Salivary Gland Disorders

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Questions and Answers

What is the term for the absence of one or more salivary glands?

Aplasia (correct)

Aberrancy

Sialolithiasis

Atresia

What is the most common location of salivary gland stones?

Submandibular gland (correct)

Parotid gland

Sublingual gland

Minor salivary glands

What is the purpose of lithotripsy in treating salivary gland stones?

To inject antibiotics to treat infection

To widen the duct to facilitate stone passage

To remove the entire salivary gland

To break up the stone using shock waves (correct)

What is the term for the abnormal obstruction or constriction of a salivary gland duct?

Atresia Signup and view all the answers

What is a possible complication of salivary gland stones?

Sialadenitis Signup and view all the answers

How often are salivary gland stones visible on x-ray?

80% Signup and view all the answers

What is the main cause of mucoceles?

Damage to duct and extravasation of saliva Signup and view all the answers

What is the typical size of a mucocele?

3mm to 1 cm Signup and view all the answers

What is the lining of a mucocele cyst?

Connective tissue Signup and view all the answers

What is the common location of mucoceles in adults?

Lower lip Signup and view all the answers

What is the typical color of a mucocele swelling?

Bluish Signup and view all the answers

What is the age group commonly affected by mucoceles?

Children and young adults Signup and view all the answers

What is the typical appearance of a deeper mucous extravasation cyst?

Diffuse swelling with no bluish hue Signup and view all the answers

What is the primary cause of necrotizing sialometaplasia?

Ischemia or trauma leading to necrosis of salivary gland tissue Signup and view all the answers

What is the typical treatment for a ranula?

Surgical removal of the lesion with the affected gland Signup and view all the answers

What is the primary complication of radiation-induced salivary gland pathology?

All of the above Signup and view all the answers

What is the term for the subjective sensation of oral dryness?

Xerostomia Signup and view all the answers

What is the typical microscopic feature of necrotizing sialometaplasia?

Lobules of salivary gland show necrosis and ductal metaplasia Signup and view all the answers

Study Notes

Salivary Gland Disorders

Aplasia: Absence of one or more of the major or minor salivary glands.

Abnormalities of Salivary Glands

Atresia: Abnormal obstruction or constriction of a salivary gland duct, often due to a stone (Sialolith).
Aberrancy: Presence of ectopic accessory salivary tissue in an abnormal site.

Sialolithiasis (Salivary Gland Stones)

Refers to the formation of stones in the salivary glands.
Most commonly found in the submandibular gland (80%).
Stones can obstruct Wharton's duct.
Formed by deposition of calcium salts around an organic nidus.

Diagnosis and Clinical Features of Sialolithiasis

Usually diagnosed by characteristic history and physical examination.
Confirmed by x-ray (80% of salivary gland calculi are visible), sialogram, or ultrasound.
Typically affects adult males.
Pain originates from the floor of the mouth, worsened by eating.
May be asymptomatic until palpable in the mouth or seen in a routine radiograph.

Complications and Treatment of Sialolithiasis

Persistent obstruction of the duct, leading to bacterial invasion, overgrowth, and infection (sialoadenitis).
Treatment options include: • Stone excision • Lithotripsy (uses shock waves to break up stones) • Interventional sialendoscopy • Simple removal (with 20% recurrence rate)

Mucoceles

Most common soft tissue lesions
Typically occur on the lower lip, measuring 3mm to 1 cm
Caused by damage to the duct and extravasation of saliva
Lead to mild inflammation and the formation of a cyst with a connective tissue lining
May be due to duct obstruction and dilation, forming a retention cyst with an epithelial lining

Clinical Features of Mucoceles

Occur in adults, especially in the minor salivary glands
Asymptomatic, soft, fluctuant swelling that may appear bluish
Histological features: cystic cavity contains mucin, lined by compressed ductal epithelium

Mucous Retention cysts

Site: minor salivary glands of the lower lip, buccal mucosa, ventral surface of the tongue, floor of the mouth, and retromolar area
Painless, fluctuant, smooth-surface, bluish swelling
Deeper lesions appear as diffuse swelling with no bluish hue
Aspiration reveals a viscous material
Histological features: mucin pool surrounded by compressed granulation tissue infiltrated by chronic inflammatory cells

Extravasation cysts (Ranula)

Clinical term that includes mucous extravasation and mucous retention cysts
Occur in the floor of the mouth, appearing as a blue fluctuant swelling
Etiology: trauma or ductal obstruction by salivary stone
Age: usually old age
Size: larger than mucoceles
Treatment: surgical removal of the lesion with the affected gland

Ranula

Clinical features: painless soft swelling in the floor of the mouth
Arises from sublingual and submandibular salivary gland in the floor of the mouth

Necrotizing Sialometaplasia (NS)

Benign non-infective inflammatory locally destructive lesion of salivary gland
Resembles malignancy both clinically and histopathologically
Etiology: ischemia/trauma leading to necrosis of salivary gland tissue
Site: at the junction between hard and soft palate
Clinically: begins as tender swelling that ulcerates
Ulcer is deep, sharply demarcated, with a yellowish-gray base
Slow healing (6-8 weeks) by secondary intention
Microscopic features: lobules of salivary gland show necrosis and ductal metaplasia
Differential diagnosis: squamous cell carcinoma, mucoepidermoid carcinoma, syphilitic chancre, and deep fungal infections

Radiation-induced Salivary Gland Pathology

Radiotherapy to the head and neck malignancy leads to changes in salivary volume, viscosity, and pH
Swelling, degeneration, and necrosis of salivary gland tissue, followed by fibrosis
Complications: caries, oral ulceration, and infections, periodontal diseases, and even osteoradionecrosis

Xerostomia

Defined as the subjective sensation of oral dryness that may or may not be associated with a reduction in salivary output
Xerostomia is the term used for the symptom of oral dryness
Oral dryness is most commonly associated with a reduction in salivary gland output (termed salivary gland hypofunction)