theme 10

Question 1

developmental abnormalities of salivary glands

Answer 1

aplasia/hypoplasia
ductal atresia
accessory salivary gland/ectopic salivary gland

Question 2

what is a sialography

Answer 2

involves injection of radio-opaque dye into duct

Question 3

2 type of salivary gland infections

Answer 3

bacterial sialadenitis

viral sialadenitis - mumps

Question 4

predisposing factors to bacterial sialadenitis

Answer 4

reduced salivary flow - medications, dehydration, radiotherapy, sjogrens, poor OH
sialolithiasis

Question 5

how are submandibular gland stones easily identified compared to parotid

Answer 5

heavily calcified compared to parotid

Question 6

2 types of bacterial sialadenitis

Answer 6

acute - suppurative, acute, redness, pain, swelling, lymphadenopathy

chronic - progressive destruction + fibrosis to protect gland

Question 7

2 examples of chronic sialadentitis

Answer 7

post radiotherapy + sjogrens

Question 8

virus causing mumps

Answer 8

paramyxovirus

Question 9

features of mumps

Answer 9

unilateral parotid swelling

Question 10

features of HIV-associated salivary gland disease

Answer 10

lymphoepithelial lesions within parotid, lymphocytes associated with cystic change - cysts within parotid

uncommon due to triple therapy

Question 11

what are mucoceles

Answer 11

mucous cyst - fluid filled swelling occurs on lower lip or FOM

temporary, painless

Question 12

2 types of mucoceles

Answer 12

extravasation - broken salivary gland duct = leakage into ST around gland

retention - blockage of salivary gland = build up of mucous

Question 13

causes of dry mouth

Answer 13

medication - antidepressants most common
dehydration
diabetes 
renal failure
radiotherapy
sjogrens

Question 14

how does pilocarpine work

Answer 14

stimulates residual secretory capacity

Question 15

characteristics of sjogrens

Answer 15

dry eyes, dry mouth, muscle + joint pain, fatigue

Question 16

causes of sjogrens

Answer 16

cause unknown - involves immune system mediated inflammatory mechanisms

Question 17

2 categories of sjogrens

Answer 17

primary + secondary

Question 18

causes of secondary sjogrens

Answer 18

RA, lupus, scleroderma, primary biliary cirrhosis

Question 19

who does primary SS affect most

Answer 19

women

Question 20

examples of objective evidence of salivary gland involvement

Answer 20

1. unstimulated whole salivary flow - <1.5ml
2. parotid sialography showing presence of diffuse sialectasis without evidence of obstruction in major ducts
3. salivary scintigraphy showing delayed uptake, reduced concentration and/or delayed excretion of tracer

Question 21

what must be present on SS biopsy

Answer 21

inflammation

focus score used

Question 22

risk of which cancer with SS

Answer 22

lymphoma - MALT associated most common

Question 23

3 components to diagnosing SS

Answer 23

symptoms, clinical signs, evidence of immune system disturbed

Question 24

what type of scan used for salivary glands

Answer 24

unltrasound

doppler detect changes in pattern of blood flow

Question 25

antibodies present in primary SS

Answer 25

anti-Ro + La

Question 26

ways to manage dry mouth

Answer 26

good OH stay hydrated less sugar/coffee/alcohol limit drug use replacement - oralube/xerostom/biotene/water immuno-modulatory - ciclosporins stimulant - pilocarpine or cevimeline, sugar freee gum, lozenges, mint also reinforce good OH

Question 27

roles of saliva

Answer 27

``` mechanical washing anti-microbial activities remineralised of dental tissues buffer lubrication - mucin limited digestion - amylase ```

Question 28

dry mouth problems

Answer 28

``` discomfort ulceration gum disase infections - fungal, ascending salivary gland infections poor denture retention alternated taste sensation speech + swallowing difficulties ```

Question 29

most common salivary gland to suffer from malignancy

Answer 29

parotid

Question 30

most common benign salivary gland tumour

Answer 30

pleomorphic adenoma

Question 31

4 malignant epithelial salivary gland tumours

Answer 31

mucoepidermoid carcinoma adenoid cystic carcinoma - bad prognosis acidic cell carcinoma adenocarcinoma

Question 32

where does warthin tumour present

Answer 32

parotid only

Question 33

type of epithelial cells on salivary glands

Answer 33

myoepithelial

Question 34

2 layers of ductal system

Answer 34

luminal + alumna (basal cells)

Question 35

features of pleomorphic adenoma

Answer 35

slow growing, mobile, smooth, painless swelling

Question 36

treatment for pleomorphic adenoma

Answer 36

superficial parotidectomy, extracapsular dissection

Question 37

risk with treating parotid gland tumours

Answer 37

risk to facial nerve

Question 38

histopathological features of pleomorphic adenoma

Answer 38

pleomorphic + ep + myoep, ep + mesenchyme = chondromyxoid matrix well demarcated, bosselated, variably encapsulated

Question 39

risk of pleomorphic ademona

Answer 39

malignancy potential ~10-15yrs carcinoma ex pleomorphic adenoma tend to be very high grade, fast growing

Question 40

risk factor for warthins tumour

Answer 40

smoking

Question 41

features of warthins tumour

Answer 41

slow growing, mobile, smooth, painless

Question 42

histopathological features of warthins tumour

Answer 42

encapsulated, papillary structure form cystic spaces, gelatinous contents, lined by oncocytic ep

Question 43

features of basal cell adenoma

Answer 43

made of back to back ducts - no chondromyxoid matrix

Question 44

features of canalicular adenoma

Answer 44

canal like systems of ep cells | decompressed bag of jelly when excised

Question 45

clinical presentation of malignancy salivary gland neoplasms

Answer 45

``` firm fixed lump poorly demarcated rapid growth painless first, pain at later stage skin/mucosal ulceration face palsy if affecting nerve bone invasion ```

Question 46

reasons for recurrent salivary gland swellings

Answer 46

salivary calculi/sialolithiasis papillary obstruction duct stricture punctuate sialectasis

Question 47

causes of persistent diffuse enlargement of salivary glands

Answer 47

sjogrens sialosis sarcoidosis

Question 48

causes of nodular enlargement

Answer 48

neoplasm lymph node cyst

Question 49

order for investigating salivary glands

Answer 49

1. clinical examination/palpation 2. plain radiography - FOM occlusal 3. ultrasound 4. sialography 5. CT/MRI

Question 50

8 types of salivary gland surgery

Answer 50

1. removal of caliculi 2. ductal dialtion/repositiioning 3. excision of sublingual gland 4. excision of submandibular gland 5. parotidectomy - superficial or total 6. extracapsular dissection 7. excision of minor salivary gland tumours 8. minimally invasive surgery

Question 51

3 nerves that may be damaged in submandibular surgery

Answer 51

1. facial nerval cervical branch 2. lingual nerve 3. hypoglossal nerve

Question 52

complications of parotidetomy

Answer 52

pain/swelling facial nerve weakness sialocele Freys syndrome

Question 53

what is Freys syndrome

Answer 53

postganglionic parasympathetic fibres connect to sympathetic instead - causes person to sweat when eating instead

Question 54

general rule for lip swellings

Answer 54

``` upper = malignant lower = mucocele ```