Salivary Gland - Part 1 1 / 39 Which tumor locations suggest malignancy? Palate only Buccal only Lower lip and ulcers Upper lip only Lower lip lesions are more likely to be malignant. [BW;Damm, N. (2022). Labial salivary gland tumors. Cancer, 61(10). https://doi.org/10.1002/1097-0142(19880515)61:10<2113::aid-cncr2820611030>3.0.co;2-b] Its important to note that the most common malignant lesion of the lip is Squamous Cell Carcinoma. 2 / 39 What are the three main xerostomia causes? Medications, radiation, Sjögren Only age Only disease Only medications Medications, radiation therapy, and Sjögren syndrome are main causes. 3 / 39 Which conditions require emergency care? Mild pain Chronic swelling Acute infection Xerostomia Acute bacterial infection and obstructive infection require immediate care. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 4 / 39 What are the three main imaging types for stones? X-ray, CT, ultrasound Only MRI MRI only Only sialography Conventional radiography, CT, and ultrasound are main imaging options. [Rastogi R et al. "Pictorial essay: salivary gland imaging."] 5 / 39 What are the three main viral causes of sialadenitis? Only mumps Mumps and EBV Herpes, CMV, EBV Mumps, CMV, Coxsackie Mumps, cytomegalovirus, and Coxsackie are main viral causes. [Jothi S. "Salivary gland infection." (2015)] 6 / 39 Which glands have the most stones? Equal distribution Parotid mainly Submandibular Minor glands Submandibular glands have 84% of stones, parotid 13%.[ Gargi Jadaun, Pillai, D., Tejal Ragji, & Saeeda Kharodia. (2023). Sialolithiasis: An Unusually Large Submandibular Salivary Stone. Cureus. https://doi.org/10.7759/cureus.41859] 7 / 39 Which symptom pattern suggests sialolithiasis? Meal-time swelling Night pain Morning swelling Constant pain Swelling with meals and gradual relief after is characteristic of stones. [Kraaij S et al. "Salivary stones: symptoms, aetiology." Br Dent J (2014)] 8 / 39 What are the 4 main categories of salivary disease? Inflammatory, obstructive, systemic, neoplastic Only benign vs malignant Only infections Only acute vs chronic Main categories are inflammatory, obstructive, systemic diseases, and neoplasms. 9 / 39 What are the 4 main functions of saliva? Only digestion and protection Only cleaning Digestion, moisture, buffering, remineralization Only lubrication The main functions are digestion/taste, moistening/lubrication, buffering/protection, and remineralization. 10 / 39 What is the main cause of sialorrhea? Infection Medication Tumors Neuromuscular dysfunction Neuromuscular dysfunction is the most common cause. [HOCKSTEIN, N. G., SAMADI, D. S., GENDRON, K., & HANDLER, S. D. (2004). Sialorrhea: A Management Challenge. American Family Physician, 69(11), 2628–2635. Retrieved from https://www.aafp.org/pubs/afp/issues/2004/0601/p2628.html ] 11 / 39 Which Salivary Gland condition most commonly affects children? Viral infections Stones Cysts Tumors Viral infections, particularly mumps, most common in children. [Iro H et al. "Salivary gland diseases in children."] 12 / 39 What is the primary treatment for parotid tumors? Medication only Radiation only Superficial parotidectomy Observation Superficial parotidectomy with facial nerve preservation is primary treatment. 13 / 39 When is sialography contraindicated? Acute conditions Tumors Chronic cases Stones Contraindicated in acute conditions due to risks with contrast medium. [Rastogi R et al. "Pictorial essay: salivary gland imaging."] 14 / 39 What characterizes HIV-associated salivary disease? Bilateral enlargement with cysts Acute pain Unilateral swelling Fever only Progressive bilateral parotid enlargement with xerostomia and lymphoepithelial cysts. [Shanti RM et al. "HIV-associated salivary gland disease."] 15 / 39 What is the most common benign tumor? Pleomorphic adenoma Monomorphic adenoma Warthin tumor Oncocytoma Pleomorphic adenoma is the most common benign tumor. 16 / 39 What distinguishes Mikulicz from Sjögren syndrome? Secretion levels Location Age of onset Gender ratio 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 . 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] 17 / 39 Which gland type is most sensitive to radiation? Mixed Minor Mucous Serous Serous (parotid) glands are most sensitive to radiation damage. [Dreyer JO et al. "Radiation-induced sialadenitis." Pathologe (1989)] 18 / 39 What is the female:male ratio in Sjögren syndrome? 9:1-20:1 5:1 1:1 3:1 Ratio ranges from 9:1 to 20:1 female predominance. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 19 / 39 Which condition typically presents with bilateral parotid swelling? Stones Sialadenosis Tumors Infection Sialadenosis typically presents with bilateral painless parotid enlargement.(Gadodia, Bhalla, Sharma, Thakar, & Parshad, 2011) 20 / 39 What are the primary components of salivary stones? Only calcium Organic and inorganic mix Only minerals Only proteins Organic (collagen, glycoproteins) and inorganic (hydroxyapatite, carbonate) components. [Kraaij S et al. "Salivary stones: symptoms, aetiology." Br Dent J (2014)] 21 / 39 Which lip is more likely to have malignant tumors? Both equally Upper lip Neither Lower lip Lower lip more likely for malignant tumors, upper lip for benign. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 22 / 39 What are the three main complications of xerostomia? Caries, candidiasis, infection Pain, swelling, fever Bleeding, pain, swelling Taste loss, speech, swelling 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] 23 / 39 Which population is most affected by viral sialadenitis? Pregnant women Children and adolescents Middle-aged adults Elderly only Children, adolescents, and debilitated adults are most commonly affected. [Jothi S. "Salivary gland infection." (2015)] 24 / 39 What is the key difference between oral and plunging ranulas? Size Pain Location relative to mylohyoid Color Plunging ranulas descend below mylohyoid muscle into neck, while oral remain in floor of mouth. A simple ranula causes swelling limited to the floor of the mouth. A plunging ranula exhibits a swelling that grows down into your neck. 25 / 39 Where do mucoceles most commonly occur? Upper lip Lower lip Palate Floor of mouth Most common on lower lip due to trauma to minor salivary glands. 26 / 39 What is the diagnostic gold standard for Sjögren's syndrome? Imaging Lip biopsy Symptoms Blood test 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] 27 / 39 What is the primary distinguishing feature of malignant tumors? Location Size only Color Rapid growth and pain Rapid growth and pain suggests malignancy vs slow growth for benign. 28 / 39 What is the most common location for intraoral tumors? Buccal mucosa Floor of mouth Tongue Palate Palate is most common site for intraoral salivary tumors. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 29 / 39 Which gland is most commonly affected by tumors? Sublingual Submandibular Minor glands Parotid 80% of major salivary gland tumors occur in parotid. [Zaid Al-Qurayshi, Peterson, J. D., & Hoffman, H. T. (2020). Buccal Space Tumors. Elsevier EBooks, 274–278. https://doi.org/10.1016/b978-0-323-67236-8.00043-2] 30 / 39 What percentage of salivary tumors are benign vs malignant? 80/20 60/40 50/50 70/30 80% are benign, 20% are malignant. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 31 / 39 What is the main cause of xerostomia in dental patients? Medications Age Disease Dehydration Medications are the most common cause, followed by radiation and Sjögren's. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 32 / 39 What percentage of salivary stones occur in submandibular gland? 60% 84% 25% 50% 84% occur in submandibular gland. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 33 / 39 What is the most common bacterial pathogen in sialadenitis? Streptococcus E. coli Pseudomonas Staphylococcus aureus Staphylococcus aureus is the most common cause. [Jothi S. "Salivary gland infection." (2015)] 34 / 39 Which imaging modality is best for tumor evaluation? Sialography Ultrasound CT scan MRI MRI is best for tumors due to soft tissue contrast. [Rastogi R et al. "Pictorial essay: salivary gland imaging." Indian J Radiol Imaging (2012)] 35 / 39 Which approach is the first step in diagnosis of SGD? Imaging Blood tests History taking Biopsy A careful history is the first step, before physical exam and imaging. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 36 / 39 What is the daily saliva production range? 1.5-2.0 L 0.5-1.5 L 0.3-0.5 L 0.1-0.3 L Normal daily production is between 0.5-1.5 L. 37 / 39 What is the approximate number of minor salivary glands? 400-600 600-800 800-1000 1000-1200 There are between 800-1000 minor salivary glands throughout oral cavity. 38 / 39 Which type of saliva secretion is correct for each gland -Parotid, submandibular and sublingual? All serous Serous, mucous, mucous All mixed Serous, mixed, mucous Parotid secretes serous, submandibular mixed, and sublingual mucous saliva. [Ogle OE. "Salivary Gland Diseases." Dent Clin North Am (2020)] 39 / 39 What is the correct order of salivary glands from largest to smallest? Sublingual, parotid, submandibular Parotid, sublingual, submandibular Parotid, submandibular, sublingual Submandibular, parotid, sublingual The order is parotid (largest), submandibular (second largest), and sublingual (smallest). [Ogle OE. "Salivary Gland Diseases." 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