Sialadenitis – a disease of inflammatory nature, localized in the salivary glands, arising for one reason or another (infection, traumatic effect, developmental abnormality). In a situation where an infectious disease serves as a substrate for the development of sialoadenitis, its secondary nature should be indicated in the diagnosis. There are primary sialoadenitis, which are most often caused by impaired embryogenesis of the salivary glands and are observed in pediatric practice.
Most often, the pathological process in sialadenitis is unilateral, asymmetric, but in 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 the parotid sialadenitis. All the reasons for the emergence of salivary gland sialadenitis 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, causing local and general inflammatory response. Under these conditions, as a rule, purulent sialadenitis develops, which can spread to healthy individuals with the method of airborne transmission of the virus. The epidemic form of sialoadenitis is more common in pediatric practice and the recognition of the disease does not cause difficulties for experienced infectiologists due to the development of a whole spectrum of pathognomonic clinical signs.
Non-epidemic acute serous sialadenitis develops as a result of disturbed outflow of mucus through the salivary duct, which occurs with a strong traumatic effect, blockage with a foreign body or calculus when calculous sialadenitis develops.
The development of inflammatory changes in the salivary glands, which always takes place with sialadenitis, is promoted by the presence of chronic infectious foci in the form of carious teeth in the oral cavity.
In addition, non-epidemic sialadenitis of the parotid gland may 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 edema, infiltration, purulent fusion and necrosis of the glandular tissue with a further replacement by the connective tissue and the formation of a scar. Not in all situations the outcome of an acute process is suppuration and necrosis, more often inflammatory changes subside at earlier stages.
In a situation where the patient has sialadenitis of the parotid gland, the pathognomonic sign is the appearance of pronounced pain syndrome at the opening of the mouth, as well as head movements. Over time, the swelling of soft tissues spreads to the adjacent areas (buccal, submandibular, mandibular, and also the upper section of the neck).
When conducting deep palpation, which is difficult due to the pronounced pain syndrome, there is an infiltration of a dense consistency in the projection of the putative location of the parotid gland. In a situation when a patient has a complication in the form of purulent fusion, a positive symptom of fluctuation is determined over the affected area.
A specific sign of sialoadenitis is hypo-or hypersalivation, with a violation of the qualitative composition of saliva (flakes of mucus, an admixture of pus and even desquamated epithelium are found in it).
Submandibular sialadenitis debuts with symptoms such as pain during swallowing movements, swelling of the submandibular and sublingual regions, followed by spreading to the cervical region. A visual examination of a patient with submandibular sialoadenitis shows an increase in the density of the gland, preserving its mobility in the projection of the distal maxillary-tongue groove.
Acute serous sialadenitis of the hypoglossal glands is accompanied by the appearance of painful sensations during movement of the tongue, as well as an increase in the hyoid folds. Objective signs of sialoadenitis are visualization of damage to the mucous membrane over the location of the gland, rejection of pus and necrotic gland tissue.
Contact sialadenitis occurs when inflammation spreads from cellulitis of the parotid-masticatory and sublingual area. After opening phlegmon, one-sided sialadenitis usually develops. In addition to clinical manifestations, cytological examination of the salivary gland secretion is a good help for establishing the correct diagnosis.
When sialadenitis is provoked by blockage of the salivary ducts by 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. Briefly, a foreign body provokes a delay in the secretion of saliva, as well as a slight swelling of the parotid and submandibular glands. 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 the melting of the capsule of the gland and the spread of the pathological process to the surrounding tissues. In some situations, there is an independent opening of the abscess with the release of a foreign body. Prolonged presence of a foreign body in the salivary gland can become a substrate for the formation of salivary calculus.
The acute form of sialoadenitis develops, as a rule, against the background of general dehydration of the body, impaired natural salivation, deterioration of oral hygiene, as well as during neuro-vegetative reactions. The predominant localization of the inflammatory process in this situation is the parotid gland.
Dysfunction of the gland should also be considered among the local causes of the development of acute sialoadenitis in inflammatory changes in the periodontal tissue, as well as in traumatic effects on the gland.
The intensity, pathognomonicity of clinical manifestations in acute sialoadenitis is correlated with the nature of the inflammation and the localization of the pathological process.
Acute serous sialadenitis makes its debut with a sharp pain syndrome in the projection of the parotid region, which increases with the performance of chewing movements. The deterioration of the patient’s condition in this pathology is developing rapidly and is characterized by the appearance of febrile-type fever, a feeling of dry mouth and pain. An objective examination of the patient with acute sialoadenitis visualized all signs of inflammation in the form of a sharp increase in soft tissue in the area of damage, pain palpation.
With the addition of purulent inflammation, there is a significant deterioration not only in clinical symptoms, but also in laboratory parameters. When managing a patient with signs of acute purulent sialoadenitis, the severity should be carefully assessed, since this pathology is characterized by a complicated course and can be fatal.
Reverse development of acute sialoadenitis is observed 20 days after the onset of clinical manifestations, and under adverse conditions, an abscess may form with signs of fluctuation.
The clinical manifestations of acute sialoadenitis present in the patient require differentiation with such diseases as lymphadenitis, periadenitis, and adenoflegmon.
Chronic sialoadenitis 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 sialadenitis of the parotid gland, which has nothing to do with epidemic parotiditis.
Given the prevalence of the pathological process in the salivary gland, it is customary to separate interstitial and parenchymal sialadenitis (the latter predominates in children).
Most specialists in oral and maxillofacial surgery believe that congenital glandular tissue failure contributes to the occurrence of chronic sialoadenitis.
The exacerbation of the disease is caused by a persistent decrease in the indices of nonspecific protection of the patient’s body, which are not normalized even during the period of clinical remission, which leads to primary chronicity of the inflammatory process.
The peculiarity of chronic sialoadenitis is its tendency to cyclical course. Interstitial chronic submandibular sialadenitis is accompanied by a narrowing of all ducts, therefore, with radiation imaging methods, a decrease in the intensity of the parenchyma is noted without disturbing its structure. The use of contrast X-ray techniques is allowed only in the period of complete remission.
Treatment of a patient with signs of chronic sialoadenitis directly depends on the stage of the disease development. So, in the period of exacerbation it is obligatory to prescribe antibacterial agents (ampioks in a daily dose of 2 g orally), desensitizing drugs (Cetrin, 1 tablet 1 time per day).
When signs of purulent inflammation appear, daily instillation of the affected gland is indicated, until saliva analysis indicators are normalized for pus. Instillation is used with the use of antiseptics and proteolytic enzymes that contribute to the lysis of necrotic tissue, anti-inflammatory, dehydration action.
As a local treatment, the use of ointment compresses and compresses with 30-50% dimexide is indicated.
As preventive measures in chronic sialadenitis, salivation stimulation is used, which is provided by the introduction of 1.5 ml of 15% Xanthineol nicotinate into the salivary duct.
Patients with signs of chronic sialadenitis require medical examination and preventive measures aimed at preventing the development of exacerbations.
Treatment of sialoadenitis
Sialadenitis salivary gland is well treatable in the acute phase of the disease, and the chronic course is difficult to treat.
The basis of pathogenetic treatment of sialadenitis is drugs that increase saliva secretion and promote it through the salivary duct (1% solution of Pilocarpine).
In addition, physiotherapeutic methods of treatment in the form of UHF to the site of injury, as well as the use of alcohol-camphor compresses, have a good therapeutic effect in sialadenitis.
By nonspecific methods of treatment of sialoadenitis should include patient compliance with the rules of oral hygiene, which involves regular cleansing of the teeth and tongue after each meal with a brush and dental floss. Also, patients should stop smoking.
The organization of the patient’s eating behavior, which implies an increase in the drinking regime, the grinding of food helps prevent the spread of inflammation to the surrounding tissues.
Severe inflammatory reaction, which is characterized by purulent sialadenitis, can provoke a fever, which should be stopped by taking antipyretic drugs (Nimid in a single dose of 100 mg). For relief of pain, which often accompanies the submandibular sialadenitis, various massage techniques should be used on the affected area.
Chronic sialadenitis is difficult to treat, and the percentage of complete recovery in this situation does not exceed 20%. All the applied methods of treatment in the chronic course of sialoadenitis are used to a greater extent to prevent the development of complications. The period of exacerbations in chronic sialadenitis is also due to the development of inflammation in the salivary gland, which makes it advisable to use antibacterial agents. During the period of remission of this category of patients, the course of the electroplating of the salivary glands is shown.
In a situation where the patient has calculous sialadenitis, the use of surgical intervention is warranted. Also, surgery is indicated in cases where there is a purulent parenchymal sialadenitis with signs of melting. The volume 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 the concomitant introduction to the area of antibiotic damage.
Sialadenitis – which doctor will help? In the presence or suspicion of the development of sialoadenitis should immediately seek advice from specialists such as infectious diseases, surgeon.