Salivary Gland Diseases Question And Answers

Salivary Gland Diseases Essay Questions

Question 1. Classify salivary gland diseases.
Answer: Salivary glands are affected by a range of diseases and disorders and are broadly classified as follows:

1. Congenital disorders:

• Aplasia/agenesis—Uni- or bilateral miss¬ing of one or more types of major salivary glands.
• Aberrancy—Salivary glands that develop in uncommon sites.
• Atresia—Absence of one or more major salivary gland ducts.
• Accessory ducts—Presence of additional ducts.
• Diverticuli—Small pouches from the wall of the major salivary gland duct. It causes the pooling of saliva and recurrent sialadenitis.

Read And Learn More: Oral Medicine and Radiology Question And Answers

2. Developmental disorders:

• Hyperplasia—Increase in size of the gland due to endocrinal disorders, and metabolic disorders (diabetic mellitus). Alcoholism, hepatic diseases, starvation.
• Darier’s disease—Strictures of salivary glands which may lead to obstructive sialadenitis.

3. Physical causes:

• Sialolithiasis
• Sialodochitis
• Radiation

4. Infection:

• Bacterial and viral sialadenitis
• HIV-related salivary gland disorders

5. Inflammatory and reactive lesions:

• Cheilitis glandularis
• Necrotizing sialometaplasia
• Chronic sclerosing sialadenitis

6. Cysts:

• Mucocele
• Ranula

7. Tumors:

• Benign tumors:
  • Pleomorphic adenoma
  • Warthin’s tumor
  • Basal cell adenoma
• Malignant tumors:
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Malignant mixed tumor

8. Autoimmune disorders:

• Sjogren’s syndrome
• Mikulicz’s disease

9. Granulomatous disorders:

• Tuberculosis
• Sarcoidosis
• Orofacial granulomatosis

10. Miscellaneous:

• Drug-induced sialadenosis—for example anti-hypertensive drugs
• Anorexia/bulimia.

Question 2. Describe the etiology, clinical features, investigations, and management aspects of Sjogren’s syndrome.
Answer:

Sjogren’s syndrome (SS) is a chronic auto-immune disorder causing dry mouth and dry eyes by lymphocytic infiltration, and destroying the exocrine glands (salivary and lacrimal glands, lungs, and kidney).

Sjogren’s Syndrome Etiology:

Circulatory autoantibodies against the ribonucleoproteins Ro and La.

• Antinuclear antibodies against DNA his-tones.
• B lymphocytes hyperactivity
• Circulating immune complexes
• Genetic
  • Primary Sjogren’s syndrome: HLA-B8 and DR3
  • Secondary Sjogren’s syndrome: HLA-B8 and DR4

Sjogren’s Syndrome Clinical Features:

• Age group—commonly between 40-50 years.
• Females are affected more than males, and the ratio is 9:1. Postmenopausal women are prone to this syndrome.

Sjogren’s Syndrome Types:

• Primary Sjogren’s syndrome—sicca syndrome; sicca complex: Dry mouth and dry eyes (xerostomia and xerophthalmia).
• Secondary Sjogren’s syndrome—symptoms of primary Sjogren’s syndrome together with another autoimmune disorder like rheumatoid arthritis or systemic lupus erythematosus.

Sjogren’s Syndrome Signs and Symptoms:

• Xerostomia or dry mouth is the principal disturbing factor causing difficulty in chewing, swallowing and speaking.
• Scanty, thick and ropey saliva.
• Chronic salivary gland enlargement.
• Frequent salivary gland obstruction and gland infections.
  Dry, cracked lips and angular cheilitis.
• Total or partial depopulation of the tongue will give a typical red and lobulated appearance.
• Altered taste due to a decrease in a number of taste buds.
• Oral mucosa will appear dry and glossy.
• Accumulation of food debris leads to increased incidence of dental caries.
• Opportunistic candidal infection.

Sjogren’s syndrome Investigations For salivary gland:

• Minor salivary gland biopsy — most accep¬ted criterion.
  • The infiltrated mononuclear cells are counted with a collection of 50 or more cells are considered as a focus. Then the focus score is calculated by the sum of foci in 4 mm2 of the specimen.
  • The focus score may range between 0-12. A focus score of 1 confirms the diagnosis of Sjogren’s syndrome.
• Histopathological evidence of degenerative changes in the acinar cells and the maintenance of architectural patterns of ducts in minor glands is also a useful diagnostic factor.
• Salivary flow rate (allometry):
  • The stimulated salivary flow rate will be less than 1 mL/min.
  • (Normal: 1-1.5 mL/min) and unstimulated salivary rate will be less than 0.1 mL/min.
• For lacrimal glands:
  • Rose Bengal dye test: Keratotic spots on the cornea will stain pink.
  • Schirmer’s test: To measure the reduced tear flow, a filter paper strip should be placed in the lower conjunctival sac. The extent of wetting will be less than 5 mm in Sjogren’s patients, whereas in normal eyes the wetting will be up to 15 mm in length.
  • Lab investigation of antibodies: Presence of antinuclear antibodies SS-A/Ro or SS-B/La.

Sjogren’s Syndrome Radiographic Diagnosis:

• Sialography:
  • Obstruction of ducts may appear as, a cherry blossom or fruit-laden branchless tree.
  • Sialectasia due to leakage of contrast medium from the weakened ducts produces a snowstorm appearance.
• Magnetic resonance imaging: Salt and pepper appearance of the salivary glands.
• Salivary scintigraphy: Use of Tc-99m pertechnetate may indicate impaired salivary function by slow and decreased excretion of the dye.

Sjogren’s Syndrome Management:

• For dry mouth:
  • In the case of salivary glands with some amount of secretary function, stimulate the salivary flow using:
    • Sugar-free gum.
    • Cholinergic medications (dialogue- gues)
    • Cevimeline, pilocarpine hydrochloride, and bromhexine.
    • Pilocarpine hydrochloride — 0.5-7.5 mg in 3-4 divided doses/day.
    • Contraindications: Asthma, narrow-angle glaucoma, cardiovascular diseases. In case of a complete absence of secretion, artificial saliva can be used with frequent oral rinses.

For other complications, a multispecialty medical team approach is necessary.

Question 3. Enumerate the cysts of the salivary gland and briefly describe them.
Answer:

Cysts of salivary glands are:

1. Mucoceles
2. Ranula

Mucoceles are broadly classified into:

1. Mucous retention type
2. Mucous extravasations type.

Retention Mucocele:

Retention-type mucocele is a true cyst sublingual salivary glands. They may be because of the dilated duct epithelial lining.

Extravasation Mucocele:

Mucocele Clinical Features:

• Mucoceles are well-circumscribed dome-shaped swellings measuring a few millimeters to several centimeters in size. It may occur at any age, but prevalence for the younger age group is common.
• The superficial cysts show a distinct bluish hue due to translucent mucin, and the deeper cysts are covered by normal appearing mucosa. They are fluctuant and non-tender.
• Mucous extravasation type frequently occurs in the lower lip (where the chance for trauma is higher). The other sites include buccal mucosa, tongue, the floor of the mouth, and retromolar area. Mucous retention type is common in the palate and floor of the mouth.
• The extravasation type is more common than the retention type of mucocele.
• Biopsy findings: Characteristic macrophages which are vacuolated macrophages.

Mucocele Treatment:

• Intralesional injections of corticosteroids.
• Surgical excision with associated salivary gland.

2. Ranulas:

• The name is derived due to its resemblance to a frog belly — in Latin, Rana = frog.
• Ranulas are larger-sized mucoceles on the floor of the mouth and develop from

Ranulas Etiology:

• Trauma
• Ductal obstruction
• Ductal aneurysm

Ranulas Clinical Features:

• Common in children and young adults.
• Painless, slowly enlarging, freely movable, soft, and fluctuant swelling.
• Usually located on the floor of the mouth, on the right or left side of the lingual frenum. However, deep-seated lesions may cross the midline.

Plunging Ranula: Deeper swellings may herniate the mylohyoid muscle and appear in the suprahyoid or infrahyoid region.

Ranulas Diagnosis:

• Radiographs are necessary to rule out sialolith.
• Bidigital palpation for plunging ranula— placing one digit over the intraoral surface of the ranula with another finger over the submandibular or cervical counterpart, application of pressure through one finger will cause fluctuation sense on the other finger.

Ranulas Treatment:

• Intralesional injections of corticosteroids.
• Marsupialization of smaller lesions.
• Excision of the gland in recurring cases.

Question 4. List the causes of xerostomia. Add a note on the management of xerostomia.
(or)
What is dry mouth? Discuss the various causes of dry mouth and its management.
Answer:

Xerostomia or hyposalivation or dry mouth is a major functional defect of salivary glands and their ductal system. The subjective feeling of dry mouth is called as xerostomia, is a symptom and not a primary cause. Changes in the salivary composition also cause xerostomia.

Xerostomia Causes:

• Developmental:
  • Agenesis:
    • Atresia
    • Darier’s disease (strictures of salivary gland ducts).
• Physical:
  • Sialolith
  • Radiation injury
• Infection:
  • Fever — dehydration
  • Viral (mumps)
  • Bacterial
  • HIV-induced salivary gland disorders
  • CMV infection
• Inflammatory and reactive conditions:
  • Necrotizing sialometaplasia
• Cysts:
  • Mucocele
  • Ranula
• Tumors:
  • Benign: Pleomorphic adenoma
    • Monomorphic adenoma
    • Warthin’s tumor
  • Malignant: Mucoepidermoid carcinoma
    • Adenoid cystic carcinoma
    • Carcinoma ex pleomorphic adenoma
• Autoimmune disorders:
  • Sjogren’s syndrome
  • Mikulicz’s disease
  • Sarcoidosis
• Metabolic disorder:
  • Uncontrolled diabetes
• Chemicals and drugs:
  • Tricyclic antidepressants
  • Antipsychotic medications
  • Antihistamines
  • Anti-HIV drugs
  • Opioids
  • Decongestants
  • Benzodiazepines
  • Proton pump inhibitors and H2 antagonists
• Nutritional deficiencies:
  • Vitamin A and B complex deficiencies
  • Iron deficiency anemia
  • Megaloblastic anemia
• Psychological disorders:
  • Psychosis
  • Manic depression
• Miscellaneous:
  • Anorexia and bulimia
  • Alcoholism.

Xerostomia Management:

• Preventive: Topical application of fluoride
• Symptomatic: Frequent sipping of water throughout the day will hydrate the mucosa and clear the debris.
• Local stimulation:
  • Sugarless chewing gums.
  • Xylitol sweetened gums.
• Systemic medications:
  • Pilocarpine Hcl increases salivary output by stimulating remaining gland tissue.
    • Dose: 0.5-7.5 mg in 3-4 divided doses/day.
    • Contraindications: Patients with uncontrolled asthma, narrow-angle glaucoma, cardiovascular diseases, and pulmonary diseases.
  • Cevimeline Hcl.
  • Bromhexine—Mucolytic agent.
• Salivary substitutes (artificial saliva) — Contain lubricants like carboxymethyl cellulose or hydroxyethyl cellulose, artificial sweeteners like sorbitol, preservatives, chloride and fluoride salts.

Question 5. What is ptyalism? Enumerate the etiology, clinical findings, and treatment of ptyalism.
Answer: An increased salivary flow characterizes ptyalism or sialorrhea.

Ptyalism Causes

1. Infection:

• Herpes simplex infection
• Ludwig angina
• Fuso-spirochetal infections

2. Inflammation:

• Aphthous stomatitis
• Teething
• Erythema multiforme

3. Physical:

• New dentures
• Instruments in the oral cavity

4. Chemicals:

• Mercury
• Iodine
• Plumbism

5. Drugs:

• Clozapine
• Risperidone
• Lithium
• Digoxin

6. Hormonal changes: Pregnancy.

Ptyalism Clinical Features:

• Saliva may drool spontaneously as well as during speech, chewing, and swallowing functions that disturb the affected individuals to varying extents.
• Infection arising from repeated salivary pooling is also a common problem at the corners of the mouth.

Ptyalism Management:

• Removal of the cause: In case of infection, inflammation, and ill-fitting dentures, possible measures should be taken to treat the underlying problem.
• Self-awareness and education: Patients should be educated and trained to improve their motor coordination. Biofeedback may be used for this purpose which will motivate the patients and make them swallow more frequently.
• Antisialagogues:
  • Atropine is an anticholinergic drug that antagonizes the action of acetylcholine in acinar cells and reduces salivary secretions.
    • Dose: Adults—It is 0.4 mg/4 times/day at 4-6 hour intervals.
      Children—It is 0.01 mg/kg/day but should not exceed the total dose of 0.4 mg/day.
  • Scopolamine—0.4-0.6 mg/day.
  • Propantheline—15-30 mg/day in divided doses.

Question 6. Describe the clinical features, investigations, and management of:
1. Bacterial sialadenitis
2. Viral sialadenitis
(or)
Describe in detail about bacterial and viral parotitis.
Answer: Sialadenitis is an inflammatory condition, and it is the sequel of bacterial or viral infections.

1. Bacterial Sialadenitis:

• It occurs in individuals with reduced salivary gland secretion.
• It results from the retrograde spread of oral microorganisms into the salivary gland through the salivary duct.

Acute Bacterial Sialadenitis:

• The most commonly affected gland is the parotid (acute parotitis). The common organism associated with the suppurative type is Staphylococcus aureus.
• Streptococcus pyogenes, Streptococcus pneu¬moniae, E. coli, Prevotella, Porphyromonas, and Fusobacterium species are also potential causative factors for sialadenitis.

Bacterial Sialadenitis Predisposing Factors:

• Poor oral hygiene
• Dehydration
• Malnutrition
• Antihistaminic drugs
• Diuretics
• Ductal obstruction
• Major surgical procedures.

Bacterial Sialadenitis Clinical Features:

• Sudden, enlargement of salivary glands with erythematous overlying skin will be the early manifestation.
• One or both the glands may involve, and the affected glands are indurated and painful. Upon milking the duct orifice, a purulent discharge may be released. There may be associated symptoms of fever and lymphadenopathy.

Bacterial Sialadenitis Diagnosis:

• Leukocytosis
• Culture the salivary exudate for aerobes and anaerobes.
• Ultrasonography: Hypoechoic swelling with increased vascularity.
• Computed tomography.

Bacterial Sialadenitis Treatment Plan:

• Penicillinase-resistant antistaphylococcal antibiotics should be initiated.
• Frequent intake of water.
• Improved oral hygiene measures.
• Salivary stimulation by sucking a lemon or sour candy.

Postoperative Parotitis (Postsurgical Parotitis):

• Patients undergoing for surgeries (especially abdominal surgery) under general ane¬sthesia may develop sialadenitis on the 5-7th day of the postoperative period.
• This condition is due to ascending bacterial infection as a result of decreased salivary flow caused by anticholinergic drugs and dehydration from restricted fluid intake.

Pathogenesis of Acute Bacterial Sialadenitis:

Acute Bacterial Sialadenitis Clinical Features: Sudden onset of firm and painful swelling at the angle of the jaw with restricted mouth opening.

Acute Bacterial Sialadenitis Management:

• Postoperative maintenance of fluid and electrolyte balance.
• Antibacterial mouth rinse (chlorhexidine 0. 2%).

2. Viral Parotitis:

• Salivary gland infection is caused by para-myxovirus, cytomegalovirus, coxsackievirus, and human immunodeficiency virus. Among these viruses, paramyxovirus infection is the most common.
• Mumps or Epidemic Parotitis: Paramyxovirus is an RNA virus and is transmitted by salivary droplets. The incubation period is 2-3 weeks.

Viral Parotitis Clinical Features:

• Mumps occurs in 4-6 years age group children, but adult age onset can also occur.
• Prodromal symptoms: Salivary gland enlargement is preceded by fever, malaise, headache, myalgia, and preauricular pain. These symptoms will persist for a week.
• Salivary gland inflammation and enlargement will follow this period and parotid is the commonly affected gland. Submandibular infection may occur in 10% of cases.
• Though the swelling occurs in both glands, the gland will become symptomatic on one side 24-48 hours before the other side gland. Swelling will last for 7 days. Inflammation of ductal orifice is common but no purulent discharge on milking the gland.

Viral Parotitis Complications:

• Mumps in adult males cause inflammation of the testis (orchitis) and leads to sterility.
• Acute pancreatitis with an elevation of serum lipase
• Meningitis and encephalitis
• Myocarditis, thyroiditis
• Deafness, oophoritis, and mastoiditis.

Viral Parotitis Investigations:

• Demonstration of:
  • Antibodies against mumps antigens V and S.
  • Antibodies to hemagglutination antigen.
  • Elevated serum amylase level.

Viral Parotitis Preventive Care:

• Enhance immunization with a live-attenuated vaccine in children at the age of 12-15 months and the second dose at 4-6 years of age.
• But vaccination is contraindicated in severely immunocompromised children.

Viral Parotitis Treatment:

• Analgesic and antipyretic support to relieve pain and swelling.
• Adequate bed rest.

Salivary Gland Diseases Short Notes

Question 1. Discuss features of Mikulicz’s disease.
Answer:

• Mikulicz’s disease is a benign lympho- epithelial condition of symmetric, bilateral, painless, enlargement of lacrimal and salivary glands due to lymphoid infiltration. Etiology is nonspecific but autoimmune, viral, and genetic causes are considered. It shows both inflammatory and neoplastic features.
• It affects middle-aged women more frequently with the typical signs of diffuse enlargement of the salivary gland with mild local discomfort, pain, and xerostomia.
• Diagnosis is by salivary gland biopsy and treatment is palliative. Malignant transformation is a potential complication.

Question 2. Briefly describe sialolithiasis
(or)
Sialolith.
Answer:

Lith = stone: Formation of calcified bodies in the duct of the major salivary glands or rarely within the major salivary gland itself is known as sialolith.

Sialolithiasis Pathogenesis:

• Small organic foci deposition due to:
  • Local irritation
  • Inflammation
  • Irregular ductal course
  • Anticholinergic medications
  • Altered salivary flow
  • Increased serum calcium and phosphorus
• It may act as a central nidus and calcification may take place in a concentric manner around the nidus.

Sialolithiasis Composition:

• Hydroxylapatite crystals are composed of calcium phosphate and carbon with less quantity of magnesium, potassium chloride and ammonium.
• About 50% of parotid calculi and 20% of submandibular calculi may not be calcified and will not be visible on radiographs.

Sialolithiasis Clinical Features:

• Sialoliths primarily form on the submandibular gland duct (80-90%) and then in the parotid (5-15%) and sublingual (2-5%) glands. Acute, painful, intermediate swelling of the affected gland are the characteristic symptom.
• Eating will initiate the swelling because the stone blocks the increased amount of salivary flow associated with eating and leads to pooling within the duct and gland.
• Since glands are encapsulated, it allows only little expansion, and enlargement causes pain.

Sialolithiasis Complication: Atrophy and fistula also occur in some cases.

Sialolithiasis Diagnosis:

• Clinical: Bidigital palpation.
• Radiographs: Occlusal view for submandibular gland and PA view for parotid.
• Noncontrast computed tomography for calcified stone and contrast CT for non-calcified sialolith.
• Ultrasound imaging.
• Rarely sialography.

Sialolithiasis Treatment:

• For acute conditions—supportive therapy with analgesics, antibiotics, and increased fluid intake.
• If stones are near the duct orifice, removal is by massaging and manipulation of the gland or by peripheral dichotomy.
• Larger stones and those away from the orifice are removed by:
  • Excision of the duct and gland
  • Lithotripsy
  • Sialoendoscopy.

Question 3. Describe necrotizing sialometaplasia.
Answer: It is a benign, reactive, inflammatory disease of the minor salivary gland that mimics both clinically and histopathologically as a malignant condition.

Sialometaplasia Etiology:

• Local ischemia precipitated by the administration of local anesthesia during oral surgical procedures and restorative treatment.
• It also, occurs in patients suffering from bulimia and practice-induced vomiting.

Sialometaplasia Clinical Features:

• More prevalent in the posterior hard palate. Other sites of occurrence include retro-molar pad, buccal mucosa, lower lip, and tongue.
• The sudden appearance of the firm nodule with intact mucosa causing a feeling of obstruction is the early symptom. Within a 2-week period, the nodule will break, and surface ulceration will occur with a dull pain.

Sialometaplasia Investigation and Treatment:

• It is a self-limiting condition and heals by secondary intention within 6 weeks. Debridement with saline rinse may accelerate healing. In symptomatic cases, analgesics can be prescribed.
• To rule out the malignant, a histopathological examination of the biopsy specimen can be carried out.

Question 4. Describe Kuttner’s disease (tumor).
Answer:

• Chronic sclerosing sialadenitis is known as Kuttner’s disease (tumor), and it frequently affects the submandibular gland.
• The suspected etiological factors include autoimmune sialadenitis, sialolithiasis, and idiopathic nature.

Kuttner’s disease Pathogenesis: Chronic inflammation leads to atrophy of serous and mucous acinar cells, and hyperplasia of glandular connective tissues resulting in tumor-like mass.

Kuttner’s disease Clinical Features: It is a firm enlargement of the affected side gland with mild or no pain.

Kuttner’s Disease Investigations:

• Sialography of the enlarged gland may reveal:
  • Sialectasia—leakage of contrast agent in the gland from the duct produces dilatation of acinar cells and is known as sialectasis.
  • Constricted ductal course with dilated lumen—sausage-like appearance.
  • Absence of terminal branches
• Ultrasound image: Enlarged gland with numerous hypoechoic regions.
• CT and MRI.

Kuttner’s disease Treatment: Surgical removal of the gland.

Question 5. Briefly describe HIV-salivary gland disease (HIV-SGD).
Answer:

• Dry mouth and enlarged salivary glands in HIV-infected individuals are collectively called as HIV-induced salivary gland disease. The uni- or bilateral enlargement of the gland is caused by both neoplastic and non-neoplastic lesions.
• Xerostomia in this condition is associated with cytomegalovirus (CMV) infection, and neoplastic conditions include Kaposi’s sarcoma and lymphoma.

HIV-salivary gland Clinical Features:

• The parotid gland is affected in 98% of cases and 60% of patients show a bilateral enlargement.
• In the later stage of HIV, benign lymphoepithelial lesions (BLEL) or AIDS-related parotid cysts (ARPC) may develop a single or bilateral, soft to firm cystic enlargement of the glands. Xerostomia may present with ocular dryness. This condition is termed as BLEL-HIV.

HIV-salivary gland Investigations:

• Lab diagnosis:
  • Elevated levels of salivary IgA.
  • Immunohistochemical analysis of minor salivary gland biopsy reveals CD8-positive cells.
  • The biopsy specimen from the major salivary gland reveals lymphocytic infiltrates, cystic cavities, and hyperplastic lymph nodes.
• Imaging studies: Ultrasonography, CT, MRI.

HIV-salivary gland Treatment:

• Symptomatic management for xerostomia- frequent sipping of water, chewing sugar-free gum or using salivary substitutes.
• For cystic lesions-aspiration of cysts is followed by injecting tetracycline solution into cystic spaces to induce sclerosis.
• External radiation therapy for benign enlargements.

Question 6. Describe cheilitis glandularis.
Answer: It is a rare, chronic, suppurative, inflammatory condition of the minor salivary glands of the lower labial mucosa.

Cheilitis glandularis Pathology:

• The mucous secreting minor salivary glands become swollen with dilated duct orifice.
• Suspected causes: Smoking, actinic damage, and bacterial infection.

Cheilitis glandularis Clinical Features:

• Swelling and eversion of the lower lip.
• Inflamed ductal opening.
• On palpation, mucopurulent discharge through the duct orifice.

Three types of cheilitis glandularis are:

1. Type 1: Simple
2. Type 2: Superficial suppurative swelling with superficial ulceration and crusting.
3. Type 3: Deep suppurative swelling with deep-seated infection and spontaneous pus discharge from duct orifice.

Cheilitis glandularis Diagnosis: Biopsy of minor salivary gland.

Cheilitis glandularis Treatment:

• Topical steroid application (0.1% triam-cinolone acetonide).
• Intralesional steroid injection.
• Antibiotics and anti-inflammatory drugs.
• Surgical management for nonresponsive cases.

Question 7. Discuss sialadenosis.
Answer:

• Sialadenosis is a noninflammatory and non-neoplastic, bilateral enlargement of parotid and submandibular glands. It is associated with systemic disorders like diabetes, hypothyroidism, obesity, anorexia, and bulimia.
• Alcoholism is also a common cause. Drugs like bronchodilators, antihypertensive agents, and psychotropic medications are also associated with small- stenosis.
• The enlargement will be gradual and usually asymptomatic.
• Autonomic neuropathy which diminishes sympathetic innervations is the proven mechanism in all these associated conditions.
• The altered innervation reduces the secretary mechanism of acinar cells. The acinar cells become hypertrophic with eventual glandular enlargement to compensate for the functional demands.

Salivary Gland Diseases Multiple Choice Questions

Question 1. The only imaging technique to find the functional capacity of salivary glands is

1. Sialography
2. Ultrasonography
3. Scintigraphy
4. Fluoroscopy

Answer: 3. Scintigraphy

Question 2. The possible alternative to sialography contra-indication is

1. CT sialography
2. Scintigraphy
3. MRI sialography
4. Ultrasonography
   (Note: Scintigraphy or Tc-99m scan).

Answer: 2. Scintigraphy

Question 3. The best imaging choice to evaluate salivary gland tumors is

1. High-resolution ultrasonography
2. Computed tomography
3. Radionuclide scintigraphy
4. Magnetic resonance imaging

Answer: 4. Magnetic resonance imaging

Question 4. In suspected cases of Sjogren’s syndrome, the preferred site for biopsy is

1. Von Ebner’s gland
2. Parotid gland
3. Labial minor salivary gland
4. Glands of Blandin and Nuhn
   (Note: Glands of Blandin and Nuhn are minor salivary glands located on the anterior ventral aspect of the tongue. Von Ebner’s minor salivary glands are located anterior to the sulcus terminalis on the dorsal aspect of the tongue, around the circumvallate papilla).

Answer: 3. Labial minor salivary gland

Question 5. The pouch or sac projecting from the walls of major salivary gland ducts is known as

1. Diverticulum
2. Atresia
3. Salivary fistula
4. Lingual thyroid

Answer: 1. Diverticulum

Question 6. Complication of diverticula is

1. Recurrent sialadinitis
2. Obstructive sialadenitis
3. Sialolithiasis
4. Sialadenosis

Answer: 1. Recurrent sialadinitis

Question 7. Darier’s disease cause

1. Recurrent sialadinitis
2. Obstructive sialadenitis
3. Diverticulosis
4. Sialadenosis

Answer: 2. Obstructive sialadenitis

Question 8. Salivary gland abnormality in Darier’s disease is a ductal dilation with

1. Aplasia of major glands
2. Aberrant minor salivary glands
3. Recurrent stricture of main ducts
4. Recurrent parotid abscess
   (Note: Salivary gland abnormality in Darier’s disease is duct dilation with recurrent stricture of main ducts).

Answer: 3. Recurrent stricture of main ducts

Question 9. Contrast CT and sialography diagnose

1. Gland inflammation
2. Minor salivary gland tumor
3. Noncalcified sialoliths
4. Deep-seated mucocele

Answer: 3. Noncalcified sialoliths

Question 10. The most efficient method for the removal of sialolith is

1. Lithotripsy
2. Sialoendoscopy
3. key-hole surgery
4. Gland removal

Answer: 2. Sialoendoscopy

Question 11. Salivary gland virus disease is the name for

1. Paramyxovirus infection
2. Infectious mononucleosis
3. Epstein-Barr virus infection
4. Cytomegalovirus infection

Answer: 4. Cytomegalovirus infection

Question 12. The PH range of saliva in health is between

1. 5.0 and 9.0
2. 6.7 and 7.4
3. c. 0 and 7.0
4. 4.5 and 11.3

Answer: 2. 6.7 and 7.4

Question 13. Increased caries rate occurred when salivary pH range goes below,

1. 0
2. 7
3. 5.5
4. 3.2

Answer: 3. 5.5

Question 14. Schirmer’s test is done for measuring the

1. Serum vitamin B12 level
2. Tear production
3. Salivary flow rate
4. Serum folate level

Answer: 2. Tear production

Question 15. Computed tomographic image of the parotid gland in an intermediate stage of Sjogren’s syndrome patients reveals

1. Parotid atrophy
2. Multiple cysts
3. Parotid hypertrophy
4. Multiple tumors

Answer: 2. Multiple cysts

Question 16. Intermediate postprandial salivary gland swelling is a diagnostic symptom of

1. Mucocele
2. Pleomorphic adenoma
3. Sialolith
4. Mumps

Answer: 3. Sialolith

Question 17. The most prevalent type of salivary gland neoplasm is

1. Pleomorphic adenoma
2. Warthin’s tumor
3. Mucoepidermoid carcinoma
4. Adenoid cystic carcinoma

Answer: 1. Pleomorphic adenoma

Question 18. A tumor occurring only in the parotid gland is Warthin’s tumor (Papillary cystadenoma lymphomatosis).

1. Pleomorphic adenoma
2. Warthin’s tumor
3. Mucoepidermoid carcinoma
4. Adenoid cystic carcinoma
   (Note: Warthin’s tumor also known as papillary cystadenoma lymphomatosis).

Answer: 4. Adenoid cystic carcinoma

Question 19. Developmental salivary gland defect is known as

1. Mucocele
2. Ranula
3. Stafne’s cyst
4. Plunging ranula
   (Note: Stafne’s cyst does not require any treatment).

Answer: 3. Stafne’s cyst

Question 20. Pseudomembranous candidiasis is common in

1. Anemia
2. Avitaminosis
3. Xerostomia
4. Anorexia nervosa

Answer: 3. Xerostomia

Salivary Gland Diseases Viva Voce

Question 1. Contraindications for sialography.
Answer:

1. Active salivary gland infection-In this condition sialography procedure further aggravates the inflammatory condition. The contrast media when injected forces the bacteria to spread throughout the ductal course and potentiate the infection.
2. Allergy –Iodine (contrast agent) may induce an allergic reaction in suspected people.

Question 2. Indications for contrast CT images of salivary glands.
Answer: To diagnose more defined lesions like tumors, abscesses, and inflamed lymph nodes.

Question 3. Indications for nonenhanced (without contrast) CT images of salivary glands.
Answer: To diagnose, sialoliths, glandular enlarge¬ments and asymmetry, and lymph node involvement.

Question 4. Serological markers (lab tests) for diagnosis of Sjogren’s syndrome.
Answer: Antinuclear antibodies (SSA/Ro or SSB/La), rheumatoid factors, elevated levels of IgG, and elevated ESR.

Question 5. Where lithotripsy is used and what are the merits and demerits of using it?
Answer: Lithotripsy is used for the removal of larger sialoliths and sialolith located away from the duct orifice.

Lithotripsy Advantage: Noninvasive treatment

Lithotripsy Disadvantages:

• Several appointments are necessary.
• Transient hearing change.
• Pain and hematoma.

Question 5. Why sialography are not usually advised for the diagnosis of sialolith
(or)
What are the drawbacks of using sialography for the detection of sialoliths?
Answer:

• Sialography is an invasive procedure and increases pain, especially in acute cases.
• In case of existing ductal infection due to salivary stasis, sialography may induce retrograde spread of infection to the gland.
• The sialographic procedure may displace the stone deeper into the gland.

Question 6. Functions of saliva.
Answer: Lubrication of oral mucosa, buffering the oral cavity, antimicrobial and antifungal protection to the oral cavity, remineralization of tissues, excretion of certain drugs and chemicals and flushing the food debris.

Question 7. What is a cracker sign?
Answer: The inability of a patient to eat a cracker (biscuit) without drinking fluid is known as a cracker sign. It indicates hyposalivation.

Question 8. What is a lipstick sign?
Answer: Lipstick adhering to the incisal edge of the upper anterior teeth is known as a lipstick sign. The positive sign indicates hyposalivation.

Question 9. What is the mouth mirror test?
Answer: If the dentist places the mouth mirror in the patient’s buccal mucosa and is unable to move the mirrored surface of the mouth mirror along the buccal mucosa effortlessly, it is an indication for hyposalivation and dry mouth.

Question 10. Name a few benign tumors of the salivary gland.
Answer: Pleomorphic adenoma, Warthin’s tumor (papillary cystadenoma lymphomatosis), canalicular adenoma, basal cell adenoma.

Question 11. Name a few malignant tumors of the salivary gland.
Answer: Mucoepidermoid carcinoma, adenoid cystic carcinoma, carcinoma example pleomorphic adenoma.

Question 12. What is a Stafne cyst?
Answer:

1. Stafne cyst is a radiographic finding (orthopantomogram) on the lingual surface of the posterior body of the mandible.
2. It appears as a round or ovoid radiolucency of 1-3 cm in size with a radiopaque border located above the inferior border of the mandible and below the inferior alveolar canal.
3. The inclusion of salivary gland tissue in the cortical plate is the reason for this defect. It is asymptomatic and does not require any treatment.

Question 13. Sialolith is common in which gland and why?
Answer: Sialolith is common in the submandibular gland. The reason is:

• Irregular and tortuous course of Wharton’s duct.
• Mucous secretion is predominant hence easily forms a plug.
• Deeper position of the gland and flow direction opposite to gravity.

Salient Points to Remember:

• Sausage appearance (dilated lumen and narrow course of the duct) is seen in chronic sclerosing sialadenitis or Kuttner’s disease.
• Salivary gland aplasia is associated with first branchial arch anomalies, hemifacial microsomia, and mandibulofacial dysostosis.
• Salivary composition is influenced by sympathetic stimulation.

Salivary Gland Diseases Highlights

• Salivary glands are exocrine (release their secretion through ducts in contrast to ductless endocrine glands) and merocrine (cell walls lose their cytoplasm when secretary products pass through them) in nature and produce serous, mucus and seromucous types of secretion.
• There are three major salivary glands in pairs and approximately 600-800 minor salivary glands in our oral cavity. The major salivary glands primarily contribute to the total salivary secretion, whereas minor salivary glands are responsible for up to 8% of total secretion.
• The secretion takes place only in the acinar cells of the gland, and their destruction reduces the amount of salivary production and transport. The role of saliva in health and diseases is the prime topic for dental health professionals.