Salivary Glands Short Question and Answers

Oral Medicine Salivary Glands Short Essays

Question 1. Sialolith.
(or)
Clinical features and Investigations of submandibular sialolithiasis.

Answer:

Sialolith

• Sialoliths are calcified organic matter that forms within the secretory system of the major salivary glands

Sialolith Etiology:

• It is unknown
• Several factors like:
  • Inflammation,
  • Irregularities in the duct system
  • Local irritants and anti-cholinergic medication
• May contribute to stone formation

Sialolith Composition:

• Hydroxyapatite
• Calcium phosphate and carbon
• A trace amount of magnesium, potassium chloride, and ammonium

Salivary Glands Diagnosis:

• Occlusal radiograph for submandibular gland
• AP view of face for parotid
• CT images have 10 folds with greater sensitivity for detect¬ing
• calcification
• FNAC is used when differential diagnosis includes: a cyst or tumor
• Sialoendoscopy:
  • It is a relatively new technique
  • Small probe(<l mm diameter) attached to a specially designed endoscopic unit can explore the primary and sec¬ondary ductal system
  • The unit has a surgical tip to obtain soft tissue biopsy and help to remove calcified material

Sialolith Occurrence:

• Submandibular gland(80-90%): Because
  • The torturous course of Wharton’s duct
  • Higher calcium and phosphate level
  • Position of gland
• Parotid (5-15%)
• Sublingual(2-5%)

Salivary Glands Clinical Presentation:

• Acute, painful, and intermittent swelling
• Eating initiates salivary gland swelling
• Stone totally or partially blocks the flow of saliva, causing salivary pooling within the ductal system
• There is little space for expansion, so enlargement causes pain
• Stasis of saliva may lead to infection, fibrosis, and gland atrophy
• Fistula, sinus tract or ulceration may occur over the stone in chronic cases
• The soft tissue surrounding the duct may show edema and inflammation

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Sialolith Complications:

• Suppurative or non-suppurative retrograde bacterial infection can occur
• Acute sialadenitis
• Ductal stricture
• Ductal dilatation

Differential Diagnosis Of Sialolithiasis:

• Gas bubbles:
  • Introduced during sialography
• Hyoid bone:
  • Seen bilaterally on panoramic film
• Myositis ossificans:
  • Restriction of mandibular movements occurs

Sialolith Treatment:

• Acute phase:
  • Supportive treatment: it includes analgesic, antibiotics, hydration, and antipyretic
• In exacerbation:
  • Surgical interventiondrainage or removal of stone
  • Stones at or near the duct are removed transorally by milking the gland
  • Deeper stones are removed by surgery or sailoendoscope
• Smaller stones are removed by gently massaging the gland
• Sialogogues, moist heat, and increased fluid intake may also promote the passage of stone
• Large sialolith are surgically removed
• Ultrasonography – it will detect stones of diameter >2 mm
• Lithotripsy – it will fragment the stone

Question 2. Mumps.

Answer:

Mumps

• It is an acute viral infection caused by RNA paramyxovirus
• It is transmitted by direct contact with salivary droplets
• Prevention:
• By MMR (measles, mumps, rubella) vaccination
• It is not recommended for severely immunocompromised children as the protective immune response does not develop and may lead to complications

Mumps Presentation:

• Age: 4-6 years
• Incubation period: 23 weeks
• Followed by salivary gland inflammation and enlargement
• Preauricular pain
• Fever
• Malaise
• Headache
• Myalgia
• Edema of the surrounding skin
• Ducts become inflamed but without purulent discharge
• Swelling is usually bilateral and lasts for approx. 7 days

Mumps Complications:

• Mild meningitis and encephalitis
• Deafness
• Myocarditis
• Thyroiditis
• Pancreatitis
• Oophoritis
• In males, epididymitis, and orchitis result in testicular atrophy and infertility

Mumps Diagnosis:

• Demonstration of antibodies against mumps S and V an¬tigens and to the hemagglutination antigen
• An oral fluid assay using a mumps-specific IgM capture enzyme immunoassay has demonstrated good sensitiv¬ity and specificity.
• A salivary test using reverse transcriptase PCR and loop-mediated isothermal gene amplification may help in the calculation of viral loads

Mumps Treatment:

• Symptomatic treatment done

Question 3. Pleomorphic adenoma of the palate.

Answer:

Pleomorphic adenoma of the palate

• It is the most common tumour
• It is a mixed tumour as it contains a both epithelial and mesenchymal component
• The majority found in the parotid, then in the submandibular, sub-lingual, and minor salivary gland

Pleomorphic adenoma of the palate Presentation:

• Palatal tumours almost always are found on the poste¬rior lateral aspect of the palate as smooth-surfaced, dome-shaped masses
• Because of the tightly bound nature of the hard palate, it is immovable

Pleomorphic adenoma Differential Diagnosis:

• Other parotid masses
• If calcification occurs in MRI, it is pleomorphic

Pleomorphic adenoma of the palate Treatment:

• Surgical removal
  • Wide resection to avoid recurrence
• Local enucleation is avoided because the entire tumor may not be removed or the capsule may be violated, resulting in the seeding of the tumour bed
• Tumours of the hard palate usually are excised down to the periosteum, including the overlying mucosa

Question 4. Xerostomia

Answer:

Xerostomia

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

Xerostomia Etiology:

1. Developmental:

• Salivary gland aplasia

2. Water/ metabolic loss:

• Impaired fluid intake
• Hemorrhage
• Vomiting/diarrhea

3. Iatrogenic:

• Medications
• Antihistamines: diphenhydramine
• Decongestants: pseudoephedrine
• Antidepressants: amitriptyline
• Antipsychotic: haloperidol
• Antihypertensive: methyldopa, CCB
• Anticholinergic: atropine

4. Radiation therapy of head and neck:

• Both stimulated and unstimulated salivary flow de-creases with increasing radiotherapy.
  • Systemic Diseases:
    • Sjogren’s syndrome
    • Diabetes mellitus
    • Diabetes insipidus
    • HIV infections
    • Psychological disorders
    • Graft-versus-host disease

5. Xerostomia Local factors:

• Decreased mastication
• Smoking
• Mouth breathing

Xerostomia Clinical Features:

• Reduction in salivary secretion
• Residual saliva is either foamy or thick
• Mucosa appears dry
• The dorsal tongue is fissured with atrophy of filiform pa¬pilla
• Difficulty in mastication and swallowing
• Food adheres to the oral membranes while eating
• Some patients who complaints of dry mouth may appear to have adequate salivary flow
• The degree of saliva production can be assessed by measuring resting and stimulated saliva
• Increased prevalence of candidiasis because of reduction in cleansing and antimicrobial activity
• More prone to dental decay, especially cervical and root caries

Xerostomia Treatment:

• Artificial saliva may help the patient
• Sugarless candy can stimulate salivary flow
• Use of oral hygiene products like Biotene toothpaste, oral balance gel
• If dryness is secondary to medications, discontinue it or reduce its dose
• Systemic pilocarpine is used:
  • It is a parasympathomimetic agonist
  • Doses: 5-10 mg, 3-4 times a day
  • ADR: excessive sweating,
  • Increased heart rate and BP ^ Cevimeline hydrochloride
  • Acetylcholine derivative
  • Approved by U.S. Food and Drug Administration
  • Both these drugs are contraindicated in narrow-angle glaucoma
• To prevent dental decay, office, and daily home fluoride application
• Chlorhexidine mouthwash minimize plaque buildup
• Local stimulation of saliva
• Chewing gums, mints, paraffin, and citric acid

Question 5. Sialometaplasia.

Answer:

Sialometaplasia Description:

• It is a benign, self-limiting, reactive inflammatory dis-order of salivary tissue

Sialometaplasia Etiology:

• Unknown
• It may represent a local ischemic event
• Infectious process or
• Immune response to an unknown antigen

Sialometaplasia Presentation:

• Site:
  • Common on palate
  • Other include anywhere in the salivary gland tissue including lips, retromolar region
• Initially, lesion is present as a tender erythematous nodule
• Once the mucosa breaks, deep ulceration with yellowish base forms
• The lesion can be large and deep
• The lesion can occur shortly after oral surgical procedure, restorative dentistry or administration of LA

Sialometaplasia Diagnosis:

• Adequate biopsy
• Histopathologic diagnosis
• Complete clinical history

Sialometaplasia Treatment:

• Self-limiting condition
• Healing by secondary intention occurs in approx. 6 weeks
• Debridement and saline rinses may help the healing process

Oral Medicine Salivary Glands Short Answers

Question 1. Causes of Sialorrhea.

Answer:

Causes of Sialorrhea

• Sialorrhea Drugs
  • Lithium
  • Cholinergic agonists
• Sialorrhea Local factors
  • Stomatitis
  • AUG
  • Erythema multiforme
• Sialorrhea Systemic diseases
• Paralysis
• Alcoholic neuritis
• Parkinson’s disease
• Epilepsy
• Down’s syndrome
• Protective buffering system
  • Miscellaneous
  • Psychic factor
  • Metal poisoning
  • Facial paralysis

Question 2. Sialosis.

Answer:

• Sialosis Synonym: sialadenosis
• It is a rare chronic inflammatory disease of the sub-mandibular salivary gland

Sialosis Presentation:

• Enlarged, firm and painful unilateral or bilateral salivary gland

Sialosis Treatment:

• No treatment is generally required
• Elimination of causative agent
• In some cases, surgical excision of the gland is required

Question 3. Why is sialolith common in the submandibular gland.

Answer:

• Sialolith is common in the submandibular gland due to
  • The torturous course of Wharton’s duct
  • Higher calcium and phosphate level e Position of the gland

Question 4. Mucocele.

Answer:

Mucocele Description:

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

Mucocele Types:

1. Extravasation:

• It is formed as a result of trauma to a minor sali¬vary gland excretory duct
• It is more common
• It does not have an epithelial cyst wall

2. Retention:

• Caused by obstruction by the calculus of duct

Mucocele Clinical Presentation:

• Site:
• Extravasation: lower lip is more common
• Other sites involve buccal mucosa, the tongue, the floor of the mouth, and the retromolar area
• Retention: palate or floor of the mouth
• Appearance:
  • Discrete, painless, smooth-surface swelling
• Size:
  • Ranges from a few millimeters to a few centimeters
• Color:
  • Superficial lesions have a blue hue
  • Deeper lesions can be more diffuse, covered by nor¬mal appearing mucosa without blue color

Mucocele Treatment:

• Surgical excision to prevent a recurrence
• Aspiration of fluid does not provide long-term benefit
• Surgical management may cause trauma to adjacent structures and can lead to the development of new lesions
• Intralesional injections of corticosteroids.

Question 5. Ranula

Answer:

Ranula

• A special type of mucocele
• Resembles the belly of a frog

Ranula Site:

• The 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:

1. Simple type
2. Plunging ranula

Ranula Treatment:

• Marsupialization

Oral Medicine Salivary Glands Viva Voce

1. Sialolith are common in submandibular glands
2. Mucous extravasation cysts are usually found on the lower lip
3. Sialoadenosis is noninflammatory disease
4. Salt and pepper appearance is seen in Sjogren’s syndrome
5. Pleomorphic adenoma is the most common parotid gland tumour
6. Sjogren’s syndrome shows cherry blossom appearance in sialography
7. In MRI, Sjogren’s syndrome shows salt and pepper appearance
8. The schimmer test is used for Sjogren’s syndrome