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Questions and Answers
Questions and Answers
What are the main etiological factors contributing to the formation of salivary gland stones?
What are the main etiological factors contributing to the formation of salivary gland stones?
Decreased water consumption and increased calcium levels in the body.
Differentiate between benign and malignant salivary gland tumors, listing specific examples of each.
Differentiate between benign and malignant salivary gland tumors, listing specific examples of each.
Benign tumors: pleomorphic adenoma, Warthin tumor; Malignant tumors: primary carcinoma, secondary carcinoma.
Describe the immunological disorders associated with salivary glands, focusing on their specific locations and related syndromes.
Describe the immunological disorders associated with salivary glands, focusing on their specific locations and related syndromes.
In the parotid gland: Sjogren's syndrome; In the submandibular gland: Mikulicz's syndrome.
Explain the surgical treatment options for salivary gland tumors, including specific nerve considerations.
Explain the surgical treatment options for salivary gland tumors, including specific nerve considerations.
What are the components of the 'triad of' that is associated with parotid involvement in Sjogren's syndrome?
What are the components of the 'triad of' that is associated with parotid involvement in Sjogren's syndrome?
Describe the diagnostic tests used to identify Sjogren's syndrome and justify the use of each test.
Describe the diagnostic tests used to identify Sjogren's syndrome and justify the use of each test.
What are the non-inflammatory disorders that can affect the salivary glands, and how are they generally treated?
What are the non-inflammatory disorders that can affect the salivary glands, and how are they generally treated?
Outline the empirical antibiotic treatment for salivary gland infections, including specific medications and considerations.
Outline the empirical antibiotic treatment for salivary gland infections, including specific medications and considerations.
Detail diagnostic methods for auriculotemporal nerve damage, including specific evaluation techniques.
Detail diagnostic methods for auriculotemporal nerve damage, including specific evaluation techniques.
Describe the key features that differentiate mucoepidermoid carcinoma from malignant mixed tumors of the salivary glands.
Describe the key features that differentiate mucoepidermoid carcinoma from malignant mixed tumors of the salivary glands.
For patients with sialolithiasis, what clinical findings would suggest that the submandibular gland is affected as opposed to the parotid gland?
For patients with sialolithiasis, what clinical findings would suggest that the submandibular gland is affected as opposed to the parotid gland?
What is the rationale behind using botulinum toxin (Botox) in the treatment of auriculotemporal nerve disorders affecting salivary glands?
What is the rationale behind using botulinum toxin (Botox) in the treatment of auriculotemporal nerve disorders affecting salivary glands?
Detail the characteristics of chronic recurrent sialadenitis, including the glands primarily affected and potential associations with other conditions.
Detail the characteristics of chronic recurrent sialadenitis, including the glands primarily affected and potential associations with other conditions.
Explain the clinical presentation and treatment approach for necrotizing sialometaplasia.
Explain the clinical presentation and treatment approach for necrotizing sialometaplasia.
Describe the viral causes of sialadenitis and their distinguishing features in terms of contagiousness and affected populations.
Describe the viral causes of sialadenitis and their distinguishing features in terms of contagiousness and affected populations.
How do factors that decrease and increase salivary flow relate to specific systemic conditions and medications?
How do factors that decrease and increase salivary flow relate to specific systemic conditions and medications?
Outline the key neurological findings associated with parotid and submandibular tumors, specifying the nerves commonly affected.
Outline the key neurological findings associated with parotid and submandibular tumors, specifying the nerves commonly affected.
What are the contraindications for sialography, and why are these conditions considered prohibitive for the procedure?
What are the contraindications for sialography, and why are these conditions considered prohibitive for the procedure?
For a patient presenting with a sublingual gland ranula, detail the first-line treatment and possible recurrence management strategies.
For a patient presenting with a sublingual gland ranula, detail the first-line treatment and possible recurrence management strategies.
Describe the association between lymphoepithelial cysts of the parotid gland and specific systemic conditions.
Describe the association between lymphoepithelial cysts of the parotid gland and specific systemic conditions.
How do computerized tomography (CT) scans and magnetic resonance imaging (MRI) contribute differently to the diagnostic evaluation of salivary gland disorders?
How do computerized tomography (CT) scans and magnetic resonance imaging (MRI) contribute differently to the diagnostic evaluation of salivary gland disorders?
Differentiate between extravasation and retention mucoceles regarding their etiology and typical location.
Differentiate between extravasation and retention mucoceles regarding their etiology and typical location.
Outline the key factors and historical findings to consider when evaluating a patient with salivary gland swelling.
Outline the key factors and historical findings to consider when evaluating a patient with salivary gland swelling.
Explain the significance of neural invasion in the context of malignant salivary gland tumors, specifically referencing potential clinical manifestations.
Explain the significance of neural invasion in the context of malignant salivary gland tumors, specifically referencing potential clinical manifestations.
Describe the etiology and clinical presentation of auriculotemporal nerve syndrome (Frey's syndrome).
Describe the etiology and clinical presentation of auriculotemporal nerve syndrome (Frey's syndrome).
Detail the clinical presentations of acute suppurative parotitis, including common signs and symptoms.
Detail the clinical presentations of acute suppurative parotitis, including common signs and symptoms.
Explain the conditions associated with salivary flow reduction.
Explain the conditions associated with salivary flow reduction.
Outline the diagnostic utility of radionuclide scans in evaluating salivary gland function and lesions, including the most common isotope used.
Outline the diagnostic utility of radionuclide scans in evaluating salivary gland function and lesions, including the most common isotope used.
For a patient with salivary swelling that subsides between meals, what specific etiology should be suspected, and why?
For a patient with salivary swelling that subsides between meals, what specific etiology should be suspected, and why?
What is the relevance of salivary stone assessment in determining the course of treatment for the patient's issues?
What is the relevance of salivary stone assessment in determining the course of treatment for the patient's issues?
Explain why a patient with iodine sensitivity would be contraindicated for sialography.
Explain why a patient with iodine sensitivity would be contraindicated for sialography.
Outline supportive measures for patients with salivary issues. Be specific.
Outline supportive measures for patients with salivary issues. Be specific.
Describe the potential causes of a sialorrhea.
Describe the potential causes of a sialorrhea.
Why is ultrasonography considered a beneficial imaging option to consider for tumors?
Why is ultrasonography considered a beneficial imaging option to consider for tumors?
Differentiate the typical age groups affected by extravasation and retention mucoceles.
Differentiate the typical age groups affected by extravasation and retention mucoceles.
What are the likely problems a patient may be facing if there are issues with the hypoglossal nerve?
What are the likely problems a patient may be facing if there are issues with the hypoglossal nerve?
Why is a stone on the orifice of the gland likely to be resolved through milking?
Why is a stone on the orifice of the gland likely to be resolved through milking?
What may be the etiology of sialadenosis?
What may be the etiology of sialadenosis?
Outline the various types of salivary gland swelling and examples of each. Be specific.
Outline the various types of salivary gland swelling and examples of each. Be specific.
Which gland is more likely to need to have a biopsy done?
Which gland is more likely to need to have a biopsy done?
What is the primary distinction between an extravasation mucocele and a retention mucocele in terms of their underlying mechanism?
What is the primary distinction between an extravasation mucocele and a retention mucocele in terms of their underlying mechanism?
How do parotid tumors affect specific cranial nerves, and what are the resulting neurological manifestations?
How do parotid tumors affect specific cranial nerves, and what are the resulting neurological manifestations?
What role does sialography play in diagnosing salivary gland disorders, and what specific contraindications should be considered before performing this diagnostic procedure?
What role does sialography play in diagnosing salivary gland disorders, and what specific contraindications should be considered before performing this diagnostic procedure?
In the context of non-specific acute suppurative parotitis, explain the significance of performing a culture and sensitivity test, and outline the potential therapeutic implications based on the results.
In the context of non-specific acute suppurative parotitis, explain the significance of performing a culture and sensitivity test, and outline the potential therapeutic implications based on the results.
Describe the clinical presentation and underlying neurological cause of auriculotemporal nerve damage, or Frey's syndrome, following parotid surgery, and detail how the starch-iodine test is utilized in its diagnosis?
Describe the clinical presentation and underlying neurological cause of auriculotemporal nerve damage, or Frey's syndrome, following parotid surgery, and detail how the starch-iodine test is utilized in its diagnosis?
Questions and Answers
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Flashcards
Flashcards
Water Consumption
Water Consumption
Refers to a reduction in water intake.
Increased Calcium (Ca) in body
Increased Calcium (Ca) in body
An increase in calcium levels within the body can be a contributing factor to certain conditions.
Gagle Syndrome
Gagle Syndrome
A syndrome possibly related to some of the conditions discussed, though details are not provided.
Pleomorphic Adenoma
Pleomorphic Adenoma
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Warthin's Tumor
Warthin's Tumor
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Primary Carcinoma (Salivary Gland)
Primary Carcinoma (Salivary Gland)
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Secondary Carcinoma (Salivary Gland)
Secondary Carcinoma (Salivary Gland)
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Sjogren's Syndrome
Sjogren's Syndrome
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Benign Lymphoepithelial Lesion (Mikulicz's Syndrome)
Benign Lymphoepithelial Lesion (Mikulicz's Syndrome)
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Enlargement Without Any Cause
Enlargement Without Any Cause
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Sialadenosis
Sialadenosis
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Most Common Tumor (Benign)
Most Common Tumor (Benign)
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Small Incision
Small Incision
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Lacrimal Probe
Lacrimal Probe
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Milking of Gland
Milking of Gland
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Stone on Orifice
Stone on Orifice
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Sialectomy
Sialectomy
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Shockwave Lithotripsy
Shockwave Lithotripsy
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Sialoendoscopy
Sialoendoscopy
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Botulinum Toxin Therapy (Botox)
Botulinum Toxin Therapy (Botox)
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Open Surgery
Open Surgery
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Supportive Treatment
Supportive Treatment
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Induction of SG by Lemon
Induction of SG by Lemon
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Xerostomia (Mouth)
Xerostomia (Mouth)
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Keratoconjunctivitis Sicca (Eye)
Keratoconjunctivitis Sicca (Eye)
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Schirmer's Tear Test
Schirmer's Tear Test
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Sialography
Sialography
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Salivary Biopsy
Salivary Biopsy
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Immunologic Test
Immunologic Test
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Sialolithiasis
Sialolithiasis
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Submandibular Gland (Sialolithiasis)
Submandibular Gland (Sialolithiasis)
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Ranula (Sublingual Gland)
Ranula (Sublingual Gland)
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Marsupialization (Ranula Treatment)
Marsupialization (Ranula Treatment)
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Culture and Sensitivity Test (Parotitis)
Culture and Sensitivity Test (Parotitis)
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Oncocytoma (Salivary Gland)
Oncocytoma (Salivary Gland)
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Mucoepidermoid Carcinoma
Mucoepidermoid Carcinoma
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Neural Invasion in Malignancy
Neural Invasion in Malignancy
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Auriculotemporal Nerve or Frey's Syndrome
Auriculotemporal Nerve or Frey's Syndrome
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Starch and Iodine Test (Frey's Syndrome)
Starch and Iodine Test (Frey's Syndrome)
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Non-Specific Acute Suppurative Parotitis
Non-Specific Acute Suppurative Parotitis
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Necrotizing Sialometaplasia
Necrotizing Sialometaplasia
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Epidemic Parotitis (Mumps - Viral)
Epidemic Parotitis (Mumps - Viral)
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Xerostomia (Decreased Saliva)
Xerostomia (Decreased Saliva)
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Sialorrhea (Increased Saliva)
Sialorrhea (Increased Saliva)
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Computerized Tomography (CT)
Computerized Tomography (CT)
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Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI)
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Radionuclide Scan
Radionuclide Scan
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Ultrasonography
Ultrasonography
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Extravasation Mucoceles
Extravasation Mucoceles
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Retention Mucoceles
Retention Mucoceles
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Flashcards
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Study Notes
Study Notes
Salivary Gland Disorders
- Salivary glands are divided into major (parotid, submandibular, sublingual) and minor glands.
- Swellings can be caused by various factors, including pus, edema, neoplasm, hematoma, or air.
- Intermittent swelling is associated with eating and may suggest an obstruction, subsiding between meals if the gland is not affected.
- Persistent swelling can be caused by tumors or generalized processes like Sjogren's syndrome, diabetes, or alcoholism.
- Diagnosis involves asking questions regarding the characterization of any mass, such as extent, duration, pain, and rate of growth.
- Characterization of a mass also includes assessing saliva consistency, testing characteristics, and checking for involvement in other areas like joints, eyes, and organs such as the pancreas, liver, or lungs (cystic fibrosis).
- Unilateral swelling results from a localized process, while bilateral swelling is associated with a systemic condition.
- Systemic conditions examples: mumps or endocrine dysfunction.
- Pain not related to eating suggests inflammation.
- Pain related to eating suggests obstruction.
- The submandibular gland is more susceptible to tumors due to tumors or generalized process.
Salivary Flow
- Decreased salivary flow (xerostomia) can be caused by drugs, systemic diseases, or secondary to radiation therapy.
- Sialorrhea (increased salivary flow) can be caused by increased flow rate, an inability to swallow normal secretion, emotional factors, or chronic neurologic disease.
- Sjogren's syndrome involves anti-Ro and La antibodies.
- Physical examination is important.
- Size of the gland may indicate single inflammatory or periapical film/tumor, or multiple issues like Sjogren's, endocrine, metabolic, or nutritional deficiency.
- Consistency of the gland can be firm/hard (tumor) or soft/rubbery (enlarged lymph node), and can be movable or fixed.
Neurological Findings
- Parotid tumors can affect the facial, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves.
- Submandibular tumors can involve the lingual and hypoglossal nerves.
- A plain radiograph is a preoperative diagnostic tool used to demonstrate the presence of calculi.
- An occlusal view is useful for visualizing Wharton's duct.
- Puffed cheek indicates parotid duct involvement.
- Sialography involves contrast media and is useful for visualizing the duct and any stones.
- Salivary stone II contraindication is acute salivary gland infection.
- Sialography determination: size of the tumor, presense of glandular impairments and involvement of adjacent tissue.
- Sialography is contraindicated in cases of acute salivary gland infection, iodine sensitivity, before thyroid gland study, and/or lack of experience.
Sublingual Gland
- Ranulas are extravasation mucoceles.
- The typical age for ranulas is mostly in adults, but they can occur in infants and children.
- The first choice of treatment is marsupialization with deroofing.
- Non-surgical treatment involves administration of a sclerosing agent.
- Recurrence is treated with enucleation (removal of the gland) or excision of the ranula and sublingual gland.
Submandibular Gland
- Tumors in the submandibular gland are rare.
Parotid Gland
- Parotid gland issues include hereditary polycystic disease, parotid duct cysts, retention cysts, and lymphoepithelial cysts (manifestation of AIDS).
- Superficial parotidectomy can be a treatment option.
- Inflammatory diseases of the salivary glands in the parotid include sialadenitis (acute, bacterial, or recurrent) and mumps (viral).
Non-Specific Acute Suppurative Parotitis
- Suppurative parotitis produces pus.
- Symptoms include painful swelling, fever, redness, and purulent discharge.
- Causative organisms: Staphylococcus, Streptococcus, and gram-negative bacteria.
- Empirical antibiotics: Augmentin + Metronidazole and Flagyl.
- Predisposing factors include systemic diseases and liver failure.
- Corticosteroids can be a factor.
- Further treatment: Culture and sensitivity tests, surgical drainage (if acute abscess), and supportive measures, such as drinking plenty of fluids and eating soft foods, and the saliva such as lemon.
Chronic Recurrent Sialadenitis
- Chronic recurrent sialadenitis affects the parotid gland.
- It may be secondary to an episode of acute parotitis, idiopathic, or associated with Sjogren's syndrome.
Necrotizing Sialometaplasia
- Necrotizing sialometaplasia can be caused by anesthesia.
- Vasoconstrictors are implicated.
- A dose greater than 0.3 is too much.
- This condition is self-limiting, resolving in 6-8 weeks.
- It often occurs on the hard palate.
Specific Inflammation
- Bacterial causes include tuberculosis (rare).
- Viral causes include mumps (epidemic parotitis), which is nonsuppurative and contagious.
- Mumps virus: Incubation period of 2-3 weeks, affects mostly children at 6-8 years old.
- Other viral causes: Coxsackievirus A and echovirus.
Salivary Gland I
Etiology
- Poor water consumption
- Increased calcium in the body
Treatment of salivary stones
- Small incision
- Lacrimal probe use
- Stone located on the orifice: Milk the gland to remove
- Stone located in the duct: Use a lacrimal probe by a specialist
- Intraoral dilation to widen the duct
- Extraoral excision to remove from gland
- Sialectomy for a partial or complete removal with a consultant
Recent Management Techniques
- Shockwave lithotripsy
- Extra corpally
- Intra corpally
- Sialoendoscopy
- Botulinum toxin therapy (Botox)
- Temporary Paralyzes the muscle
- Open surgery
Salivary Gland Tumors
- Tumors can be benign or malignant.
- Benign tumors:
- Pleomorphic adenoma
- Warthin tumor
- Malignant tumors:
- Primary carcinoma
- Secondary carcinoma
- Immunologic disorders are associated with salivary gland tumors.
- In the parotid gland, the associated disorder is Sjogren's syndrome.
- In the submandibular gland, the associated disorder is Mikulicz syndrome. -Enlargement without any cause is connected to sialodenosis
Pleomorphic Adenoma
- Most common tumor
- Found in the parotid gland
Signs of Malignancy
- Fixation during palpation indicates the presence of a stone.
Treatment
- Complete excision of the tumor.
- Parotidectomy; however, this can lead to facial nerve paralysis.
- Removal of a submandibular tumor can result in lingual and hypoglossal nerve problems, with resultant tongue movement difficulties.
- A biopsy may be needed to determine appropriate treatment.
Salivary Gland II
Immunologic Disorders
- Sjogren's Syndrome is a key immunologic disorder.
- In the parotid gland
- Triad
- Xerostomia (mouth)
- Keratoconjunctivitis sicca (eyes)
- CT Disease (Rheumatoid Arthritis)
- Sjogren's Disease
Diagnosis
- Schirmer's tear test
- Sialography shows an "apple tree in blossom" pattern.
- Salivary biopsy
- Immunologic tests
- Empirical antibiotics
- Augmentin or Clindamycin or 3rd generation of sephabsporen
- Culture done if no result from the biopsy
Treatment
- Soft diet as TMDs
- Support treatment
- Increased fluid intake
- Induction of SG by lemon or milking of gland
- Saliva Substitute
Non-Inflammatory Disorders
- Sialadenosis: Non-neoplastic enlargement.
- Types:
- Metabolic or Endocrine.
- Nutritional: Starvation
- Alcoholic
- Drugs
- Idiosyncratic
Obstructive Disorders
- Sialolithiasis involves the formation of stones within the ductal system.
- Clinical appearance:
- Submandibular gland: 80%
- Parotid: 19%
Warthin's Tumor
- Lymphatic system is affected, as in Sjogren's.
- Usually in the parotid gland.
- Oncocytoma is a rare finding.
Malignant Tumors
- Mucoepidermoid carcinoma
- Malignant mixed tumor
- Can be both in the parotid gland.
- Mucoepidermoid carcinoma
- Parotid: 70% (high grade)
- Post hard palate (low grade).
Important Note
- Neural invasion in malignancy can result in paralysis or facial palsy. It will go toward malignant.
Auriculotemporal Nerve
- Auriculotemporal Nerve or Frey's Syndrome associated.
- Sweating and flushing of the skin in the area of distribution of the auriculotemporal nerve.
- Caused by stimulus to secrete saliva.
Causes of Nerve
- Surgery of the parotid or TMJ.
- Arthrocentesis
Damage to Auriculotemporal Nerve
- Damage to the branch from the mandibular nerve.
Diagnosis
- Stimulation test.
- Starch and iodine test.
Treatment
- There is no treatment for diagnosis of the nerve only Botax local to nerve
Diagnostic Modalities
- Computerized Tomography (CT)
- Radiographic examination of mass.
- Study of diffuse non-inflammatory enlargement of glands.
- Magnetic Resonance Imaging (MRI)
- Gold standard for soft tissue.
- Better than CT in:
- Detection of lesion or mass.
- Marginal appearance.
- Architecture.
- Regional extension.
- Artifact degradation.
- Radionuclide Scans
- Radioisotope scanning techniques are useful for evaluation of glandular parenchyma.
- Used for:
- Determination of space-occupying lesion.
- Evaluation of salivary function.
- The most common isotope used is technetium.
- Ultrasonography
- Advantages:
- Fast.
- Economical.
- Simple.
- Indications:
- Detect space-occupying lesion.
- Differentiate a cystic lesion from a solid mass.
- Advantages:
Biopsy
- A biopsy in Sjogren's can be taken from the lower lip
Sialochemistry
- Is used to diagnose disease
Blood Tests
- Mantoux test is appropriate when mycobacterial infection is suspected.
Cystic Conditions
Extravasation Mucoceles
- Mechanical trauma in minor excretory duct.
- Site
- lower lip: 80%
- others: 15% in the cheek.
Retention Mucoceles
- Age: older patients
- Etiology: Caused by blockage of mucus in ductal system.
- Partial obstruction of the duct due to microliths or bends in the ductal system.
- Treatment
- May be spontaneous burst.
- Surgical removal.
- Laser.
- May be spontaneous burst.
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