Diseases Of Salivary Glands Question And Answers

Diseases Of Salivary Glands Important Notes

1. Sialolith
   • Mostly occurs in submandibular glands due to
     • Highly viscous secretion
     • Presence of gland independent position
     • Alkaline secretion with a high concentration of calcium and phosphate ions
     • Gland duct is torturous
   • Sialolith Complications
     • Ductal stricture
     • Acute sialadenitis
     • Ductal dilation
   • Sialolith Treatment
     • Small stones are removed by manipulation
     • Larger stones are removed by transoral sialolithotomy
2. Nerves that are at risk during submandibular gland excision are
   • Marginal mandibular branch of facial nerve
   • Lingual nerve
   • Hypoglossal nerve
3. Classification of salivary gland tumours
   • Based on spread of tumours
   • Histological classification
     • Adenoma
       • Pleomorphic
       • Myoepithelioma
       • Basal cell adenoma
       • Warthin’s tumours
       • Canalicular adenoma
       • Cystadenoma
   • Carcinoma
     • Acinic cell carcinoma
     • Mucoepidermoid carcinoma
     • Adenoid cystic carcinoma
     • Adenocarcinoma
     • Squamous cell carcinoma
   • Nonepithelial tumour
   • Malignant lymphomas
   • Secondary tumours
   • Unclassified
   • Tumour like lesions
     • Sialoadenesis
     • Oncocytosis
     • Necrotizing sialometaplasia
     • Salivary gland cyst
4. Malignant transformation of pleomorphic adenoma occurs when tumour
   • Becomes painful
   • Starts growing rapidly
   • Feels stony hard
   • Gets fixed
   • Cervical lymph nodes gets enlarged
   • Causes restriction of movements of the jaws
5. Mucous retention cyst and ranula
6. Types of ranula
   • Simple – ranula situated in the floor of the mouth without cervical prolongation
   • Deep/plunging ranula – intra buccal ranula with cervical prolongation
7. Complications of ranula
   • Infection
   • Bursting
   • Repeated trauma
   • Difficult in speech arid eating
8. Causes of xerostomia
   • Chronic anxiety and depression
   • Dehydration
   • Antimuscarinic and sympathomimetic drugs
   • Salivary gland diseases like Sjogren’s syndrome
   • Nutritional deficiencies
9. Causes of sialorrhoea
   • Painful oral ulcers
   • Dentures
   • Parkinson’s disease
   • Atropine

Diseases Of Salivary Glands Long Essays

Question 1. Describe clinical features, diagnosis, and management of carcinoma of parotid gland and classify salivary gland tumours
Answer:

Carcinoma of Parotid Gland: It consists of 70% of the salivary tumours

Carcinoma of Parotid Gland Clinical Features:

• It starts growing rapidly
• Skin infiltration occurs
• Facial nerve paralysis
• Exhibits fixation to the masseter muscle
• Red, dilated veins over the surface
• Presence of regional lymphadenopathy
• Tumours becomes stony hard

Read And Learn More: General Surgery Question and Answers

Carcinoma of Parotid Gland Investigations:

• Fine needle aspiration cytology
  • It is done to confirm the diagnosis and rule out malignancy
• Diagnostic imaging techniques
  • Radiograph of the bones- shows bone resorption
  • Computrer tomography
    • It allows direct, bilateral visualization of the salivary gland tumour and detects overall dimension and tissue invasion
    • Demonstrate bony invasion
    • Define extra glandular spread and cervical lymph node
  • Magnetic resonance imaging
    • Provides superior soft tissue delineation such as perineural invasion

Carcinoma of Parotid Gland Treatment:

• Radical parotidectomy
  • Includes removal of both the lobes of the parotid gland, facial nerve, parotid duct, fibres of masseter, buccinator, pterygoids, and radical block dissection of the neck
• Postoperative radiotherapy
  • Indications
    • If the deep lobe is involved
    • If the lymph nodes are involved
    • High-grade tumours
    • If margins are positive

Carcinoma of Parotid Gland Classification:

1. Epithelial tumours:
   • Adenomas
   • Pleomorphic adenoma
   • Cystadenoma
   • Basal cell adenoma
   • Warthin’s tumour
2. Carcinoma
   • Adenocarcinoma
   • Epidermoid carcinoma
3. Nonepithelial tumours:
   • Fibroma
   • Lipoma
   • Lymphoma
4. Malignant lymphoma
5. Secondary tumours
6. Unclassified tumors
7. Tumour like lesions
   • Sialadenitis
   • Oncocytosis
   • Necrotizing sialometaplasia

Question 2. What is mixed parotid tumour? Give clinical features and its management
Answer:

Mixed Parotid Tumour: Pleomorphic adenoma is called mixed parotid tumour

Mixed Parotid Tumour: Clinical Features:

• Age: 5th and 6th decade
  • Sex: common in females
  • Site: common in parotid gland

Mixed Parotid Tumour: Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of the mandible
• Deeper lesions:
• Over the lateral wall of oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Mixed Parotid Tumour: Investigation

1. Duration of the lesion:
   • Longer duration- malignancy
2. Nature of onset
   • Gradual and painless- malignant
   • Sudden and painful- inflammatory
3. Rapidity of growth
   • Slow-benign
   • Rapid- malignant
4. Associated symptoms
   • Discharge of pus
   • Dryness of mouth
   • Constitutional symptoms
5. FNAC- to rule out malignancy
6. CT Scan- for deeper lesions
7. FNAC- for lymph nodes involvement
8. X-ray of bone- for resorption

Mixed Parotid Tumour: Treatment:

• Surgical excision-parotidectomy
  • It is a surgical treatment for salivary glands tumours

Mixed Parotid Tumour: Types:

1. Superficial parotidectomy
   • Anaesthesize
   • Incision over the preauricular crease, curved downward upto tip of mastoid
   • Elevation of skin and superficial fascia
   • Preserve the facial nerve
   • Dissect the gland away from each branch of gland
   • Hemostasis
   • Placement of drains
   • Suturing
2. Total parotidectomy
   • Involves removal of entire parotid gland
   • Superficial parotidectomy done
   • Then remove tumour deep to the facial nerve

Question 3. What are the causes of acute parotitis? Describe its clinical features and management.
Answer:

Acute Parotitis: It is an acute inflammation of the salivary gland

Acute Parotitis Etiology:

• It is caused by Staphylococcus aureus
• Factors causing it are:
  • When the salivary flow is reduced
  • Partial obstruction of the duct with retention of secretions

Acute Parotitis Clinical Features:

• Pain and swelling of the side involved D There is brawny oedematous swelling over the parotid region
• The temperature is high n Cellulitis occurs of the overlying skin
• Pus may come out through the internal opening of the parotid gland

Acute Parotitis  Management:

• Improve general health of the patient n Maintain oral hygiene
• Soft diet should be prescribed n Antibiotics are started
• Gentle parotid massage is done at regular intervals
• Drainage of pus

Question 4. Describe the pathology, clinical features, and management of submandibular salivary calculus.
Answer:

Submandibular Salivary Calculus Clinical Features:

• Age: middle-aged adults
• Sex: common in males

Submandibular Salivary Calculus Pathology:

• Site: common in the submandibular gland due to the following:
  • Due to viscous secretion
  • Higher concentration of calcium and phosphate
  • Tortuous anatomy of the ducts
  • Dependent position of the gland

Submandibular Salivary Calculus Features:

• Recurrent swelling of the gland region
• Recurrent episodes of sialadentitis
• Tense and tender gland
• Aggregates at the meal time
• Type of pain: pulling or drawing sensation
  • Severe, stabbing type
• Enlarged gland
• Location: unilateral
• In chronic cases: formation of fistulas, sinus tracts and ulcerations in the area
• Necrosis of the gland acini
• Lobular fibrosis
• Complete loss of secretion of the gland
• So there is increased risk of infections

Submandibular Salivary Calculus Diagnosis:

• Manual palpation
• Occlusal radiograph in case of the submandibular gland
• Sialography

Submandibular Salivary Calculus Treatment:

• Locate the sialolith radiographically
• Suture behind and below the duct to prevent the spillage of stone
• If sialolith is present posteriorly, incision is given medially
• If sialolith is present anteriorly, incision is placed medial to plicasublingualis
• Locate the duct
• Locate the stone
• Incise over the stone
• Remove it through the forceps

Question 5. Discuss in detail about salivary gland tumors of clinical features, investigations, pathology, management, and complications of pleomorphic adenoma of parotid gland

Answer:

Pleomorphic Adenoma:

• Clinical Features:
  • Age: 5th hand 6th decade
  • Sex: common in females
  • Site: common in parotid gland

Pleomorphic Adenoma of Parotid Gland Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of mandible
• Deeper lesions:
• Over the lateral wall of the oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Pleomorphic Adenoma of Parotid Gland  Pathology:

• Pleomorphic adenoma is a benign parotid tumour
• It is derived from a mixture of epithelial and myoepithelial cells
• The tumour has three components
  • Epithelial cell component
  • Myoepithelial cell component
  • Stromal component
• Investigation:
  • Duration of the lesion:
    • Longer duration- malignancy
  • Nature of onset
    • Gradual and painless- malignant
    • Sudden and painful- inflammatory
  • Rapidity of growth
    • Slow- benign
    • Rapid- malignant
  • Associated symptoms
    • Discharge of pus
    • Dryness of mouth
    • Constitutional symptoms
  • FNAC- to rule out malignancy
  • CT Scan- for deeper lesions
  • FNAC- for lymph nodes involvement
  • X-ray of bone- for resorption

Pleomorphic Adenoma of Parotid Gland  Treatment:

• Surgical excision-parotidectomy
• It is a surgical treatment for salivary glands tumours

Pleomorphic Adenoma of Parotid Gland  Types:

1. Superficial parotidectomy
   • Anaesthesize
   • Incision over the pre auricular crease, curved downward upto tip of mastoid
   • Elevation of skin and superficial fascia
   • Preserve the facial nerve
   • Dissect the gland away from each branch of gland
   • Hemostasis
   • Placement of drains
   • Suturing
2. Total parotidectomy
   • Involves removal of entire parotid gland
   • Superficial parotidectomy done
   • Then remove tumour deep to the facial nerve

Pleomorphic Adenoma of Parotid Gland  Complication:

• Facial palsy
• Frey’s syndrome

Question 6. Classify salivary glands tumours. Discuss the etiology, clinical features, and management of War- thin’s tumour.

Answer:

Warthin’s tumour Classification:

1. Based on spread of tumours

2. Histological classification

• Adenoma
  • Pleomorphic
  • Myoepithelioma
  • Basal cell adenoma
  • Warthin’stumours
  • Canalicular adenoma
  • Cystadenoma
• Carcinoma
  • Acinic cell carcinoma
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Adenocarcinoma
  • Squamous cell carcinoma
• Nonepithelial tumour
• Malignant lymphomas
• Secondary tumours
• Unclassified
• Tumour like lesions
  • Sialoadenesis
  • Oncocytosis
  • Necrotizing sialometaplasia
  • Salivary gland cyst

Warthin’s tumour Clinical features

• Age: 50-70 years
• Sex: common in males
• Site: common in parotid gland especially in lower part overlying angle of the mandible
• Characterised by slow enlarging, well-circumscribed soft, painless swelling of gland
• Well-capsulated and movable
• Present over angle of mandible
• Size – 2-4 cm in diameter
• Shape- spherical in shape
• Occurs bilaterally
• Produces compressible and doughy feeling on palpation
• Little movable in all directions

Etiology:

• It is derived from salivary tissue inclusions present in lymph node

Warthin’s tumour  Management:

Anaesthesize the area
/
Incision is given over the pre-auricular area
/
Elevate skin and superficial fascia
/
Isolation of facial nerve
/
Dissection of superficial portion of parotid gland from underlying tissues
/
Removal of gland along with tumour inside
/
Hemostasis
/
Placement of drains
/
Suturing

Diseases Of Salivary Glands Short Essays

Question 1. Salivary fistula/ parotid fistula

Answer:

Salivary fistula

• A parotid fistula may arise from the parotid gland or parotid duct
• Openings
  • Internally inside the mouth
  • Externally to the exterior

Salivary fistula Causes:

• Penetrating injuries
• Rupture of parotid abscess
• Inadverent incision and drainage
• Complication of superficial parotidectomy

Salivary fistula Clinical Features:

• Opening in the cheek with discharge
• Discharge comes out during meals

Salivary fistula Investigations:

• Sialogram with watery solution of lipiodol is performed

Salivary fistula Treatment:

• When fistula is connected with the main duct- reconstruction of the duct by Newman or Seabrock’s operation is performed
• If reconstruction fails, resection of the auriculotemporal nerve is done
• If above measures fails, a complete parotidectomy is done

Question 2. Salivary gland or submandibular gland calculi

Answer:

Salivary gland

It is a pathological condition characterized by the presence of one or more calcified stones within salivary gland itself or within its duct

Etiology:

• Stagnation of saliva
• Ductal epithelial inflammation and injury
• Biological factors

Pathogenesis:

• Formation of soft nidus of mucin, protein, bacteria and desquamated cells.
• Allows concentric, lamellar crystallization
• Gradually sialolith increases in size

submandibular gland calculi Composition of Sialolith:

• Calcium phosphate
• Calcium carbonate
• Salts of Mg, Zn, etc
• Glycoproteins
• Mucopolysaccharides
• Cellular debris

submandibular gland calculi Clinical Features:

• Age: middle-aged adults
• Sex: common in males
• Site: common in the submandibular gland due to the following:
  • Due to viscous secretion
  • Higher concentration of calcium and phosphate
  • Tortuous anatomy of the ducts
  • Dependent position of the gland

submandibular gland calculi Features:

• Recurrent swelling of the gland region
• Recurrent episodes of sialadentitis
• Tense and tender gland
• Aggregates at the meal time
• Type of pain: pulling or drawing sensation
  • Severe, stabbing type
• Enlarged gland
• Location: unilateral
• In chronic cases: formation of fistulas, sinus tracts & ulcerations in the area
• Necrosis of the gland acini
• Lobular fibrosis
• Complete loss of secretion of the gland
• So there is increased risk of infections

submandibular gland calculi Diagnosis:

• Manual palpation
• Occlusal radiograph in case of submandibular gland
• Sialography

submandibular gland calculi Treatment:

• For submandibular gland:
• Locate the sialolith radiographically
• Suture behind and below the duct to prevent the spillage of stone
• If sialolith is present posteriorly, incision is given medially
• If sialolith is present anteriorly, incision is placed medial to plicasublingualis
• Locate the duct
• Locate the stone
• Incise over the stone
• Remove it through the forceps

For parotid gland:

• Locate the sialolith
• Semilunar incision given anterior to the opening of the duct
• Reflection of gland n Locate the stone
• Incise over the stone ” Remove it

Question 3. Surgical anatomy of parotid gland

Answer:

Surgical anatomy of parotid gland

• Parotid gland is present on the lateral aspect of the face
• It is divided by the facial nerve into
  • Superficial lobe- overlies masseter and mandible
  • Deep lobe- present between mastoid process and the styloid process, ramus of the mandible, and the medial pterygoid muscle
• Parotid duct
  • It arises from the superficial lobe
  • It is called Stenson’s duct
  • It is 2-3 mm in diameter
  • It receives tributaries from the superficial, deep, and accessory lobes
  • It passes through the buccinator muscle and opens in the mucosa of the cheek oppposite the upper 2nd molar tooth
• Parotid gland is covered by a
  • True capsule which is a condensation of fibrous stroma of the gland,
  • False capsule
  • Parotid fascia
• Parotid swellings are very painful
• They can be infected by the mumps virus
• Spread of infection from the oral cavity can result in parotid abscess

Question 4. Mucous cyst or mucocele

Answer:

Mucous cyst or mucocele

• It is a swelling caused by the accumulation of saliva at the site of a traumatized or obstructed minor salivary gland duct

Mucous cyst Types:

• Extravasation:
  • It is formed as a result of trauma to a minor salivary gland excretory duct
  • It is more common
  • It does not have an epithelial cyst wall
• Retention:
  • Caused by obstruction by calculus of duct

Mucous cyst Clinical Presentation:

• Site:
  • Extravasation: lower lip more common
  • Other sites involve buccal mucosa, tongue, floor of the mouth, and retromolar area
  • Retention: palate or floor of the mouth
• Appearance:
  • Discrete, painless, smooth-surface swelling
• Size:
  • Ranges from few millimeters to few centimeters
• Colour:
  • Superficial lesions have blue hue
  • Deeper lesions can be more diffuse, covered by normal appearing mucosa without blue colour
• Treatment:
• Surgical excision to prevent recurrence
• Aspiration of fluid does not provide long-term benefit
• Surgical management may cause trauma to adjacent structures and can lead to development of new lesions
• Intralesional injections of corticosteroids

Question 5. Ranula

Answer:

Ranula

• Special type of mucocele
• Resembles the belly of a frog

Site:

• Floor of the mouth
• Superficial or deep to the mylohyoid muscle

Ranula Cause:

• Trauma to duct

Ranula Features:

• Slow-growing unilateral lesion
• Soft and freely movable
• Superficial lesions:
  • Thin-walled bluish lesion
• Deeper lesions:
  • Well circumscribed
  • Covered by normal mucosa

Ranula Types:

• Simple type
• Plunging ranula

Ranula Treatment:

• Marsupialization

Question 6. Adenolymphoma of parotid gland
(or)
Warthin’s tumour

Answer:

Adenolymphoma of parotid gland

• It is located in the inferior pole of the gland, posterior to the angle of mandible

Parotid Gland Presentation:

• SEX: common in males
• AGE: 5th and 8th decade of life
• Presents as a well-defined, slow-growing mass in the tail of parotid
• Painless but can become superinfected n It is smooth with well defined capsule

Parotid Gland  Treatment:

• Easily removed with margin of normal tissue
• Large tumour treated by superficial parotidectomy

Question 7. Xerostomia

Answer:

Xerostomia

• It refers to a subjective sensation of a dry mouth, but not always, associated with salivary hypofunction

etiology:

• Development
  • salivary gland aplasia
• Water or metabolic loss
  • Impaired fluid intake
  • Hemorrhage
  • Vomiting or diarrhea
• Iatrogenic
• Medications
  • Antihistamines
  • Decongestants
  • Antidepressants
  • Antipsychotic
• Radiation therapy
• Systemic diseases
  • Diabetes mellitus
  • Sjogren’s syndrome
  • HIV infections
• Local Factors
  • Decreased mastication
  • Smoking
  • Mouth breathing

Xerostomia Clinical Features:

• Reduction in salivary secretions
• Residual saliva is either foamy or thick
• Mucosa appears dry
• Tongue is fissure
• Difficulty in mastication and swallowing
• Food adheres to the oral membranes
• Increased prevalence of candidiasis
• More prone to dental caries

Xerostomia Treatment:

• Elimination of causative agents
• Avoid medications causing xerostomia
• Use of noncarbonatea sugarless fluids, xylitol-containing gums
• Use of pilocarpine to treat xerostomia

Question 8. Submandibular sialadenitis

Answer:

Submandibular sialadenitis Causes

• Occurs due to
  • Sequele to acute inflammation
  • Intermittent obstruction by calculus
  • Autoimmune disease
  • Bilateral Sjogren’s syndrome

Submandibular sialadenitis Features

• Recurrent attacks of pain and swelling
• Discharge of small amount of pus
• Dilatation of ductules, atrophic acini
• Replacement of gland by chronically inflamed scar tissue
• Unilateral pain and swelling
• Reduced salivary flow

Submandibular sialadenitis Treatment

• Antibiotics to control infection
• Removal of calculus
• Dilatation of constricted ducts
• Duct irrigation
• Radiotherapy
• Total conservative parotidectomy

Question 9. Adenoid cystic carcinoma

Answer:

Adenoid cystic carcinoma

• It is highly malignant tumour of salivary gland

Adenoid cystic carcinoma Clinical features

• Slow growing
• Spreads along perineural tissue
• May invade periosteum or medullary bone
• Bony tenderness occurs
• It is hard and fixed
• Produce anaesthesia of skin overlying the tumour
• Spreads through local infiltration, lymphatics, and blood

Pathology

• Contains cords of dark staining cells with cystic spaces containing mucin
• Contains myoepithelial cells and duct epithelium

Adenoid cystic carcinoma Treatment

• Radical parotidectomy with block dissection of neck
• Palliative radiotherapy to reduce pain and to arrest the progress of the disease

Diseases Of Salivary Glands Short Answers

Question 1. Ranula

Answer:

Ranula

• Special type of mucocele
• Resembles the belly of a frog

Ranula Site:

• Floor of the mouth
• Superficial or deep to mylohyoid muscle

Ranula Cause:

• Trauma to duct

Ranula Features:

• Slow-growing unilateral lesion
• Soft and freely movable
• Superficial lesions:
• Thin walled bluish lesion

Ranula Deeper lesions:

• Well circumscribed
• Covered by normal mucosa

Question 2. Sialogram
(or)
Sialography

Answer:

Sialogram

Used for investigation of sialolith

Sialogram Procedure:

1. Identification of duct
2. Exploring of the duct
3. Introduction of cannula
4. Introduce contrasting media
   • Lipid soluble or
   • Water soluble agents
5. Amount of the agent
   • Submandibular gland: 0.5-0.75 ml
   • Parotid gland- 0.76-1 ml
6. Radiograph is taken
   • Occlusal view
   • AP view

 SialogramInterpretation:

1. Parotid Gland- tree in winter appearance
2. Submandibular gland- Bush in winter appearance
3. Sjogren’s syndrome- Cherry blossom appearance
4. Malignant tumour- Ball holding in hand appearance

Question 3. Acute parotitis
(or)
Parotid abscess

Answer:

Acute parotitis

• It is an acute inflammation of the salivary gland

Etiology:

• It is caused by Staphylococcus aureus
• Factors causing it are:
  • When the salivary flow is reduced
  • Partial obstruction of the duct with retention of secretions

Acute parotitis Clinical Features:

• Pain and swelling of the side involved
• There is brawny oedematous swelling over the parotid region
• The temperature is high
• Cellulitis occurs of the overlying skin
• Pus may come out through the internal opening of the parotid gland

Question 4. Salivary calculus

Answer:

Salivary calculus

• It is a pathological condition characterized by the presence of one or more calcified stones within salivary gland itself or within its duct

Etiology:

• Stagnation of saliva
• Ductal epithelial inflammation and injury
• Biological factors

Pathogenesis:

• Formation of soft nidus of mucin, protein, bacteria, and desquamated cells.
• Allows concentric, lamellar crystallization
• Gradually sialolith increases in size

Composition of Sialolith:

• Calcium phosphate
• Calcium carbonate
• Salts of Mg, Zn, etc
• Glycoproteins
• Mucopolysaccharides
• Cellular debris

Question 5. Mikulicz’s disease

Answer:

Mikulicz’s disease

• It is a benign lesion
• Characterize by symmetric lacrimal, parotid, and submandibular gland swelling with associated lymphocytic infiltration
• It is associated with prominent infiltration of IgG4- positive plasmocytes into the involved gland, so called IgG4-related plasmacytic endocrinopathy

Etiology:

• It is unknown
• Been speculated that autoimmune, viral, or genetic factors are involved

Mikulicz’s disease Presentation:

• Affects middle-aged persons
• Unilateral or bilateral salivary gland swelling
• Reduced salivary flow

Mikulicz’s disease Treatment:

• Methylprednisolone pulse therapy and prednisolone

Question 6. Mixed parotid tumour
(or)
Pleomorphic adenoma

Answer:

Mixed parotid tumour Clinical Features:

• Age: 5th and 6th decade
• Sex: common in females
• Site: common in parotid gland

Mixed parotid tumour Features:

• Slow growing
• Exophytic growth
• Solitary lesion
• Swelling of gland
• Smooth surface of the lesion
• No pain
• Superficial lesions
• Located near the angle of mandible
• Deeper lesions:
• Over the lateral wall of the oropharynx
• Minor gland neoplasms exhibit firm, nodular swelling
• Palatal lesion causes surface ulceration
• In buccal mucosa it is present as small, painless nodular lesion

Question 7. Xerostomia

Answer:

Xerostomia

• It refers to a subjective sensation of a dry mouth, but not always, associated with salivary hypofunction

Xerostomia Clinical Features:

• Reduction in salivary secretions
• Residual saliva is either foamy or thick
• Mucosa appears dry
• Tongue is fissure
• Difficulty in mastication and swallowing
• Food adheres to the oral membranes
• Increased prevalence of candidiasis
• More prone to dental caries

Xerostomia Treatment:

• Elimination of causative agents
• Avoid medications causing xerostomia
• Use of noncarbonated sugarless fluids, xylitol containing gums
• Use of pilocarpine to treat xerostomia

Question 8. Sjogren’s syndrome

Answer:

Sjogren’s syndrome

• It is a chronic autoimmune disease
• Characterize by oral and ocular dryness, exocrine dysfunction, and lymphocytic infiltration

Etiology:

• It is unknown

Sjogren’s syndrome Presentation:

• Decreased salivary function
• Dry mouth
• Difficulty in chewing, swallowing, and speech
• Dry, cracked lips
• Angular chelitis
• Mucosa is painful and sensitive to species
• Mucosa is pale and dry
• Friable or furrowed
• Minimal salivary pooling
• Tongue is smooth and painful
• Increased dental caries and erosion of enamel
• Susceptible to infection
• Increased risk of developing malignant lymphoma
• Hypergammaglobulinemia
• Autoantibodies
• Elevated sedimentation rate
• Decreased WBC
• Monoclonal gammopalhies
• Hypocomplementemia

Question 9. Plunging ranula

Answer:

Plunging ranula

• When the intrabuccal ranula has a cervical prolongation it is called plunging or deep ranula.
• It is derived from the cervical sinus
• It passes beyond the floor of the mouth along the posterior border of the mylohyoid muscle and appears in the submandibular region

Plunging ranula Complications:

• It bursts due to repeated trauma
• Rarely infected
• Causes difficulty in rating and speech

Plunging ranula Differential Diagnosis:

• Sublingual dermoid
• Lipoma
• Submandibular lymph node swelling
• Submandibular salivary gland swelling

Plunging ranula Treatment:

• Complete excision of the ranula

Question 10. Sialadenitis

Answer:

Sialadenitis Causes

• Occurs due to
  • Sequele to acute inflammation
  • Intermittent obstruction by calculus
  • Autoimmune disease
  • Bilateral Sjogren’s syndrome

Sialadenitis Features

• Recurrent attacks of pain anti-swelling
• Discharge of small amount of pus
• Dilatation of ductules, atrophic acini
• Replacement of gland by chronically inflamed scar tissue
• Unilateral pain and swelling
• Reduced salivary flow

Diseases Of Salivary Glands Viva Voce

1. Commonest location of the pleomorphic adenoma in the parotid gland is tail of the gland
2. Superficial parotidectomy is the treatment ot choice for pleomorphic adenoma
3. Adenoid cystic carcinoma is the only tumour that shows a tendency for perineural invasion
4. Tumors of the minor salivary glands are encountered most frequently in the palate
5. Ranula usually arises from glands of Blandin and Nuhn situated on the floor of the mouth