisons (3)

• hypotension (reduced aldoesterone)

  • bronzing of skin

• salt craving

hypophosphatasia:

• decreased?

• defiency of tissue: nonspecific alkaline phosphatase, especially in bone, __ kidney

• __ fatal

• childhood?

phosphate

• liver

• perinatal

• short stature

absence of cementum over radicular dentin (pic), __

childhood hypophosphatasia, loss of anterior mandibular teeth

chronis diseae: where?

• what sign?

• distal ileum and prox colon

• string sign: barium GI due to narrow bowel lumen

gingival inflammation, irergular ulcers

cobblestone apperance of mucosa:

chrons dissae

oral manifestation of ulcerative or crhonis disease

pyostomatitis vegetans

serpentine pastules>

pystomattis vegetans

yellowish, slightely elevate mucosal pastules: pyostomatis vegetans

release of ammoniua that damages oral mucosa

• resemebles?

• smell of?

• clears?

• uremic stomatitis

• white plaques on buccal mucosa, tongue, floor of mouth resembling hairy leukoplakia

• smell of ammonia or urine

• clears in few days following renal dialysis