Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Salivary glands pathology. Acute and chronic sialodenitis: etiology, classification, clinic, diagnosis, prevention. Treatment, prevention of complications. Salivastone disease: etiology, pathogenesis, clinical features, differential diagnosis, treatment, complications and their prevention. Mucocele VS Mucus Retention Cyst VS Salivary Duct Cyst Mucocele: Prognosis and Significance The prognosis is excellent, although occasional mucoceles will recur, necessitating re-excision, especially if the feeding glands are not removed. Ranula: Clinical Features A ranula is the term used for mucoceles that occur in the floor of the mouth. The term ranula is derived from the Latin word for frog. They appear as dome-shaped, fluctuant swellings unless they are deep in the tissue. Typically, they are lateral to the midline. “Plunging” or cervical ranulas dissect through the myohyoid muscle to produce swelling in the neck. Sialolithiasis: Clinical Features Salivary gland stones occur most often in the submandibular gland ducts but they may also occur in the minor glands particularly of the upper lip and buccal mucosa. Young and middle-aged adults are most frequently affected. Patients frequently present with episodic pain and swelling particularly around mealtime. Sialolithiasis: Clinical Features Stones in the terminal ducts can usually be palpated. If the sialolith is well calcified, it may appear on radiograph as a radipaque mass. Minor gland stones are often asymptomatic. Sialolithiasis: Cause, Treatment and Significance Deposition of calcium salts around a nidus of debris in the duct lumen occurs but the exact cause of this is unknown. The blockage of the duct and resultant inflammation can cause significant damage to the gland. Small sialoliths can sometimes be removed by gentle message, sialagogues, moist heat, or increased fluid intake. Larger stones are removed surgically. Stones in minor glands/ducts are best treated by surgical removal including the associated gland. Sialadenitis Inflammation of the salivary glands can arise from various infectious and non-infectious causes. The most common viral infection is mumps. Most bacterial infections arise as a result of ductal obstruction or decreased salivary flow. One of the more common causes of sialadenitis is recent surgery. Sialadenitis: Clinical Features Acute bacterial sialadenitis is most common in the parotid where it produces a painful swelling. The overlying skin may be erythematous and the patient may have low-grade fever, trismus and purulent discharge. Chronic sialadenitis is associated with periodic swelling and pain. Subacute necrotizing sialadenitis is more common in young (males?) adults. The lesion usually involves the minor glands of the hard or soft palate. It appears as a painful nodule, which does not ulcerate or slough like necrotizing sialometaplasia. Sialadenitis: Cause The inflammation of the glands can arise for various causes as noted previously. While mumps is the most common viral cause, other viruses such as Coxsackie A, ECHO, choriomeningitis, parainfluenza and cytomegalovirus may be the cause. The most common cause of acute bacterial sialadenitis is Staphylococcus aureus but streptococci and a host of other bacteria have been implicated at different times. Medications that can induce xerostomia can predispose the patient to infection. Non-infectious causes include Sjögren syndrome, radiation therapy, sarcoidosis and some allergens. Sialadenitis: Treatment, Prognosis and Significance Acute sialadenitis is treated by antibiotic therapy and rehydration to stimulate salivary flow. Surgical drainage may be required if abscesses occur. Management of chronic sialadenitis depends upon the severity and duration of the condition. Subacute necrotizing sialadenitis is self-limiting and usually resolves in 2 weeks. Significant inflammatory destruction of the salivary gland can occur requiring its surgical removal. Xerostomia: Clinical Features Xerostomia, dry mouth, is more common in females and the elderly. With decreased salivary flow, the saliva becomes foamy or thick and “ropey”. There is a lack of polling of saliva in the floor or the mouth and the mucosa appears dry. The dorsal tongue is often fissured with atrophy of the filiform papilla. Sjögren Syndrome: Clinical Features Sjögren syndrome is a chronic, systemic autoimmune disorder that principally involves the salivary and lacrimal glands. It predominantly affects middle-aged and older adults with 80-90 % of them being women. The principal oral symptom is xerostomia. A third to a half of all patients have diffuse, firm enlargement of the major salivary glands, usually bilaterally. Sialadenosis (Sialosis): Clinical Features Sialadenosis is a non-inflammatory disorder characterized by salivary gland enlargement, most common of the parotid. Most cases present as a slowly developing, painless swelling of the parotids. Most cases present with bilateral involvement. Decreased salivary secretion may occur. Sialography demonstrates a “leafless tree” pattern. Salivary Gland Tumors Pleomorphic Adenoma (Benign Mixed Tumor): Introduction This tumor is easily the most common salivary neoplasm. Pleomorphic adenomas are derived from a mixture of ductal and myoepithelial elements. This mixture gives rise to a remarkable diversity of microscopic appearances both among different pleomorphic adenomas and within any one tumor. Pleomorphic Adenoma (Benign Mixed Tumor): Introduction Neither the term pleomorphic nor mixed are entirely accurate in describing this neoplasm. The basic pattern of the neoplasm is highly variable but rarely are individual cells actually pleomorphic. Pleomorphic Adenoma (Benign Mixed Tumor): Introduction Although the tumor often has prominent mesenchymal appearing “stroma”, it is not truly a mixed neoplasm that is derived from more than one germ layer. These “stromal” changes are believed to be produced by the myoepithelial cells. Occasionally, salivary tumors are seen that are composed almost entirely of myoepithelial cells with no ductal elements. These tumors are called myoepitheliomas. Pleomorphic Adenoma: Clinical Features As indicated, this lesion is the most common salivary gland neoplasm representing from 53-77% of all parotid tumors, 44-68 % of submandibular tumors and from 38-43 % of all minor gland tumors. Benign mixed tumors are most commonly diagnosed between the ages of 30-50 years and there is a slight female gender predilection. They typically appear as slow growing, painless masses. Pleomorphic Adenoma: Clinical Features In the parotid, they occur more commonly in the superficial lobe and initially the lesion is movable. Intraorally, they are most common in the palate (posterior-lateral) followed by the upper lip and buccal mucosa. The intraoral lesion is typically smooth-surfaced, domeshaped and non-ulcerated (if traumatized the pleomorphic adenoma can be ulcerated). In the hard palate, pleomorphic adenomas will be nonmobile due to the mucosa being tightly bound to the underlying bone. Pleomorphic Adenoma: Cause, Treatment, Prognosis & Significance The cause of this tumor is unknown. Pleomorphic adenomas are best treated by surgical excision. With adequate surgery, there is a 95 % cure rate. With inadequate surgery, multifocal seeding occurs. In such cases multiple recurrences are not unusual. Malignant transformation is a potential complication but the rate is < 5 % of all cases. Transformation typically occurs many years (10-15) after the tumor is originally recognized. Warthin Tumor: Cause, Treatment, Prognosis and Significance The cause is unknown. Some authors have suggested it results from heterotopic salivary gland tissue occurring within the parotid lymph nodal tissue. Smokers are said to have an eightfold greater risk than non-smokers. Treatment consists of surgical removal and there is a 612 % recurrence rate. Since some tumors are multicentric in nature, is it a recurrence or a proliferation of another nodule. Malignant Warthin tumors do occur but these are exceedingly rare. Polymorphous Low-Grade Adenocarcinoma: Clinical Features This malignant salivary gland neoplasm occurs almost exclusively in the minor salivary glands, where it is one of the more common malignancies. Sixty percent of the cases occur on the hard or soft palates following in frequency by the upper lip and buccal mucosa. Most commonly occurs in older adults (6-8th decades) and there is a female gender predilection ( two thirds of cases). Most commonly presents as a slow-growing mass occasionally accompanied by bleeding or discomfort. Polymorphous Low-Grade Adenocarcinoma:Cause & Treatment The cause of this tumor is unknown. Treatment consists of wide surgical excision sometimes including resection of the underlying bone. It is a low-grade malignancy which uncommonly metastizes. Radical neck surgery is usually unwarranted. Polymorphous Low-Grade Adenocarcinoma: Prognosis Eighty percent of the patients are tumor free after treatment and most of the rest are controlled with reexcision. Death due to the tumor is rare. Perineural invasion, like adenoid cystic carcinoma, occurs frequently and does not appear to affect prognosis if it occurs. This tumor must be differentiated from adenoid cystic carcinoma. The histopathology of this tumor is deceptively uniform and can be mistaken for a benign lesion. THANK YOU FOR ATTENTION