MUCOCELE

1. Mucin filled cavity
   1. Mucous extravasation phenomenon = PSEUDOCYST
   2. Mucous retention cyst = TRUE CYST
2. Dome shaped swelling 
3. MC site = lower lip 
4. Superficial lesion = bluish, translucent 
5. Deeper = color and surface is normal 
6. Pseudocyst = Lined by compressed connective tissue
   
7. True cyst = cystic cavity is lined by ductal epithelium
   
8. MEP is more common than MRC

RANULA 

1. Form of mucocele 
2. Present in floor of mouth 
3. Lateral to midline 
4. 

PLUNGING RANULA 

1. Mucocele dissects through mylohyoid muscle 
2. Swelling in the neck 
3. Cervical Ranula
4. 

SIALOLITHIASIS 

1. Stone present in gland or duct 
2. Associated with submandibular gland
   1. Saliva production = high in mucin and binds to foreign particles 
   2. Duct is long and tortious 
   3. Antigravity direction 
3. Bimanual Palpation 
4. Occlusal radiograph to diagnose
   

SIALADENITIS 

1. Itis means inflammation 
2. Inflammation of salivary glands due to
   1. Infection = mc viral infection of parotid gland = mumps 
   2. Non infectious 
3. 

SJOGREN SYNDROME 

1. MC autoimmune disease of salivary glands
2. Primary = dry eyes + dry mouth = sicca syndrome 
3. Secondary = Primary + Rh arthritis or SLE or Scleroderma
4. 
5. H/p = Infiltration of lymphocytes = Destroy the normal architecture of gland 
6. Few remnants of gland is left behind = Epimyoepithelial islands
7. Diagnostic criteria
   1. Ocular symptoms >3 months
   2. Oral symptoms >3 months
8. Tests for Ocular symptoms
   1. Schirmer’s test = less than 5 mm in 5 mins 
   2. Rose bengal test = less than 4 = positive 
9. Tests for Oral symptoms
   1. Unstimulated salivary flow = less than 1.5 ml in 15 mins 
   2. Sialography = cherry blossom pattern or branchless fruit laden tree pattern or apple tree pattern
      
   3. Radioactives dyes = Scintigraphy 
10. Histopathology
    1. Site of biopsy = lower lip or labial mucosa which is clinically normal 
    2. 4mm² = more than 50 lymphocytes 
    3. 4mm² = more than or equal to 1 focus score
11. Serological tests = Antinuclear antibodies
    1. Anti Ro ( Anti SS- A)
    2. Anti La (Anti SS – B)
12. Exclusion Criteria
    1. Past head and neck radiation – xerostomia 
    2. Hepatitis C infection 
    3. AIDS
    4. Preexisting lymphoma 
    5. Sarcoidosis 
    6. Graft vs Host disease
    7. Use of anticholinergic drugs – dry mouth 

MIKULICZ DISEASE 

1. MILDER FORM of sjogren syndrome 
2. Improvements with steroids – not seen in SS
3. No cherry blossom pattern is seen 
4. Also called benign lymphoepithelial lesion of SG 
5. Presence of epimyoepithelial islands 

SIALADENOSIS 

1. Non inflammatory salivary gland enlargement 
2. Sialography – leafless tree pattern 

NECROTIZING SIALOMETAPLASIA

1. Locally destructive inflammatory condition
   
2. Cause – ischemia leading to tissue infarction 
3. Crateriform ulcer = mimic SCC clinically and histologically
4. Resolve spontaneously 
5. Average healing time is approx = 5 weeks  
6. Epithelial islands in connective tissue
   1. In SCC = cells are dysplastic 
   2. In NSM = cells are not dysplastic 
7. Also called Pseudocarcinomatous hyperplastic 
8. Also called Epitheliomatous 

SALIVARY TUMORS

1. MC salivary gland neoplasm 
2. Its benign SG neoplasm 
3. MC site = parotid and palate
   
4. Slow growing 
5. Facial Paralysis = rare 
6. Epithelial component = Islands or ducts 
7. CT components
   1. Myxomatous areas 
   2. Chondroid
   3. Osseous 
   4. Hyalinized 
8. All these components are derived from Ductal reserve or Myoepithelial cells 
9. Hence, its pseudo mixed tumor H/P
10. Eosinophilic coagulum is surrounded by hyaline areas
    
11. Plasmacytoid cells = look like plasma cells – eccentric nucleus
    
12. Myxomatous = Increase in mucoid material 
13. Vacuolar degeneration of cells = Chrondroid area
14. All these components are seen in Pleomorphic Adenoma

WARTHIN’S TUMOR 

1. Also called adenolymphoma 
2. Almost exclusively seen in parotid gland 
3. Pathogenesis = Heterotopic salivary gland tissue in para-parotid lymph nodes 
4. Smokers have 8 fold higher risk 
5. 

PAPILLARY CYSTADENOMA LYMPHOMATOSUM 

1. Papillary projections into lumen 
2. Core is made of lymphocytes
3. Aspirate = chocolate brown coloured 
4. Prone to develop lymphoma 
5. 

MUCOEPIDERMOID CARCINOMA 

1. MC malignant SG neoplasm 
2. MC in parotid and palate
   
3. Facial Paralysis is seen 
4. H/p 

Low grade	Good Prognosis
Intermediate grade
High Grade	Worst Prognosis

	Cystic/ Solid	Cellular atypia	Mucous cells/ Epidermoid cells/intermediate
Low grade	more	less	more
Intermediate
High Grade	more	more	more

5. Low grade
   
6. High Grade 

ADENOID CYSTIC CARCINOMA 

1. Old term = cylindroma = now rejected 
2. Palate = 50% cases
3. Parotid – Facial paralysis is seen 
4. Invades and splits nerves = Perineural invasion and spread = This is also seen in Polymorphous low grade adenocarcinoma
5. Cribriform Pattern
   1. lots of cystic spaces
   2. Swiss cheese pattern 
6. Tubular pattern = Tumor cells are arranged in form of tubules 
7. Solid pattern
   1. Very rare 
   2. Arranged in islands 
   3. Highly aggressive 
   4. Worst prognosis