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Test 4 Study Guide

Test 4 Study Guide

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Published by Sagal Nur

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Published by: Sagal Nur on Oct 03, 2012
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Oral Pathology Exam 4—2006 
1
of
22
 
Salivary Gland PathologyMucocele (Mucus Extravasation Phenomenon)
 
Common lesion resulting from damage of the salivary duct, with extravasation, withextravasation (spillage) of mucin into the surrounding tissue
 
Frequently due to local trauma
 
Most on the lower lip of children or young adults
 
Fluctuant, dome shaped swelling with a translucent blue color(if firm, probablyfibroma);May wax and wane
 
Superficial mucocele 
-variant secondary to superficial location of the mucin
o
 
Palate, retromolar pad, posterior buccal mucosa
 
Histo: Mucin surrounded by granulation tissue and fibrous connective tissue(not atrue cyst)
 
Mixed inflammatory infiltrate, featuring neutrophils and foamy histiocytes
 
Treatment: Some resolve spontaneously
o
 
Conservative surgical excision along with the associated minor salivarygland tissue; May recur
Ranula
 
Variant of mucocele occurring in the floor of the mouth
 
Rana=frog
 
Usually from the sublingual gland
 
Translucent blue or normal colored, fluctuant swelling in the floor of the mouth
 
May cause elevation of the tongue
 
Plunging ranula 
- Mucin penetrating the mylohyoid muscle, showing submandibularswelling or swelling of the neck
 
Histology similar to that of mucocele
 
Tx: Marsupialization may allow for re-establishment of the involved duct
o
 
Surgical removal along with the associated sublingual gland
Salivary Duct Cyst (Mucus Retention Cyst; Mucus Duct Cyst)
 
Epithelial-lined cavity filled with mucin(true cyst) 
 
Most probably arise secondary to ductal obstruction
 
Typically adults Typically adults
 
Major (parotid) or minor glands (floor of mouth, buccal mucosa, lips)
 
Fluctuant, asymptomatic swelling
 
Histo 
Cystic spacelined by cuboidal or columnar epithelium(mucocele not lined byepi.)
o
 
May acquire papillary infoldings
 
Treatment--
Conservative surgical excision
o
 
Major gland involvement may require partial or complete removal of thegland
o
 
Recurrence rare
Sialolithiasis (Salivary Stones or Calculi)
 
Salivary duct calcifications of unknown etiology
 
Arise secondary to deposition of calcium salts around a nidus of debris
 
Unrelated to calcium-phosphorus metabolism
 
Usually within the submandibular duct
 
Oral Pathology Exam 4—2006 
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22
 
 
Episodic pain and/or swelling
 
May have palpable mass
 
Minor gland involvement will often be asymptomatic
 
Radiographic appearance: 
Opaque mass
 
Histology = Concentric laminations around an amorphous central nidus
o
 
Inflammation of duct and adjacent glands
o
 
May see squamous, oncocytic, or mucous cell metaplasia
 
Treatment
o
 
Major glands –Sialolith
may 
be stimulated through the duct and out
o
 
Massage, sialogogues, hydration
o
 
Those in minor glands and major glands that cannot otherwise be removedrequire surgical excision, with/without the involved gland
 
CLASS NOTE: may be a cause of mucocele
Sialadenitis
 
Inflammation of salivary glands
 
Infectious (viral, bacterial) or noninfectious(Sjogren syndrome, sarcoidosis,radiation) etiology
 
“Surgical mumps ” – 
Post abdominal surgery
 
Acute bacterial sialadenitis-
Typically involves the parotid
o
 
Swollen, painful gland; Purulent discharge
 
Chronic sialadenitis -
Recurrent or persistent ductal obstruction obstruction
o
 
Episodic pain and swelling
o
 
Usually secondary to sialolith
 
Histology
 
Acute
– Acute inflammatory cells within the ductal system and acini
 
Chronic
– Diffuse or patchy aggregates of chronic inflammatory inflammatory cells,with/without acinar degeneration or atrophy
 
Treatment
o
 
Acute – Antibiotic therapy, rehydration
 
Milk gland, if pus
Æ
Bacterial
Æ
PCN, if Clear
Æ
viral
Æ
Valtrex, etc.)
o
 
Chronic– Sialolith removal if appropriate; Surgical removal of the gland maybe indicated
Sialorrhea
 
Excessive salivation
 
Associated with local irritation (dentures) medications, metal poisoning,gastrointestinal reflux disease;Also common in GERD 
 
May also be seen in patients with poor neuromuscular control
 
Drooling, choking
 
May cause irritation or open sores of the surrounding skin
 
Treatment: None necessary for mild or transitory cases
o
 
Anticholinergic medications (scopolamine) for severe cases
o
 
Surgical intervention(last resort) 
Xerostomia
 
Subjective sensation of dry mouth Secondary to a number of systemic conditions,aging, smoking, or medications and treatments
 
Oral Pathology Exam 4—2006 
3
of
22
 
 
Etiologies
o
 
Developmental
 
Aplasia,
o
 
Water/metabolite loss
 
Impaired fluid intake, Hemorrhage
o
 
Iatrogenic
 
Medications
o
 
Systemic diseases
 
Sjogren syndrome, Diabetes. Sarcoidosis, HIV
o
 
Local Factors
 
Smoking, Mouth breathing
 
Medications Associated with Xerostomia(
don’t memorize drugs, just knowcategories)
 
o
 
Antihistamines
o
 
Diphenhydramine
o
 
Decongestants
o
 
Pseudoephidrine
o
 
Antidepressants
o
 
Amitriptyline
o
 
Antipsychotics
o
 
Antihypertensives
o
 
Anticholinergics
o
 
Atropine
o
 
Scopolamine
 
Clinical Features=
F>M, elderly
 
Thick, foamy saliva
 
Dry mucosa, with atrophy and fissuring(mirror will stick to buccal mucosa)
 
Increased incidence of candidiasis infection (and sialoadenitis)
 
Xerostomia-related caries 
– Caries of the root surface or cervical area secondaryto lack of salivary protection
 
Treatment= Continuous hydration
 
Artificial saliva (Biotene products)
 
Fluoride application
 
Pilocarpine (Sialogen) may be used in more severe cases, but are accompanied withsome side effects
Benign Lymphoepithelial Lesion
 
Intense lymphocytic infiltration of the salivary glands
 
Most are associated with Sjogren syndrome
 
“Mikulicz’s disease vs. Mikulicz’s syndrome”
(Mikulicz’s dx. is bilateral parotid-lacrimal enlargement while Mik. Syn. is associated secondary to another condition 
 
Typically bilateral
 
F>M, average age 50
 
Usually an asymptomatic, diffuse swelling of the parotid gland
 
Histology= Heavy lymphocytic infiltrate, with/without germinal centers
o
 
Destruction of salivary gland acini
o
 
Epimyoepithelial islands
 
Treatment and Prognosis
o
 
Surgical removal of the involved gland
o
 
Good prognosis, although an increased risk of developing lymphoma
o
 
MALT (mucosa associated lymphoid tissue) lymphoma

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