Which is painful Sarcoidosis or acute Sialadenitis ?

Acute Sialadenitis is painful sarcoidsis is not painful

Sialadenitis of Minor Glands

- Minor Salivary glands found in the lower lip for example the inflammation will be due to trauma , mechanical trauma ,thermal injury

- Usually its associated with mucous extroversion tearing of the minor saliva duct and leakage of saliva from it

-Sialadenitis of Minor Glands May however be of diagnostic significance :some time the biopsy of the minor gland is important to diagnosis other diseases that affect the major Salivary gland because its easier for instant to take a biopsy from the lower lip than to take it from parotid gland ,,,, which diases should be consider := sarcoidosis & Sjgren syndrome.

In the lower lip the most common cause for siladentias is Salivary extraversion the palate its rarely traumatized , so is another diseases effecting the palate its called nicotinic stomatitis

I see chronic inflammation fibrosis surrounding the duct preservation of the lobular architecture of the gland dilated duct and some time the epithelium is hyperplastic and this what we also see in chronic sialdentis in the major salivary gland

 stomatitis glandularis The patient comes to u with multiple inflamed orifices of the lower lip if u Evert the lower lip and looked to the orifices of the slivary gland u will see multiple inflamied minor gland with pus leaking of these gland and this is mainly stomatitis glandularis and it effect mainly males cheilitis glandularis is specifecly to the lip and usually it is associated with chronic inflammation of the lower lip

Obstructive & Traumatic Lesions

Salivary calculi (sialoliths) Necrotizing sialometaplasia Mucoceles

Salivary calculi (sialoliths)

We talked about chronic sialadenitas preceed by obstruction of the gland and now we well talk talk about these calculi the obstruct the gland

I.

This is a yellowish stone in a duct of a salivary gland eg submandbular salivary gland

II.

stone bulging inside the floor of the mouth the stone may be in the duct or in the gland it self

its usually seen in middle age patient because we need time to develop these minerals to have a stone the stone may be in the duct or in the gland it self , By using sialography they can defined the location of the stone most commonly found in submandibular SG then followed by parotid , sub lingual \ minor slivary gland is rare Usually unilateral, although may be multiple in same gland there may be a coincidence the stone is forming in both gland clinical feature

Usually its asymptomatic but if its symptomatic what will happen swelling of the gland in the meal times it may be annoying to the patient and he might seek for removing of the gland ! Reduction of the salivary flow rate beacause of obstruction it will decrease the washing effect , bacterial infection will occuer , rampant caries , poor retention of dentures difficulty in swallowing

we can detect calcluli be radiograph or be palpation and we can removed it

Histological I can see calcified materials , calcified materials are deeply eosinophilic ,salivary gland lining is usually coulmoanr in this casue I see it squamous and I see it stratified and thickend and we mention that we may see epithelial hyper plasia in case of chronic inflammation or chronic obstruction and its type of protective reaction of the gland

Necrotizing Sialometaplasia

It usually affect the minor salivary gland of the palate usually there is a source of trauma like ischemic cause reduced blood supply if the patient is having an execration in this area , or if the patient toke infiltration anesthesia anesthesia contain vasoconstrictints ,,,, so blood supply will be decressed to the salivary glands and then the necrosis will start occurring in the effected area The problem with Necrotizing Sialometaplasia that it occur like an ulcer and this ulcer will last for 8- 12 weeks and u know if the ulcer last for more than 6 week we will start investigating for malignance

So because they last for more than 6 week they maybe confuised with basal cell carcinoma and the need to be biopsied Clinical features:

1. Presents most commonly as a deep, crater-like ulcer which may mimic a malignant ulcer. 2. May take up to 10-12 weeks to heal. 3 .Ulcer may be preceded by an indurate swelling and now you will now why its called necrotizing , and why its called metaplesia

The lobules of the salivary gland the minor salivary gland contains of 100% mucous acini and here I see the mucous acini are merging with each other - So necrosis is starting here - the lobular architecture is preserved u will still see the outline, but the acini are gone the are necrotizing. - squamous metaplaisa metaplasia occur in the epithelium of the duct ,so epithelium changes from cuboidal or columnar to squamous , so what we have here is squamous

metaplasia of the duct

*****NOTE******
SO we see epithelium islands within the lesion ,,,, I might think that these are squamous cell carcinoma invading and infiltrating the structure WHICH IS NOT TRUE ,ITS JUST METAPLASIA OF THE DUCT BESIDE we dont see the feature of malignance << hyper chromatism increase

mitotic rate increase nucleus to cytoplasm ratio , ect .. >> , when u see the necrosis and the metaplasia u will immediately understand that this lesion is necrotizing sialo metamplasia and it is not squamos sell carcinoma

Let look at the clinical picture it may start as swallowing in the palate followed by ulcer formation and look at this ulcer its relatively deep and its suspicious for squamous cell carcinoma ,,, I will not allow my patient to go home with this ulcer or I will keep fallowen him for two weeks to see what will happen ,or I can take incisinal biopsy and after several weeks healing occurred . if u worry u should take biopsy

Let look at the over lying epithelial it self the over lying epithele is hyper plastic it will increase in thickness and there may be something called pseudoepitheliomatous hyperplasia. Some of these island may come from the surface epithelium pseudoepitheliomatous hyperplasia is seen in certain condition one of these condition is necrotizing sialo metaplasia ,,,, we see it also in deep fungial infection and there for it may be mistaken dignosed as squamous cell carcinoma if we didnt pay attention to the cytological feature

and therefore we call it pseudoepitheliomatous hyperplasia some time called pseudocarcimnotis hyperplasia why epitheliomatous in the benign squamous cell carcinoma was used to call squamous cell epithelumo but its malgnent ,, so they keep using the epithiluoma world and the called it pseudoepitheliomatous hyperplasia . But it should be called psuedocarcinmotis hyperplasia why pseudo because it is not true carcinoma why hyperplasia because there is increase in the thickness of epithelium