The University of

Jordan

Oral Pathology-II
4th Year
2016/2017

Faleh Sawair: BDS, FDS RCS (England),PhD

Professor of Oral Pathology
 Developmental anomalies:
 Aplasia
 Atresia: SMG, retention cyst Associations and oral
manifestations
 SG hypoplasia: Melkersson-Rosenthal

 Ectopic tissue: Stafne’s IBC, Middle ear, Cervical LNs

 Accessory ducts and lobes:
  Sialadenitis:
 Mumps: (‫(النكاف‬
 Common
 Children
 Highly infectious: airborne droplets
 Parotid
 Clinically:
 IP → fever & malaise, rapid painful swelling.
 Bilateral (70%)
 Duration: 7 days

 Prognosis:

 Orchitis (20%), Oophoritis, Encephalitis, Pancreatitis

 Dx: clinical, amylase, Abs to “s” & “v” Ags
 Immunity
MMR
 Acute bacterial sialadenitis:
 Uncommon
 Parotid
 Xerostomia
 Seen in pts with:
 Sjogren’s syndrome & radiation
 Tricyclic antidepressants
 Immunosuppression
 Obstructed glands
 Microbiology: Staph, mixed
 Clinically:
 Rapid onset
 Swelling
 Redness
 Pain & Trismus
 Fever
 Malaise
 LN
 ↑ ESR & leukocytosis
  Pus

Biopsy & Sialography

 Hist:
 Intense AICI in acini, periductal tissue & within ducts.
 Ductal dilatation.
 Abscess formation → healing by fibrosis
 Chronic bacterial sialadenitis:-

 Ductal obstruction or ↓ secretion

 Submandibular G
 Unilateral

 Clinically:
 Recurrent tender swelling
 Inflamed orifice
 Pus
 Hist:
 Destruction of acini

Scattered CICI
Interstitial fibrosis
Duct dilatation & sq metaplasia & stone

 Chronic sclerosing sialadenitis

 Recurrent Parotitis

 Children
 Aetiology: ?
 Clinically:
Uni/bilateral recurrent painful swelling
 Redness, and fluctuation are absent
 Most cases: resolves spontaneously Pus
 Obstructive & traumatic lesions:
 Causes:
 Parotid papilla & duct stricture:

 Chronic trauma to parotid papilla, RAS

 Ulceration around a stone

 Surgery
 Sialolithiasis:
 Gland or duct
 SMG: ~ 90%, mostly at the duct bend and distal third.
 Parotid
 Sublingual & minor SGs 2%
Dead Sea
 Clinically:
 Adults, 2 M: 1F
 Unilateral
 Can be multiple
 Most cause symptoms: pain & swelling, retrograde infection
Dx:

 Palpation
 Radiographs

However;

Parotid 40%, SMG 20%

 Sialography

Stone
Sialoendoscopy
 Pathogenesis:

Ca salts around a nidus

of organic material

 Stone:
 Yellowish-white
 Round/oval, rough/smooth
 Ca, PO4, Bicarbonate
• Gland changes:
 Duct dilatation w sq metaplasia
 Acinar atrophy & replacement fibrosis
 Periductal CICI & fibrosis
 CICI of lobules
 Radiation induced sialadenitis:
 Sensitive
 Serous acini
 Xerostomia and tender swelling of SGs within 24 hours
  dose  Irreversible fibrosis & sq metaplasia
 Complications
 Sialadenitis of minor SGs:-
 MEC
 Necotinic stomatitis
 Sarcoidosis
 Sjogren’s syndrome
 Necrotizing sialometaplasia:

 ? Aetiology
 Spontaneous necrosis
 Site: H-S palate

 Clinically:
 Middle age
 Deep ulcer  2cms
 Painless
 2 months
 CICI

 Hist: ME

Pseudoepitheliomatous hyperplasia
Sq metaplasia of ducts & acini

Necrosis of SG lobules
 Sialadenosis (Sialosis):-
 Definition:
 Aetiology: ?, defect in neurosecretory control
o Alcoholism
o DM, hypothyroidism, Acromegaly
o Pregnancy
o Bulimia N.
o Drugs (Clozapine)
o Malnutrition
o Cirrhosis, CRF
 Hist: hypertrophy of acini & oedema of CT
 Sialochemistry: ↑ K+& Ca++
A useful guide to whether the
patient is simply obese or has
parotid enlargement
 Sjogren’s syndrome:-‫متالزمة شوغرن‬
 Pathogenesis:
 Immune-mediated CI disease (non-organ specific AID)
 Lymphocytic infiltratn & replacement of glandular parenchyma
 Xerostomia & Xerophthalmia
 Clinically:
  1% of population
 Middle age
 Females: ~ 90%
 Two types:
 Primary SS (Sicca S): X & X

 Secondary SS: X & X + CT disease

 RA (15%)

 SLE (30%)
 Systemic sclerosis
 Primary biliary cirrhosis
 Dermatomyositis
 Mixed CT disease
 Mouth:
 Discomfort
 Difficulties in eating, swallowing & speech
 Disturbed taste sensation
 Dry, red & shiny mucosa
 Candidosis, sialadenitis, root caries
 Red, atrophic, lobulated (cobble-stone) tongue
 Eyes: Keratoconjunctivitis sicca
 Corneal keratotic lesions
 Failure of tear secretion:
 Conjunctivitis

Schirmer test
Others:

 Severe tiredness & Arthralgia

 Xeroderma, nasal dryness, vaginal dryness

 Sinusitis, tracheitis, dysphagia
 Atrophic gastritis, pancreatitis, purpura
 Anaemia, leucopenia, thrombocytopenia
 SG enlargement
 Hist:-
 Lymphocytic infiltrate (T)
 Intralobular ducts
 Interlobular septa & capsule
 Acinar atrophy
 Epimyoepithelial islands
 Dx:

 Sialometry: mixed USFR:

< 0.1 ml/min

Schirmer test
 Tear
5 mm
 SG biopsy

4 mm2
 Sialography: sialectasis

“Snowstorm”

Cherry blossom
 Salivary scintiscanning: [99Tm] pertechnetate

 Ab screening:
 SS-A,
 SS-B,

 RF,

 ANA

 Serology:
 ESR,

 Hypergammaglobulinaemia
Dx: 4 of the following 6 Criteria to be present:

1. At least 1 specified ocular symptom;

2. At least 1 oral symptom;

3. Abnormal findings on Schirmer's test;

4. Abnormal results on salivary gland biopsy;

5. At least 1 abnormal result for unstimulated salivary flow rate,

sialography, or scintigraphy; and

6. Presence of at least 1 of the following antibodies, RF, ANA,

SS-A or SS-B.
 Aetiology:
 Unknown
 Autoimmune: ?Ag
 CMV, EBV, HHV-6, Retrovirus
 Complications:
 B-cell malignant lymphoma

↑ primary or 2ndary form