Term
|
Definition
• Mucus extravasation phenomenon
• Common lesion due to spillage of mucin
• Often result of local trauma
• Not a true cyst: no epithelial lining
• Dome‐shaped: 1‐2 mm to several cms
• Most common: children, young adults
• Mucin : bluish translucent hue
• Characteristically fluctuant |
|
|
Term
|
Definition
• History of recurrent swelling with periodic
rupture and refilling of contents
• Lower lip most common site (75%)
• Rare on upper lip
– Tumors not unusual in the upper lip but distinctly
uncommon in the lower lip
• To minimize recurrence remove any adjacent
feeder MS glands |
|
|
Term
|
Definition
• Mucocele in the FOM
• Derived from Latin rana
• Blue, dome‐shaped, fluctuant swelling
• Larger than mucoceles
• Marsupialization and/or removal of gland -subling gland cause
|
|
|
Term
|
Definition
• True cyst lined by epithelium
• Usually in adults
• Arise within either the major or minor glands
• Most frequent on the FOM, buccal mucosa,
and lips -upper>lower
• Resemble mucocele
• Treated by conservative surgical excision |
|
|
Term
|
Definition
• Calcified structures within salivary ducts
• Build‐up of Ca++ around a nidus of debris
• Debris: inspissated mucus, bacteria, ep cells, or foreign bodies • Present with episodic pain or swelling of the affected gland,especially at mealtime |
|
|
Term
|
Definition
• Most common in the submand , less in parotid
– Long, tortuous path of the Wharton's duct (lots of bends)
– Thicker, mucoid secretions of the gland |
|
|
Term
|
Definition
• Typically appear as radiopaque masses
• Although not all are visible on x‐rays
• Small ones of the major glands can be
treated milking the stone out
• Larger ones usually need surgery including
removal of the gland |
|
|
Term
|
Definition
• Inflammation of salivary glands
• Ductal obstruction or decreased flow
• Retrograde spread of bacteria (mostly Staph
aureus)
• Blockage ‐ sialolithiasis • Decreased flow ‐ dehydration, debilitation,
or medications |
|
|
Term
|
Definition
• Common cause ‐ "surgical mumps“ (esp
abdominal)
– Without food or fluids
– Atropine during surgery
• Noninfectious sources – Sjögren’s
syndrome, sarcoidosis, radiation therapy |
|
|
Term
|
Definition
• Periodic swelling and pain
• Usually at mealtime
• demonstrates ductal dilatation
• Can also occur in minor glands
– Result of blockage of ductal flow or local trauma |
|
|
Term
|
Definition
• Antibiotic therapy
• Rehydration
• Removal of sialolith or other obstruction |
|
|
Term
|
Definition
• Rare inflammatory condition of minor SGs
• Cause uncertain
• Several etiologic factors
– actinic (sun) damage
– Tobacco
– Syphilis
– Poor hygiene
– Heredity |
|
|
Term
|
Definition
• Characteristically on the lower lip
• Swelling and eversion of lip due to
hypertrophy and inflammation of the glands
•Openings of ducts inflamed and dilated
• Most often in middle‐aged and older men
• 18‐35% chance of developing a scca
• Treatment ‐ vermilionectomy (lip shave) |
|
|
Term
|
Definition
• Subjective sensation of dry mouth
• Numerous factors in pathogenesis
– salivary gland aplasia
– aging
– smoking
– mouth breathing
– local radiation therapy
– Sjögren's syndrome
– human immunodeficiency virus (HIV) infection
– medications |
|
|
Term
|
Definition
• Common in older people
• Function of age ? but older patients take more medications anyways • Medications related to development of:
– Antihistamines
– Decongestants
– Antidepressants
– Antipsychotics
– Antihypertensives
– Anticholinergics |
|
|
Term
|
Definition
• Reduction in saliva
• Saliva appears either foamy or thick and "ropey"
• Mucosa may appear dry
• Dorsum of tongue ‐ atrophy of filiform papillae
• Increase in candidiasis
• More prone to dental decay ‐ cervical & root caries |
|
|
Term
|
Definition
• Treatment is difficult and unsatisfactory
• Artificial saliva is available.
• Sugarless candy, gum, etc
• Pilocarpine, Civemeline
• Discontinuation or dose modification of medication
• Frequent dental visits
• Fluoride applications
• Chlorhexidine (Peridex) mouth rinses |
|
|
Term
|
Definition
Uncommon, multifactorial condition
• Local irritation
– Aphthous ulcers
– Ill‐fitting dentures
– New dentures
– Water brash‐GERD
• Heavy metal poisoning
• Rabies
• Medications
• Lithium
• Cholinergic agonists |
|
|
Term
|
Definition
• Poor neuromuscular control – drooling
– Cerebral palsy
– Surgical mandibular resection
– Mental retardation
• Soiling of clothes
• Secondary infection ‐ mouth, chin, neck sores
• Choking ‐ Social embarrassment
• Idiopathic paroxysmal _______ , 3‐5min
– Prodrome ‐ nausea, epigastric pain |
|
|
Term
|
Definition
• If manageable – no tx
• Speech therapy
• Surgical methods
– Relocation – parotid, submandibular duct ( excision of sublingual gland)
– Submandibular gland ex (parotid duct ligation)
– Tympanic neurectomy + sectioning of chorda tympanii
• Anticholinergic agents – side effects
– Transdermal scopolamine |
|
|
Term
BENIGN LYMPHOEPITHELIAL LESION (BLEL) |
|
Definition
• Bilateral painless lacrimal gland swelling
& all salivary glands ( Mickulicz dis)
• ?able cause (TB,sarcoidosis,lymphoma)
• Mickulicz disease – P. sjogren -no longer benign --> sjogren's
-primary
• Mickulicz syndrome – S. sjogren
( associated with other diseases) -secondary
|
|
|
Term
BENIGN LYMPHOEPITHELIAL LESION (BLEL) |
|
Definition
• usually sjogren component
• Adults, – 50yrs, 60‐80%, F
• 85%, Parotid gland
• Firm, diffuse swelling,asympt / mild pain
• Bilateral, isolated unilateral
• Other Salivary gland pathology
– Sialoliths
– Benign & malignant lesions |
|
|
Term
BENIGN LYMPHOEPITHELIAL LESION (BLEL) |
|
Definition
• Surgical excision
• Higher chances of lymphoma ‐ ‘maltoma’
• Occasionally – Malig lymphoepithelial lesion/
lymphoepithelial carcinoma
– In inuits and asians de novo
• Non ‐ inuits from _____ ’s
• EBV is ?
• Prognosis ‐ guarded |
|
|
Term
|
Definition
• Chronic, systemic autoimmune disorder
– mainly involves salivary ‐xerostomia (dry mouth) such as parotid glands and bilateral – Lacrimal glands ‐ xerophthalmia (dry eyes)
• Eye effects ‐keratoconjunctivitis sicca
(sicca=dry)
• Xerostomia & xerophthalmia ‐ sicca syndrome
– primary sjogren -40% chance to develope a lymphoma
|
|
|
Term
|
Definition
• Strong genetic influence
• Not rare ‐80‐90% in middle‐aged females
(F:M, 9:1)
• With Rh arthritis, scleroderma, secondary ______ |
|
|
Term
|
Definition
• Principal oral symptom is xerostomia
• Diffuse, firm enlargement of the major salivary glands ‐ usually ilateral
• Gritty sensation under the eyelids
• +ve Rheumatoid factor inspite of absence of rheumatoid arthritis -~60%
|
|
|
Term
|
Definition
• +ve schirmer test ( <5mm wetting /5min of
sterile absorbent paper strips )
– SAN‐DIEGO CRITERIA
• Two nuclear autoantibodies ‐ anti‐SS‐A &
anti‐SS‐B
• Biopsy of the minor SG of lower lip
– Lymphocytic infiltration of the glands with
destruction |
|
|
Term
|
Definition
• Mostly supportive
• Dry eyes ‐ periodic use of artificial tears
• Artificial saliva, daily Fl, antifungal therapy
• Increased risk for lymphoma, 40 X higher,
usually non‐Hodgkin's B‐cell lymphomas |
|
|
Term
|
Definition
• Unusual noninflammatory disorder characterized by asymptomatic nlargement, particularly of parotid
• Almost always associated with an underlying systemic problem
– Hormonal disorders (especially diabetes mellitus)
– Alcoholism
– Anorexia nervosa
– Bulimia
– Malnutrition
– Drug reactions
• Usually bilateral |
|
|
Term
| NECROTIZING SIALOMETAPLASIA |
|
Definition
• Abrams et al ‐1973
• Uncommon, locally destructive inflammatory
condition
• Results from ischemia leading to infarction (ischemic necrosis)
• Mimics SCCa both clinically and microscopically ‐ misdiagnosis
• Most frequent in the palate >75% posterior ,
2X more in adult M than F |
|
|
Term
| NECROTIZING SIALOMETAPLASIA |
|
Definition
• Initially non‐ulcerated swelling, often with
pain or paresthesia
• Within 2‐3 wks, necrotic tissue sloughs out,
leaving a crater‐like ulcer 1‐5 cm in diameter
• Pseudoepitheliomatous hyperplasia ‐
squamous metaplasia of ducts ‐ very similar to
scca / muco‐epidermoid ca
• Biopsy indicated to rule out malignancy |
|
|
Term
| • Pseudoepitheliomatous hyperplasia |
|
Definition
| ‐ squamous metaplasia of ducts ‐ very similar to scca / muco‐epidermoid ca |
|
|
Term
|
Definition
• Uncommon but not rare
• Most common site ‐ parotid 64‐80%
• Overall 2/3rds to 3/4ths of all tumors
• 2/3rds to 3/4ths benign
• 8‐11% in submandibular gland, but
malignancy almost double 37‐45%
• Sublingual ______ rare but 70‐90%
malignant |
|
|
Term
| MINOR SALIVARY GLAND TUMORS |
|
Definition
• 9 to 23%
• Second most common site
• Almost 50% malignant
• “Smaller the gland, the greater the chances of malignancy"
• Palate ‐ most frequent site (42 to 54%)
• Most on the posterior lateral hard or soft palate
• Lips‐ second most common |
|
|
Term
|
Definition
• Canalicular Adenoma
• Basal Cell Adenoma
|
|
|
Term
|
Definition
– Almost exclusively in minor SG
– Striking predilection for upper lip (>75%)
– Nearly always occurs in older adults
– Slowly growing, painless mass
– Female predilection |
|
|
Term
|
Definition
– Basaloid appearance of the tumor cells
– Primarily parotid lesion |
|
|
Term
| ONCOCYTOMA (Oxyphilic Adenoma) |
|
Definition
• Benign salivary gland tumor composed of
large epithelial cells known as oncocytes
• Rare neoplasm
• Predominantly a tumor of older adults
• Multi‐focal, oncocytosis -full of mitochondri -old age population
|
|
|
Term
| ONCOCYTOMA (Oxyphilic Adenoma) |
|
Definition
• Primarily parotid ‐ 80% of all cases
• Firm, slowly growing, painless masses
• Composed of sheets of oncocytes ‐ an
overabundance of mitochondria |
|
|
Term
|
Definition
• Papillary cystadenoma lymphomatosum -cyst like space • Benign neoplasm almost exclusively parotid
• Smokers – 8 X risk than onsmokers -bilateral
|
|
|
Term
|
Definition
• Slow growing, painless, nodular mass
• Unique ‐tendency to occur bilaterally
• Male predilection (the only one)
• Although the name is umbersome, it accurately
describes microscopic features |
|
|
Term
|
Definition
• Benign Mixed Tumor
• Most common salivary neoplasm
• 2/3rds to 3/4ths of parotid tumors
• Painless, slowly growing, firm mass |
|
|
Term
|
Definition
• Young adults 30 to 50
• Slight female predilection
• Best treated by surgical excision
• Malignant degeneration possible in long
standing lesions ‐ about 5% |
|
|
Term
|
Definition
• Most common SG malignancy
• Most common malignant SG tumor in children
• Most common in parotid
• Minor SG – palate 2nd
• Minor gland ‐ asymp fluctuant swellings blue
or red |
|
|
Term
|
Definition
• May arise within jaws from odontogenic ep of
dentigerous cysts
– More common in the mandible than maxilla
– Molar‐ramus area
– Overall prognosis is fairly good
– 10% of patients die, due to local recurrence |
|
|
Term
|
Definition
• Mixture of mucus‐producing cells and
epidermoid or squamous cells
• Usually treated by surgical excision
• Low‐grade tumors have good prognosis
• >90% are cured
• High‐grade tumors the prognosis is guarded,
only 30% survive |
|
|
Term
| ACINIC CELL ADENOCARCINOMA |
|
Definition
• Malignancy with serous acinar differentiation
• Most common in the parotid, 75‐80%
• Variable microscopic appearance
• May even appear encapsulated
• Better prognosis than others -glandular element
|
|
|
Term
|
Definition
• Originally called a cylindroma
• Approx 50% within the minor SG ‐ palate
most common site
• Usually a slowly growing mass
• Pain is a common and important early finding,
occasionally occurring before there is
noticeable swelling |
|
|
Term
|
Definition
• Tendency to show perineural invasion,
corresponds to pain
• Excision usually the treatment of choice
• 5‐year survival rate as high as 70%
• By 20 years, only 20% -angulated nucleus
|
|
|
Term
| CARCINOMA EX PLEOMORPHIC ADENOMA |
|
Definition
• Mean age about 15 years more than benign
counterpart
• Mass present for many years with recent rapid
growth with assoc pain or ulceration
• Best treated by wide excision, with local node
dissection and radiation
• Prognosis guarded, with 50% local recurrence
or metastases and dying |
|
|
Term
POLYMORPHOUS LOW GRADE
ADENOCARCINOMA |
|
Definition
• Recently recognized ‐1983
• Almost exclusively in the minor SG
• 60% on the hard or soft palate
• 2/3rds in females
• Tumor cells have deceptively uniform
appearance |
|
|
Term
POLYMORPHOUS LOW GRADE
ADENOCARCINOMA |
|
Definition
• Different growth patterns • Perineural invasion common
• Wide surgical excision
• Overall prognosis relatively good, with 80%
cure rate |
|
|
Term
Frequency Of Salivary Gland Tumors By
Location Palate |
|
Definition
– Pleomorphic adenoma – Adenoid cystic ca -Mucoepidermoid ca – PLGA
– Monomorphic adenoma |
|
|
Term
| Frequency Of Salivary Gland Tumors By Location Parotid |
|
Definition
– Pleomorphic adenoma
– Warthin’s tumor
– Basal cell adenoma – Mucoepidermoid ca
– Acinic cell ca
– Adenoid cystic ca
– Ca ex mixed tumor |
|
|
Term
Frequency Of Salivary Gland Lesions
By Location • Upper Lip |
|
Definition
– Canalicular Adenoma – Salivary Duct Cyst
– Pleomorphic Adenoma |
|
|
Term
Frequency Of Salivary Gland Lesions
By Location • Lower Lip |
|
Definition
– Mucocele
– Mucoepidermoid Ca
– Pleomorphic Adenoma |
|
|
