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Non-Neoplastic Salivary Pathology (Mucocele (Rupture of the salivary gland…
Non-Neoplastic Salivary Pathology
Mucocele
Rupture of the salivary gland duct & spillage of mucin into surrounding tissues
Clinically
If FOM/Lower lip --> ranula
If Upper lip --> consider neoplasm
Dome-shaped swelling, bluish colour, fluctuant (pearls)
Histology
Pseudo lining w/ granulation tissues
inflammatory infiltrate
central lumen w/ muncinophages and mucin spills
Mucous Retention cyst
True epithelium lined cavity, arising from salivary gland tissues, arising from dilation or distention of duct
Clinically
Dome-shaped swelling, bluish colour
Mainly parotid, also FOM, buccal & lips
Histology
Lined mainly by cuboidal or columnar epithelium similar to ductal lining
inflammatory infiltrate
central lumen w/ muncinophages and mucin spills
Sialolithiasis
Calcified material in the ductal lumen
"salivary stone"
, due to Inspissitated mucin, bacterial, epithelial cells, foreign materials ect
Histology
Concentric rings due to deposition of calcified materials
Clinically
Rx = Large multilocular radioopacity
More common in submandibular due to a tortuous path and thicker mucous
Sialadentitis
Inflammation of the salivary gland
Viral Sialadentitis
Causes
: Mumps (paramyxovirus)
Feats:
Headache, fever, malaise, abdominal pain
Tender Swelling of 1 (25%) or both parotid without trismus
Clinical diagnosis
: with +/2 mump IgG/IgM vaccination
Bacterial Sialadenitis
Acute Sialadentitis
Cause: ductal obstruction/ decreased salivary flow, allowing retrograde spread of bacteria
Feats:
Partoid swelling, trismus,
Low grade fever, purlent discharge
Tx: antibiotics/analgesics
address predisposing factor
Chronic Sialadentitis
Signs and Symptoms
similar to actue sialadentitis
Dx
= Sialography- sialectasia proximal to obstruction
Tx: antibiotics/analgesics
address predisposing factors
Sjogren's Syndrome
Chronic systemic autoimmune disorder that principally involves the exocrine glands (salivary/lacrimal)
Clinical Triad
Associated autoimmune disease (RA, SLE)
Keratoconjunctivitis (Ocular)
Xerostomia (Oral)
Primary Presentation (Sicca Syndrome)
= Keratoconjunctivitis + xerostomia
Secondary Presentation
= Sicca syndrome + another associated autoimmune disease
Symptoms:
Reduced saliva
Mouth soreness
Difficulty chewing/swallowing
Abnormal taste
Diagnosis
Parotid flow rate
Labial salivary gland biopsy
Sialography
Haematological investigations = ESR, RF, ANA
Management
Exclude candida infection
Encourage oral hygiene
Fluoride + Mouthwashes
Salivary stimulants + Salivary replacements
Xerostomia
The clinical presentation of dry mouth, i.e reduced salivary flow rate
Factors affecting the autonomic pathway
= Infection, surgery, tumors, drugs
Factors affecting the salivary gland function
= Aplasia, Sjogren's Syndrome, obstruction, infection, irradiation, excision