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Oral Pathology - 09 - Salivary Gland Reactive Diseases

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Oral Pathology1

Table Of Contents

Developmental and Mucosal Conditions2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant

Connective Tissue and Salivary Gland Diseases

  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant

Neoplasms, Cysts, and Bone Lesions

  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Salivary Gland Diseases

Overview

Salivary gland diseases impact the submucosa and can affect both major and minor salivary glands. These conditions are often reactive, influenced by factors such as trauma, infection, metabolic changes, and immunologic dysfunction.

Clinical Presentations of Mucous Accumulation3

Reactive Salivary Gland Lesions

  • Reactive lesions are a miscellaneous category of conditions resulting from external influences on the salivary glands.

  • Mucocele: Common lesion typically located in the lower lip.

  • Ranula: A term used when this type of lesion occurs specifically on the floor of the mouth.

    • Mucus Extravasation Phenomenon: This occurs when mucus leaks out into the surrounding tissue, typically caused by trauma to the salivary duct.
    • Mucocele: Often appears as a bluish, translucent swelling.
    • Ranula: The name is derived from "frog's belly" due to its large clinical appearance.
    • Treatment: Requires complete excision of the entire affected minor or accessory salivary gland to prevent a high chance of recurrence.

Salivary Retention Phenomena

Pathophysiology and Histology4

  • This condition is histologically characterized as a true cyst lined by epithelium.
  • It is caused by the blockage of a salivary duct, often due to a sialolith.
    • Mucus Retention Cyst: While sometimes used interchangeably with extravasation phenomena, it is histologically distinct.
    • Cause: Typically caused by a blockage of the salivary duct by a sialolith (a calcified mass) rather than direct trauma.

Ischemic And Inflammatory Conditions

Necrotizing Sialometaplasia5

  • Clinical Presentation: A rapidly expanding ulcerative lesion.
  • Etiology: Usually results from ischemic necrosis of minor salivary glands, often in response to trauma or local anesthesia.
    • Triggers: Often occurs following a greater palatine block.
  • Treatment: Typically heals spontaneously within 6–10 weeks.
    • Management: Treatment is palliative to manage symptoms.

Sinus And Antral Conditions

Antral Pseudocyst Characteristics6

  • Also known as an antral pseudocyst.
  • Etiology: Caused by the blockage of glands within the sinus mucosa.
  • Treatment: No treatment is required.
    • Clinical/Radiographic Presentation: It cannot be seen clinically but appears radiographically as a radiopaque, dome-shaped lesion on the floor of the sinus.
    • Sinus Mucocele: Caused by trauma or blockage of the ostium (the opening draining the maxillary sinus into the nasal cavity). Unlike the retention cyst, it tends to expand gradually and can be more aggressive.

Systemic And Immunologic Diseases

Clinical Features of Sarcoidosis7

  • Pathology: A hyperimmune condition characterized by the formation of granulomas.
  • Etiology: May be triggered by mycobacteria.
  • Manifestations: Primarily a pulmonary disease, but it also affects salivary glands and oral mucosa, leading to xerostomia
    • Xerostomia in sarcoidosis significantly increases the risk of dental caries.

Associated Syndromes

  • Lofgren’s Syndrome: Characterized by erythema nodosum, bilateral hilar lymphadenopathy, and arthritis
    • Bilateral hilar lymphadenopathy is specifically associated with the lungs.
  • Heerfordt Syndrome (Uveoparotid Fever): Characterized by anterior uveitis, parotid gland enlargement, facial nerve palsy, and fever.

Management

  • Treatment: Corticosteroids
    • Corticosteroids are used as an anti-inflammatory to calm the overactive immune response.

Autoimmune Salivary Conditions

Sjogren’s Syndrome Overview8

  • Pathophysiology: An autoimmune, lymphocyte-mediated condition.
  • Target Organs: Affects the salivary and lacrimal (tear) glands.

Classifications

  1. Primary: Consists of keratoconjunctivitis sicca (dry eyes) and xerostomia (dry mouth).
  2. Secondary: Includes the primary symptoms plus another autoimmune disease, most commonly Rheumatoid Arthritis (RA
    • Rheumatoid Arthritis (RA) may also involve the TMJ.).

Management

  • Treatment: Symptomatic care
    • Patients have a high caries risk due to chronic xerostomia.

Footnotes

  1. Original PDF page 1: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.6 ↩

  7. Original PDF page 7: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.7 ↩

  8. Original PDF page 8: Oral Pathology - 09 - Salivary Gland Reactive Diseases, p.8 ↩

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