Salivary Gland MCQs | Level II

Lower lip lesions are more likely to be malignant. The most common malignant lesion of the lip is Squamous Cell Carcinoma.

[BW;Damm, N. (2022). Labial salivary gland tumors. Cancer, 61(10)]
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Medications, radiation therapy, and Sjögren syndrome are main causes.

Acute bacterial infection and obstructive infection require immediate care. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)]

Mumps, cytomegalovirus, and Coxsackie are the main viral causes of SGD.

Key Differences:

• Mumps is vaccine-preventable and primarily affects children, causing notable bilateral parotid swelling.
• CMV often presents in immunocompromised individuals or congenitally, with a broader range of systemic effects.
• Coxsackie virus typically causes mild, self-limited illness with occasional salivary gland involvement

The submandibular salivary glands are the most common location for salivary stones, accounting for the majority of cases. Submandibular glands have 84% of stones, parotid 13%.

[S. Kraaij, Karagozoglu, K. H., T. Forouzanfar, Veerman, I., & Brand, H. S. (2014). Salivary stones: symptoms, aetiology, biochemical composition and treatment. BDJ, 217(11), E23–E23. https://doi.org/10.1038/sj.bdj.2014.1054 ]

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Swelling with meals and gradual relief after is characteristic of stones. [Kraaij S et al. "Salivary stones: symptoms, aetiology." Br Dent J (2014)]

The main functions are digestion/taste, moistening/lubrication, buffering/protection, and remineralization.

Neuromuscular dysfunction is the most common cause.

Sialorrhea, or excessive salivation, is most commonly caused by neuromuscular dysfunction, which impairs the ability to control swallowing and saliva clearance. It is frequently associated with neurological conditions such as cerebral palsy, Parkinson's disease, and amyotrophic lateral sclerosis (ALS).

Other causes include medications (e.g., anticholinesterases), infections, or oral irritations. Management focuses on addressing the underlying cause and may include behavioral therapy, medications (e.g., anticholinergics), or interventional procedures such as botulinum toxin injections or salivary gland surgery.

[Lakraj, A., Narges Moghimi, & Jabbari, B. (2013). Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins, 5(5), 1010–1031. https://doi.org/10.3390/toxins5051010 ]

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Viral infections, particularly mumps, are most common in children.

Superficial parotidectomy with facial nerve preservation is primary treatment.

Progressive non-tender, bilateral parotid enlargement with xerostomia and lymphoepithelial cysts.

[Shanti RM, Aziz SR. HIV-associated salivary gland disease. Oral Maxillofac Surg Clin North Am 2009;21:339–43. 10.1016/j.coms.2009.04.002 [DOI] [PubMed] [Google Scholar]]

Pleomorphic adenoma is the most common benign salivary gland tumor.

Mikulicz's disease (MD) and Sjögren's syndrome (SS) are both autoimmune disorders that affect the salivary and lacrimal glands, but they have several differences .

Mikulicz syndrome is characterized by benign, non-specific, bilateral enlargement of the salivary (parotid and submandibular) and lacrimal glands.

There is less secretion depletion in Mikulicz compared to Sjögren. [Lin, P., & Medeiros, L. J. (2020). Benign and Malignant Hematopoietic Diseases of the Head and Neck. Elsevier EBooks, 973–1011. https://doi.org/10.1016/b978-0-323-53114-6.00013-4]

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Serous (parotid) glands are most sensitive to radiation damage.

Jasmer, K. J., Gilman, K. E., Muñoz Forti, K., Weisman, G. A., & Limesand, K. H. (2020). Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions. Journal of Clinical Medicine, 9(12), 4095. https://doi.org/10.3390/jcm9124095

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Ratio ranges from 9:1 to 20:1 female predominance. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)]

Sialadenosis is a non-inflammatory, non-neoplastic enlargement of the salivary glands, most commonly the parotid glands, presenting as bilateral, painless swelling without signs of infection.

It is often associated with systemic conditions such as diabetes, hypothyroidism, and hormonal changes, as well as nutritional disorders like malnutrition, alcoholism, bulimia, and anorexia. Certain medications, including antihypertensives and psychotropics, can also contribute. Management focuses on addressing the underlying cause and providing supportive care.

Other causes of bilateral parotid swelling:

Mumps, a viral infection which primarily affects children and involves the parotid gland, may occur bilaterally (75%) or unilaterally.

Note: This is unlike Bacterial parotitis which tends to occur unilaterally.

HIV-associated: Parotid gland enlargement occurs in individuals with HIV due to lymphoepithelial cysts or lymphadenopathy.

Sarcoidosis: Bilateral swelling with possible systemic symptoms like pulmonary involvement and uveitis.

Malignant lymphoid proliferation can cause parotid gland enlargement as part of systemic disease or localized involvement.

Eveson, J. W., Cawson, R. A., & Lucas, R. B. (2008). Pathology of the salivary glands. In Cawson's Essentials of Oral Pathology and Oral Medicine (8th ed., pp. 276-278). Elsevier

A Gadodia, Bhalla, A. S., Sharma, R., Thakar, A., & R Parshad. (2011). Bilateral parotid swelling: a radiological review. Dentomaxillofacial Radiology, 40(7), 403–414. https://doi.org/10.1259/dmfr/17889378

Organic (collagen, glycoproteins) and inorganic (hydroxyapatite, carbonate) components. [Kraaij S et al. "Salivary stones: symptoms, aetiology." Br Dent J (2014)]

The lower lip is a more likely location for malignant tumors, upper lip for benign. Reminder: Lip malignancies typically present as a non-healing ulcer on the vermillion of the lower lip.

Dental caries, oral candidiasis, and bacterial infections are main complications. [Sjogren Disease. (2019). Retrieved October 30, 2024, from Ada.org website: https://www.ada.org/resources/ada-library/oral-health-topics/sjogren-disease]

Children, adolescents, and debilitated adults are most commonly affected.

[Salivary gland infections: MedlinePlus Medical Encyclopedia. (2021). Retrieved from : Link]‌

Most common on lower lip due to trauma to minor salivary glands.

Lip biopsy showing lymphocytes around salivary glands is diagnostic. [OParke, A. L. (2000). Sjögren’s Syndrome. Elsevier EBooks, 740–752. https://doi.org/10.1016/b978-012288145-9/50066-8]

Rapid growth and pain suggests malignancy vs slow growth for benign.

80% are benign, and 20% are malignant.

[Ogle, O. E. (2019). Salivary Gland Diseases. Dental Clinics of North America, 64(1), 87–104. https://doi.org/10.1016/j.cden.2019.08.007]

85% of Sialoliths occur in the submandibular gland, and the majority arise within Wharton's Duct. The main symptoms are pain and swelling during/around meal time.

Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)

Syed, A. Z. (2024). Soft Tissue Calcifications in the Head and Neck Region. Dental Clinics of North America, 68(2), 375–391. https://doi.org/10.1016/j.cden.2023.10.002

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Staphylococcus aureus is the most common cause.

[Ogle, O. E. (2019). Salivary Gland Diseases. Dental Clinics of North America, 64(1), 87–104. https://doi.org/10.1016/j.cden.2019.08.007]

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Normal daily saliva production is between 0.5-1.5 L.

Iorgulescu, G. (2024). Saliva between normal and pathological. Important factors in determining systemic and oral health. Journal of Medicine and Life, 2(3), 303. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5052503/

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There are between 800-1000 minor salivary glands throughout oral cavity.

Parotid secretes serous, submandibular mixed, and sublingual mucous saliva. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)]

The order is parotid (largest), submandibular (second largest), and sublingual (smallest). [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)]