Chronic sialadenitis is a sluggish inflammation of the salivary gland, which is characterized by alternating periods of exacerbations and remissions. There are no complaints during the latent phase of chronic sialadenitis. During the manifest stage, a painless swelling appears in the projection of the affected gland, salivation decreases, a feeling of heaviness and soreness periodically occurs, there is an unpleasant taste in the mouth. Diagnosis includes collection of complaints, clinical examination, additional research methods. Treatment is aimed at relieving inflammation, normalizing salivation, and preventing the development of degenerative changes.
Chronic sialadenitis is an inflammatory disease of the salivary gland, which proceeds with erased symptoms and leads to irreversible destructive changes, accompanied by a decrease in secretory activity. According to the localization of the pathological focus, chronic mumps is most often detected (in children, chronic sialadenitis of the auricular salivary gland is diagnosed in 90% of cases), submaxillitis occurs in 3% of patients. The parenchymal form of disease mainly affects women, whereas interstitial sialadenitis is more often found in men.
The highest percentage of patients with sialodochitis (ductal sialadenitis) is detected among the elderly. In most cases, the cause of chronic sialadenitis is the nonspecific microflora of the oral cavity. Tuberculous and actinomycotic lesions are extremely rare. Unilateral chronic sialadenitis is diagnosed in 44% of cases, and signs of bilateral inflammatory process are found in 56% of patients.
Parenchymal chronic sialadenitis occurs against the background of congenital pathology of the ducts of the salivary gland. As a result, stagnant processes develop, retention of secretions produced by the gland is observed. Thus, favorable conditions are created for infection of parenchymal cells with nonspecific microflora of the oral cavity by a ductogenic route.
The etiology of interstitial chronic sialadenitis has not been fully studied. Scientists suggest that metabolic disorders are at the heart of the disease. Sialodochitis occurs as a result of injuries, congenital ectasia of the ducts, as well as due to compression of the mouth of the excretory duct by a tumor, enlarged lymph nodes. Predisposing factors in the development of chronic sialadenitis are general somatic diseases (diseases of the respiratory system, digestive organs, endocrine glands).
Microscopically, in the parenchymal form of chronic sialadenitis, swelling and proliferation of blood vessels of various calibers in the interlobular zones are detected. Inflammatory infiltrate cells are concentrated around the expanded distal sections of the excretory ducts. In places, the development of coarse connective tissue in the form of narrow strands is noted. Acinuses are formed by cylindrical epithelial cells whose cytoplasm is vacuolized, the nuclei are hyperchromic.
In interstitial chronic sialadenitis, edematous connective tissue is detected. In the interlobular areas, there is an overgrowth and dilation of blood vessels. In other parts of the gland, along with strands of fibrous tissue, clusters of lymphocytes and histiocytes are found. Parenchyma is represented by lymphoid cells.
In clinical dentistry , there are three forms of chronic sialadenitis:
- Parenchymal chronic sialadenitis. It is characterized by the involvement of parenchymal cells in the pathological process. Chronic parenchymal inflammation of the auricular salivary gland is most often diagnosed.
- Interstitial chronic sialadenitis. It proceeds with a lesion of the interlobular space. Interstitial submaxillitis (inflammation of the submandibular gland) is most often detected. Mostly men are ill.
- Ductal chronic sialadenitis. It occurs as a result of injuries, congenital pathology of the excretory ducts. The disease is more common in old age.
In the parenchymal form of chronic sialadenitis in the first days of the development of the disease, patients do not complain. During an external oral examination, the patient’s face is symmetrical, the skin is not changed in color. Mouth opening is free. The affected salivary gland is not enlarged in size. Salivation is normal.
With the progression of pathology, patients indicate the appearance of a feeling of heaviness, swelling of the inflamed gland, the presence of an unpleasant taste in the mouth. At the same time, the amount of secretions produced is reduced. In the absence of proper treatment of chronic sialadenitis, the affected gland increases in size, its surface becomes uneven, bumpy. The main complaints are reduced to a feeling of dry mouth. Soreness occurs periodically.
In the interstitial form of chronic sialadenitis, patients are concerned about minor soreness in the area of the inflamed gland. At the same time, there are no signs of secretory insufficiency in the initial phase of the disease. With the progression of the inflammatory process, the gland increases in size, the feeling of soreness becomes more pronounced. Sometimes with interstitial chronic sialadenitis, patients indicate hearing loss. Palpatory examination reveals an enlarged inflamed gland of a testy consistency with a smooth or bumpy surface. Secretory function is disrupted.
With ductal chronic sialadenitis, a feeling of bursting occurs after eating spicy, spicy foods. After a while, the soreness goes away. Stagnant saliva is released from the duct, there is an unpleasant salty taste in the mouth. During the examination, a roller-like thickening is detected along the course of the excretory duct of the inflamed gland. When pressing on the swelling, an abundant amount of turbid saliva with an admixture of fibrinous inclusions is released from the mouth.
Diagnosis of chronic sialadenitis is reduced to collecting complaints, compiling a medical history, clinical examination and conducting additional research methods, including sialometry, sialography, cytological analysis of the secreted secretions:
Objective data. In the initial phase of development, there are no external signs of the disease: the patients’ face is symmetrical, the skin is not changed in color, the affected gland is not enlarged in size. During intraoral examination of the mouth of the excretory duct without signs of pathological changes, saliva is transparent. The secretory function is not impaired. With the progression of chronic sialadenitis, there is the appearance of a painless swelling in the area of the inflamed salivary gland, the surface of which becomes bumpy. Hyposalivation is observed. With ductal chronic sialadenitis, the dentist detects a thickening along the course of the excretory duct. After massaging the seal, saliva of a stagnant nature is released, the swelling disappears. The late phase of ductal chronic sialadenitis is characterized by uneven thickening of the gland.
Cytological analysis. Cytological examination of the secretion at the stage of initial manifestations and during remission of the disease reveals a small amount of mucus, there are accumulations of lymphocytes, as well as cells of the flat and cylindrical epithelium. During the exacerbation of chronic sialadenitis, the mucus content increases in secret, the number of neutrophils and goblet cells increases.
Rengenography of salivary glands. During the sialometric analysis, a decrease in salivation is observed during the phase of pronounced manifestations. In the parenchymal form, small cavities filled with a contrast agent are detected using sialography, the lumen of the ducts is narrowed, the contours are traced well, the parenchyma is not determined. In the case of interstitial sialadenitis, narrowed ducts with uneven contours are found. The parenchyma of the gland is not traceable. With sialodochitis, a significant expansion of the main duct is established. In the late phase of the disease, small ducts enlarged in diameter are detected.
Chronic sialadenitis is differentiated with acute sialadenitis of bacterial and viral etiology, benign and malignant neoplasms of glandular tissue, pseudoparotitis of Herzenberg, sialadenoses. The patient is examined by a dental surgeon.
Treatment of chronic sialadenitis is aimed at relieving the inflammatory process, normalizing salivation, preventing the development of degenerative changes in the parenchyma and stroma of the affected gland. During the manifest phase, the therapy of chronic sialadenitis is reduced to the appointment of antibacterial and anti-inflammatory drugs. Proteolytic enzymes together with antibiotics are also administered topically by ductogenic route (through the excretory duct).
Blockades of the stellate ganglion are effective for stimulating salivation. In order to reduce sensitization, antihistamines are used. Multivitamin complexes are shown to increase the protective properties of the body. To prevent the development of destructive changes during the remission of chronic sialadenitis, physiotherapy procedures are used, namely, potassium iodide electrophoresis.
In case of ineffectiveness of conservative treatment of chronic sialadenitis, surgical intervention is indicated. When abscesses occur, they are opened and drained. With an exacerbation of sialodochitis, an intraoral incision of the duct is performed, rinsing with solutions based on medicinal herbs is prescribed. Depending on the area of the lesion, partial or complete resection of the gland can be performed.
If chronic sialadenitis is detected, the prognosis is favorable in 50% of cases. Timely diagnosis and comprehensive treatment of the disease lead to recovery. If the cause of the inflammatory process is a congenital pathology of the excretory ducts, even in the absence of complaints, the patient is registered at the dispensary after clinical treatment.
- Sialadenitis in the Old-Old and Its Risk Factors – Khalil Rahman, Katie Kreicher, Karen Kost, Kourosh Parham link
- Studies on newly recognized chronic sialadenitis link
- Iodine-Associated Sialadenitis: An Inflammatory Condition – Shivani J Deopujari, Michelle Troendle
- [Autoimmune sialadenitis] – O Guntinas-Lichiu, A Vissink, S Ihrler