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The salivary glands · Oral Pathology · INBDE Patient Cases

Salivary Gland Pathology INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on salivary gland pathology. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases on salivary gland pathology: a recurrent lower lip mucocele (mucus extravasation), a floor-of-mouth ranula from the sublingual gland, submandibular sialolithiasis with mealtime swelling, Sjogren syndrome with dry mouth, dry eyes, rampant caries and lymphoma risk, a pleomorphic adenoma of the parotid and the facial nerve consideration, a firm palatal minor salivary gland tumor and the smaller-the-gland-more-malignant rule with mucoepidermoid carcinoma, acute bacterial sialadenitis (Staphylococcus aureus) in a dehydrated patient, and a painful salivary mass with nerve involvement raising adenoid cystic carcinoma. Topics include mucus cysts and obstruction, salivary gland infection and inflammation, Sjogren syndrome and xerostomia, and the benign and malignant salivary gland tumors.

Case Coverage Map
What each case is testing
A bluish lip bump that keeps coming back:
Mucocele as mucus extravasation, why it recurs, excision with the feeding minor gland, and submitting tissue.
A swelling under the tongue:
Ranula from the sublingual gland, the plunging variant, surgical management, and the contrast with a lip mucocele.
A gland that swells at meals:
Sialolithiasis of the submandibular system, the mealtime-swelling clue, localization, stone removal, and secondary sialadenitis.
Dry mouth, dry eyes, and rampant decay:
Sjogren syndrome (secondary, with rheumatoid arthritis), caries from lost saliva, aggressive prevention, and lymphoma risk.
A slow, painless lump in front of the ear:
Pleomorphic adenoma as the most common salivary tumor, the facial nerve in the parotid, recurrence risk, and referral.
A firm lump on the palate:
A palatal minor salivary gland tumor, the smaller-gland-more-malignant rule, mucoepidermoid carcinoma, and image-and-biopsy over incision.
A painful swollen gland in a dehydrated patient:
Acute bacterial sialadenitis (Staphylococcus aureus), low salivary flow, hydration and antibiotics, and prevention.
A painful salivary mass with numbness:
Malignancy red flags, adenoid cystic carcinoma and perineural invasion, urgent referral, and long-term follow-up.
Patient case: A bluish lip bump that keeps coming back
0 of 5 answered, 0 correct
Patient
Male, 19 years old
Chief Complaint
"I keep getting a soft bluish bump on my lower lip that pops and returns."
Background and/or Patient History
  • Recurrent soft, dome-shaped swelling of the lower lip
  • History of biting the lip
  • The swelling sometimes ruptures and then reforms
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • A bluish, fluctuant nodule on the lower labial mucosa
  • No induration
  1. Question 1
    Moderate
    A recurrent bluish, fluctuant swelling of the lower lip after lip trauma is most likely a:
  2. Question 2
    Moderate
    The mechanism is:
  3. Question 3
    Moderate
    Why does the swelling keep recurring?
  4. Question 4
    Moderate
    Definitive management is:
  5. Question 5
    Moderate
    Excised tissue should be:

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Patient case: A swelling under the tongue
0 of 5 answered, 0 correct
Patient
Female, 23 years old
Chief Complaint
"There's a soft bluish swelling on the floor of my mouth."
Background and/or Patient History
  • A dome-shaped, bluish swelling on one side of the floor of the mouth
  • Slowly enlarging, mostly painless
  • Slight interference with tongue movement
  • No fever
Allergies
NKDA
Medications
  • None
Current Findings
  • A translucent bluish swelling of the floor of mouth lateral to the midline
  • Soft and fluctuant
  1. Question 1
    Moderate
    A bluish, fluctuant swelling of the floor of the mouth is most consistent with a:
  2. Question 2
    Moderate
    A ranula most commonly arises from which gland?
  3. Question 3
    Hard
    A ranula that extends below the mylohyoid muscle into the neck is called a:
  4. Question 4
    Moderate
    Management of a ranula typically involves:
  5. Question 5
    Moderate
    Compared with a lip mucocele, a ranula differs mainly in its:

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Patient case: A gland that swells at meals
0 of 5 answered, 0 correct
Patient
Male, 49 years old
Chief Complaint
"The gland under my jaw swells and hurts when I eat, then goes down."
Background and/or Patient History
  • Recurrent painful swelling below the jaw, worst at mealtimes
  • Swelling subsides between meals
  • Occasional gritty sensation in the floor of the mouth
  • Otherwise well
Allergies
NKDA
Medications
  • None
Current Findings
  • Submandibular gland enlarges and is tender with salivation
  • A firm body palpable along the floor of mouth (Wharton duct)
  1. Question 1
    Moderate
    Painful submandibular swelling that worsens at mealtimes and then subsides indicates:
  2. Question 2
    Hard
    Salivary stones most commonly form in the submandibular system because:
  3. Question 3
    Moderate
    A useful chairside step to locate the stone is:
  4. Question 4
    Moderate
    Management of a symptomatic sialolith may include:
  5. Question 5
    Moderate
    A complication of an untreated obstructing stone can be:

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Patient case: Dry mouth, dry eyes, and rampant decay
0 of 5 answered, 0 correct
Patient
Female, 58 years old
Chief Complaint
"My mouth and eyes are always dry, and I keep getting cavities."
Background and/or Patient History
  • Chronic dry mouth and dry eyes for over a year
  • New caries, especially at the gumline and root surfaces
  • History of rheumatoid arthritis
  • Difficulty swallowing dry foods
Allergies
NKDA
Medications
  • Rheumatoid arthritis therapy
Current Findings
  • Dry, glazed oral mucosa with little pooled saliva
  • Multiple cervical and root caries; angular cheilitis
  1. Question 1
    Moderate
    Dry mouth plus dry eyes with an autoimmune history most suggests:
  2. Question 2
    Moderate
    Because she also has rheumatoid arthritis, this is classified as:
  3. Question 3
    Moderate
    Her rampant cervical and root caries are explained by:
  4. Question 4
    Moderate
    Her dental management should emphasize:
  5. Question 5
    Hard
    A serious systemic risk to keep in mind in Sjogren syndrome is:

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Patient case: A slow, painless lump in front of the ear
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
"There's a slow-growing painless lump in front of my ear."
Background and/or Patient History
  • A firm, mobile, painless mass in the parotid region for many months
  • No facial weakness
  • No pain or skin changes
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • A discrete, mobile, non-tender mass in the parotid
  • Facial nerve function intact
  1. Question 1
    Moderate
    A slow-growing, painless, mobile parotid mass is most likely a:
  2. Question 2
    Moderate
    The pleomorphic adenoma is:
  3. Question 3
    Moderate
    An important surgical consideration with parotid tumors is the:
  4. Question 4
    Moderate
    If a pleomorphic adenoma is incompletely removed, it may:
  5. Question 5
    Moderate
    The appropriate next step for this parotid mass is to:

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Patient case: A firm lump on the palate
0 of 5 answered, 0 correct
Patient
Male, 54 years old
Chief Complaint
"There's a firm lump on the roof of my mouth that isn't sore."
Background and/or Patient History
  • A slowly enlarging, firm swelling on the posterolateral hard palate
  • Non-ulcerated and not painful
  • No obvious dental source
  • Otherwise well
Allergies
NKDA
Medications
  • None
Current Findings
  • A firm, non-ulcerated submucosal palatal swelling lateral to the midline
  • Adjacent teeth vital, no periapical source
  1. Question 1
    Moderate
    A firm, non-ulcerated swelling on the posterolateral hard palate should first be considered a:
  2. Question 2
    Hard
    Compared with parotid tumors, tumors of the minor glands and palate are:
  3. Question 3
    Moderate
    Which salivary malignancy commonly arises in the palate (minor glands)?
  4. Question 4
    Moderate
    The correct approach to this palatal swelling is to:
  5. Question 5
    Moderate
    Adjacent teeth testing vital is useful because it:

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Patient case: A painful swollen gland in a dehydrated patient
0 of 5 answered, 0 correct
Patient
Female, 78 years old
Chief Complaint
"My cheek by my ear is painful, swollen, and there's a bad taste."
Background and/or Patient History
  • Recently hospitalized and poorly hydrated
  • Acute painful swelling of the parotid region
  • Reduced oral intake and dry mouth
  • Feels generally unwell
Allergies
NKDA
Medications
  • Several, including a drug that dries the mouth
Current Findings
  • Tender, swollen parotid with pus expressible from the duct
  • Dehydrated, low salivary flow
  1. Question 1
    Moderate
    An acutely painful, swollen gland with expressible pus in a dehydrated elderly patient is:
  2. Question 2
    Moderate
    The most common causative organism is:
  3. Question 3
    Moderate
    A key contributing factor in this patient is:
  4. Question 4
    Moderate
    Initial management includes:
  5. Question 5
    Moderate
    A practical preventive measure in at-risk hospitalized patients is to:

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Patient case: A painful salivary mass with numbness
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
"I have a lump near my jaw that aches, and part of my face feels numb."
Background and/or Patient History
  • A firm salivary region mass present for months
  • Persistent pain, unusual for a benign tumor
  • Developing numbness in the area
  • No infection signs
Allergies
NKDA
Medications
  • None
Current Findings
  • A firm, somewhat fixed mass with associated pain and altered sensation
  • Possible nerve involvement on examination
  1. Question 1
    Moderate
    Pain and nerve involvement (numbness) with a salivary mass are features that suggest:
  2. Question 2
    Hard
    The salivary malignancy classically associated with perineural invasion and pain is:
  3. Question 3
    Moderate
    Perineural invasion explains why this tumor tends to cause:
  4. Question 4
    Moderate
    The appropriate action is to:
  5. Question 5
    Moderate
    Why is long-term follow-up especially important after treating adenoid cystic carcinoma?

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