Sialoadenitis is an inflammatory disease, localized in the salivary glands, arising for one reason or another (infection, traumatic effect, developmental anomaly). In a situation where the substrate for the development of sialoadenitis serves an infectious disease, it is necessary in the diagnosis to indicate its secondary nature. There are also primary sialadenitis, which are most often due to a violation of salivary gland embryogenesis and are observed in pediatric practice.
Most pathological process with sialoadenitis is one-sided asymmetric in nature, but in the world practice there are data on multiple lesions.
Causes of sialoadenitis
The most common in the overall morbidity structure of the etiopathogenetic variant of this pathology is parotid sialadenitis. All the reasons for the emergence of the sialadenitis of the salivary gland can be attributed to one of the two main etiological groups (epidemic and non-epidemic group).
The main cause of the development of the epidemic form of sialoadenitis is the ingestion of viral or bacterial particles into the body that cause a local and general inflammatory reaction. Under these conditions, usually purulent sialadenitis develops, which can spread to healthy individuals with the method of airborne virus transmission. The epidemic form of sialadenitis is more common in pediatric practice and the recognition of the disease does not cause difficulties for experienced infectionists due to the development of a whole spectrum of pathognomonic clinical signs.
The non-epidemic acute serous sialoadenitis develops as a result of a disturbance in the outflow of mucus along the salivary duct, which occurs when the traumatic effect is severe, blocked by a foreign body or concrement, when calculous sialadenitis develops.
The development of inflammatory changes in the salivary glands, which is always the case with sialoadenitis, is facilitated by the presence in the oral cavity of chronic infectious foci in the form of carious teeth.
In addition, non-epidemic parotid sialadenitis can develop as a complication of other diseases of the infectious profile or surgical interventions.
Symptoms and signs of sialoadenitis
Acute sialadenitis of the salivary gland is accompanied by the development of puffiness, infiltration, purulent melting and necrosis of the glandular tissue with further replacement by connective tissue and scar formation. Not in all situations, the outcome of an acute process is suppuration and necrosis, more often inflammatory changes subside in earlier stages.
In a situation in which the patient has parotid gland sialoadenitis, the pathognomonic sign is the appearance of severe pain syndrome when opening the mouth, as well as head movements. Over time, swelling of soft tissues extends to the adjacent areas (buccal, submandibular, mandibular area, as well as the upper part of the cervical region).
When carrying out deep palpation, which is difficult due to severe pain syndrome, a dense infiltrate is felt in the projection of the supposed location of the parotid gland. In a situation in which a complication in the form of purulent fusion is attached to the patient, a positive symptom of fluctuation is determined over the lesion area.
A specific sign of sialoadenitis is hypo- or hypersalivation , with a violation of the qualitative composition of saliva (it reveals flakes of mucus, an admixture of pus, and even a desiccated epithelium).
Submandibular sialoadenitis debuts with such symptoms as pain in swallowing movements, edema of the submandibular and sublingual region with subsequent spread to the cervical region. Visual inspection of the patient with submandibular sialoadenitis shows an increase in the density of the gland with preservation of its mobility in the projection of the distal part of the maxillofacial groove.
Acute serous sialoadenitis of the sublingual glands is accompanied by the appearance of painful sensations during the movement of the tongue, as well as an increase in sublingual folds. Objective signs of sialoadenitis should be considered visualization of damage to the mucous membrane above the location of the gland, rejection of pus and necrotic tissue of the gland.
Contact sialoadenitis occurs when inflammation spreads from the phlegmon of the parotid-masticatory and sublingual areas. After opening phlegmon, as a rule, unilateral sialoadenitis develops. In addition to clinical manifestations, cytological examination of the secretion of the salivary gland serves as a good tool for establishing the correct diagnosis.
With sialoadenitis, triggered by a blockage of the salivary ducts with a foreign body, the patient may develop various clinical symptoms. In some situations, this pathology is manifested only by a slight increase in the gland, while in others, extensive inflammation develops in the form of an abscess and phlegmon. A short-term foreign body provokes a delay in saliva secretion, as well as a small swelling of the parotid and submandibular gland. Pain syndrome for this form of sialoadenitis is not typical.
The process of purulent inflammation of the salivary gland, in the absence of timely treatment, inevitably provokes melting of the glandular capsule and the spread of the pathological process to the surrounding tissues. In some situations, there is an autopsy of the abscess with the allocation of a foreign body. The prolonged presence of a foreign body in the salivary gland can become a substrate for the formation of the salivary calculus.
The acute form of sialoadenitis develops, as a rule, against the background of general dehydration of the body, violation of natural salivation, impaired hygiene of the oral cavity, and also in neurovegetative reactions. The preferential localization of the inflammatory process in this situation is the parotid gland.
Among the local causes of acute sialoadenitis also should be considered a dysfunction of the gland with inflammatory changes in periodontal tissue, as well as traumatic effects on the gland.
Intensity, patognomonichnost clinical manifestations in acute sialoadenitis has a correlation dependence on the nature of inflammation and localization of the pathological process.
Acute serous sialoadenitis debuts with a sharp pain syndrome in the projection of the parotid region, which is enhanced by the performance of masticatory movements. Deterioration of the patient's condition in this pathology develops rapidly and is characterized by febrile type fever, dry mouth and pain syndrome. In an objective examination of a patient with acute sialoadenitis, all signs of inflammation are visualized in the form of a sharp increase in soft tissues in the affected area, painful palpation.
With the adherence of the purulent nature of inflammation, there is a significant deterioration not only in clinical symptoms, but also in laboratory indicators. When managing a patient with signs of acute purulent sialoadenitis, severity should be carefully evaluated, since this pathology is complicated by a complicated course and can end up lethal.
The reverse development of acute sialadenitis is observed after 20 days from the onset of clinical manifestations, and under adverse conditions, an abscess with signs of fluctuation may form.
The patient's clinical manifestations of acute sialoadenitis need differentiation with such diseases as lymphadenitis , periadenitis, adenophlegmon.
The chronic course of sialadenitis is a fairly common disease and in pediatric practice is at least 14% in the structure of the incidence of maxillofacial surgery. The most common chronic sialoadenitis of the parotid gland, which has nothing to do with epidemic parotitis.
Given the prevalence of the pathological process in the salivary gland, it is common to separate the interstitial and parenchymal sialadenitis (the latter predominates in children).
Most specialists in maxillofacial surgery believe that the emergence of chronic sialoadenitis contributes to congenital failure of the glandular tissue.
The aggravation of the disease is caused by a persistent decrease in the indices of nonspecific protection of the patient's body, which do not normalize even during the period of clinical remission, which causes the primary chronicization of the inflammatory process.
A feature of chronic sialoadenitis is its propensity to cyclic flow. Interstitial chronic submandibular sialoadenitis is accompanied by narrowing of all ducts, therefore, with radiation imaging methods, the intensity of the parenchyma is reduced without disturbing its structure. The use of contrast methods of X-ray examination is allowed only during the period of complete remission.
Treatment of a patient with signs of chronic sialoadenitis directly depends on the stage of the development of the disease. So, in the period of exacerbation, the appointment of antibacterial agents (Ampiox in a daily dose of 2 g orally), desensitizing drugs (Cetrin 1 tablet once a day) is mandatory.
When signs of purulent inflammation appear, the daily instillation of the affected gland is shown until the saliva analysis parameters are normalized for the presence of pus. The instillation is used with the use of antiseptics and proteolytic enzymes that promote the lysis of necrotic tissues, anti-inflammatory, dehydration action.
As a local treatment, the use of ointment compresses and compresses with 30-50% dimexide is indicated.
As preventive measures for chronic sialoadenitis, salivation stimulation is used, which is provided by injecting into the salivary duct 1.5 ml of 15% Xanthinal nicotinate.
Patients with signs of chronic sialoadenitis need medical examination and preventive measures aimed at preventing the development of exacerbations.
Treatment of sialoadenitis
Sialoadenitis of the salivary gland is well treatable in the acute phase of the course of the disease, and the chronic course is difficult to treat.
The basis of pathogenetic treatment of sialoadenitis is made by drugs that enhance the salivary secretion and its progress along the salivary duct (1% solution of Pilocarpine).
In addition, physiotherapeutic methods of treatment in the form of UHF at the site of the lesion, as well as the use of alcohol-camphor compresses, have a good therapeutic effect with sialoadenitis.
Nonspecific methods of treatment of sialoadenitis include the patient's compliance with the rules of oral hygiene, which involves regular cleaning of the teeth and tongue after each meal using a brush and dental floss. Patients should also stop smoking.
The organization of the patient's eating behavior, implying an increase in the drinking regime, grinding food products helps to prevent the spread of inflammation to surrounding tissues.
The pronounced inflammatory reaction characterized by purulent sialoadenitis can provoke fever, which should be stopped by the use of antipyretic drugs (Nimide in a single dose of 100 mg). To relieve the pain syndrome, which often accompanies the submaxillary sialoadenitis, various techniques of massage of the affected area should be used.
Chronic sialoadenitis is difficult to treat, and the percentage of complete recovery in this situation does not exceed 20%. All the methods of treatment used in the chronic course of sialoadenitis are used to a greater extent to prevent the development of complications. The period of exacerbations in chronic sialoadenitis is also due to the development of inflammation in the salivary gland, which makes it expedient to use antibacterial agents. During the remission of this category of patients, the course of galvanization of the salivary glands is indicated.
In a situation where the patient has calculous sialoadenitis, surgical intervention is justified. Also, surgical intervention is indicated in cases when there is a purulent parenchymatous sialoadenitis with signs of melting. The amount of surgical intervention and surgical benefit directly depends on the degree of damage to the salivary gland and is more limited to the opening and drainage of the gland with concomitant administration of the antibiotic in the area of the lesion.
? Sialoadenitis - which doctor will help ? If there is or suspected development of sialoadenitis, you should immediately consult a specialist such as an infectious disease specialist, a surgeon.