is not a true cyst: no epithelial lining

Mucocele

often result of trauma

Mucocele

dome-shaped 1-2mm to several cm and most common in children and young adults

Mucocele

bluish translucent hue, fluctuant, mucus extravasation phenomenon, and most common lesion due to spillage of mucin

Mucocele

most common site is lower lip

Mucocele

history of recurrent swelling with periodic rupture and refilling of contents

Mucocele

- mucocele in the FOM

- derived from latin rana

-blue, dome-shaped, fluctuant swelling

- larger than mucoceles

Ranula

true cyst lined by epithelium

Salivary Duct Cyst

- usually found in adults

- arise in either major or minor glands

- most frequently on FOM, buccal mucosa, and lips

- resembles mucocele

- treated by convervative surgical excision

Salivary Duct Cyst

- calcified structures within salivary ducts

- build up of calcium around nidus of debris

Sialoithiasis

debris: inspissated mucus, bacteria, ep cells, or foreign bodies

Sialolithiasis

most common in the submandibular, less in parotid

- long, tortuous path of the Wharton's duct

- thicker, muciod secretions of the gland

Sialolithiasis

episodic pain or swelling of the affected gland, especially at mealtime

Sialolithiasis

typically appear as radiopaque masses

Sialolith

small ______ of the major glands can be treated by milking the stone out

sialoliths

larger ______ usually need surgery including removal of the gland

sialoliths

inflammation of salivary glands

Sialadenitis

- ductal obstruction or decreased flow (dehydration, debilitation, or medications)

- retrograde spread of bacteria (mostly Staph aureus)

- blockage (sialolithiasis)

Sialadenitis

common cause - surgical mumps (esp abdominal)

- without food or fluides

- atropine during surgery

Sialadenitis

what are the noninfectious sources of sialadenitis?

- Sjogren's syndrom

- sarcoidosis

- radiation therapy

- periodic swelling and pain

- usually at mealtime

- sialography demonstrates ductual dilation

- can also occur in minor glands (result of blockage of ductal flow or local trauma)

clinical and radiographic features of sialenitis

- antibiotic therapy

- rehydration

- removal of sialolith or other obstruction

treatment and prognosis of sialenitis

rare inflammatory condition of minor slaivary glands

Cheilitis Glandularis

- actinic (sun) damage

- tobacco

- syphilis

- poor hygiene

- heredity

etiologic factors of cheilitis glandularis

- characteristically on 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

- Tx- vermilionectomy (lip shave)

Clinical features of Chilitis Glandularis

what is the most common cause of xerostomia?

medications

- antihistamines

- decongestants

- antidepressants

- antipsychotics

- antihypertensives

- anticholinergics

Medications related to causing Xerostomia

- reduction of 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 and root caries

Clinical features of Xerstomia

- artifical saliva

- sugarless candy and gum

- pilocaine, civemeline

- change medication

- frequent dental visits

- fluoride applications

- chlorhexidine mouth rinse

Treatment and Prognosis of Xerostomia

- mainly involves salivary glands - xerostomia

- lachrymal glands - xerostomia (dry eyes)

Primary SS

-eye effects - keratoconjunctivitis sicca (sicca=dry)

- strong genitic influence

- not rare - 80-90% in middle aged females

- with Rh arthritis, scleroderma, SLE - secondary SS

SJÖGREN'S SYNDROME

- principle oral symptom is xerostomia

- diffuse, firm enlargment of the major salivary glands - usually bilateral

- lymphotic inflitration of the glands with destruction

- biopsy the minor SG of lower lip

SJÖGREN'S SYNDROME

what are the two major nuclear autoantibodies of SJÖGREN'S SYNDROME?

- anti-SS-A

- anti-SS-B

- mostly supportive

- dry eyes- periodic use of artifical tears

- artifical saliva, daily Fl, antifungal therapy

treatment for

SJÖGREN'S SYNDROME

increased risk for lymphoma - 40X higher

SJÖGREN'S SYNDROME

unusual noninflammatory disorder characterised by asymptomatic enlagrement, particularly of parotid

Sialadenosis

______ is almost always associated with an underlying systemic problem

Sialadenosis

- hormonal disorders (especially diabetes)

- alcoholism

-anorexia nervosa

- bulimia

- malnutrition

- drug reactions

usually bilateral

Underlying systemic problems associated with Sialadenosis

uncommon, locally destructive inflammatory condition

Necrotizing Sialometaplasia

_____ results from ischemia leading to infarction

Necrotizing Sialometaplasia

Necrotizing Sialometaplasia mimics squamous cell carinoma both ______ and _______

clinically, microscopically

Necrotizing Sialometaplasia is most frequently found in the ______ 75%

palate

- initially non-ulcerated swelling, often with pain or paresthesia

- within 2-3 weeks, necrotic tissue sloughs out, leaving a crater-like ulcer 1-5cm in diameter

- pseudoepitheliomatous hyperplasia- squamous metaplasia of ducts

progression of Necrotizing Sialometaplasia

uncommon, but not rare

Salivary Gland Tumors

- most common site - parotid 64-80%

- overall 2/3rds to 3/4ths of all tumors

- 2/3 to 3/4 benign

- 8-11% in submandibular gland, but malignancy almost double 37-45%

- sublingual gland tumors rare but 70-90% malignant

Salivary Gland Tumors

- 9-23%

- second most common site

- almost 50% malignant

- palate - most frequent site (42-54%)

- most on the posterior lateral hard or soft palate

- lips second most common

Minor Salivary Gland Tumors

smaller the gland, the greater the chance of malignancy

Minor Salivary Gland Tumors

- Canalicular Adenoma

- Basal Cell Adenoma

Monomorphic Adenoma

- almost exclusively in minor SG

- striking predilection for upper lip (>755)

- nearly always occurs in older adults

- slow growing, plainless mass

Canalicular Adenoma

- basaloid appearance of the tumor cells

- primarily parotid lesion

Basal Cell Adenoma

papillary cystadenoma lymphomatosum

Warthin's Tumor

what unique clinical feature occurs with Warthin's Tumor?

tendency to occur bilaterally

- benign neoplasm almost exclusively parotid

- smokers - 8X risk than nonsmokers

- slow growing, painless, nodular mass

- male predilection

- although the name is cumbersome, it accurately descirbes microscopic features

Warthin's Tumor

what tumor occurs in young adults ages 30-50?

Pleomorphic Adenoma

- benign mixed tumor

- 2/3rds to 3/4ths of parotid tumors

- painless, slow growing, firm mass

- slight female predilection

- best treated by surgical excision

- malignant degeneration possible in long standing lesion's - 5%

Pleomorphic Adenoma

most common salivary neoplasm

Pleomorphic Adenoma

most common SG malignancy

Mucoepidermoid Carcinoma

most common malignant SG tumor in children

Mucoepidermoid Carcinoma

- most common in parotid

- minor SG - palate 2nd

- minor gland - asymp fluctuant swelling blue or red

Mucoepidermoid Carcinoma

what area's of bone are more susepctible for mucoepidermoid carcinoma?

- more common in mandible than maxilla

- molar-ramus area

- 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

Mucoepidermoid Carcinoma

- malignancy with serous acinar differentiation

- most common in the parotid

- variable microscopic appearance

- may even appear encapsulated

- better prognosis than others

Acinic Cell Adenocarcinoma

pain is a common and important early finding

Adenoid Cystic Carcinoma

- originally called a cylindroma

- approx 50% within the minor SG - palate most common site

- usually a slow growing mass

- 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, 20%

Adenoid Cystic Carcinoma

perineural invasion common

Polymorphous Low Grade Adenoncarcinoma

- recently recognized - 1983

- almost exclusively in the minor SG

- 2/3rds in females

- tumor cells have deceptively uniform appearance

- different growth patterns hence, "polymorphous"

- wide surgical excision

- overall prognosis relatively good, with 80% cure rate

Polymorphous Low Grade Adenoncarcinoma

- mean age about 15 years more than benign counterpart

- mass present for many years with recent rapid growth

- best treated by wide excision, with local node dissection and radiation

- prognosis guard, with 50% local recurrence or metastases and dying

Carcinoma Ex Pleomorphic Adenoma

- pleomorphic adenoma

- adenoid cystic ca

- mucoepidermoid ca

- PLGA

- monomorphic adenoma

frequently located in the palate

- pleomorphic adenoma

- Warthin's tumor

- basal cell adenoma

- mucoepidermoid ca

- acinic cell ca

- adenoid cystic ca

- ca ex mixed tumor

frequently located in the parotid gland

- canalicular adenoma

- salivary duct cyst

- pleomorphic adenoma

found on the upper lip

- mucocele

- mucoepidermoid ca

- pleomorohic adenoma

found on lower lip