Salivary gland abscess is a limited purulent inflammation of the exocrine gland that secretes its secret (saliva) into the oral cavity. Salivary gland abscess is usually a complication of sialadenitis or sialolithiasis and has a bacterial etiology. Salivary gland abscess manifests itself by dry mouth, increased body temperature, weakness, as well as swelling, redness, shooting pain and a feeling of bursting in the affected area. The disease is diagnosed on the basis of examination, bacteriological and cytological examination of the secretion of glands, ultrasound, sialography, etc. Treatment of salivary gland abscess consists in surgical opening of the abscess, drainage and antibiotic therapy.
Salivary gland abscess most often affects the parotid glands, but it can also occur in the submandibular, sublingual, small salivary glands. In half of the cases, the pathological process extends to the paired salivary gland. Salivary gland abscess, like abscesses of other localizations, is characterized by the presence of a pyogenic membrane that restricts the abscess from surrounding structures and tissues, but with the progression of the disease, the accumulation of purulent exudate leads to rupture of the infiltrative capsule. In this case, it is possible to form a fistula with the outpouring of pus into the oral cavity or on the surface of the skin, or the penetration of purulent contents into the surrounding tissues with the development of phlegmon. Salivary gland abscess is a dangerous disease that requires immediate hospitalization of the patient in the department of surgical dentistry.
Causes of salivary gland abscess
The cause of the development of a salivary gland abscess is a bacterial infection – staphylococci, streptococci, anaerobic microflora. An abscess is a complication of the following diseases and conditions:
- Diseases of the salivary glands. The abscess develops due to inflammation (sialadenitis) or salivary stone disease (sialolithiasis) and is formed due to untimely treatment of these pathologies, as well as poor oral hygiene. In young children, a salivary gland abscess may be a complication of sialadenitis caused by cytomegalovirus.
- Piggy. Salivary gland abscess can also occur against the background of specific inflammation of the parotid glands in mumps. This viral disease is dangerous by affecting not only the salivary glands, but also other glands: pancreas, genital and mammary.
- Postoperative period. Unsatisfactory hygienic oral care after surgical operations may predispose to the development of a salivary gland abscess. This is because anesthesia significantly inhibits the function of the salivary glands, resulting in a decrease in saliva production and a decrease in its bactericidal role.
- A foreign body. Often, the formation of an abscess is caused by the ingress of a foreign object (a small bone, a grain, etc.) into the duct of the salivary gland.
The formation of a salivary gland abscess often occurs against the background of exhaustion of the body, a general decrease in immunity caused by viral (influenza, herpes), bacterial (tuberculosis, pneumonia) and chronic (diabetes mellitus, etc.) diseases.
Symptoms of salivary gland abscess
The development of an abscess is usually preceded by general symptoms of diseases of the salivary glands. An unpleasant taste appears in the mouth, dryness of the mucous membrane is observed, painful sensations when chewing and swallowing. There is swelling and hyperemia at the site of inflammation. There is a sharp increase in body temperature to 40 ° C, general weakness and malaise. A dense painful formation is felt in the inflamed gland during palpation.
Characteristic signs of the development of an abscess are shooting pain in the affected salivary gland, as well as a feeling of pressure and bursting, which indicates the accumulation of pus. Painful sensations can be given to the upper jaw, ear and neck. In case of damage to the parotid salivary glands (purulent mumps), the swelling spreads to the cheek, the lower jaw area and the upper part of the neck, the patient feels pain when turning his head and opening his mouth. When the abscess is localized in the sublingual and submandibular glands, swelling occurs in the chin area, severe pain is felt when swallowing.
The disease can develop very quickly: in 1-2 days, purulent inflammation melts the structure of the gland, and necrosis begins. In 50% of cases, the inflammatory process passes to the paired salivary gland. A significant accumulation of pus in the future leads to spontaneous opening of the abscess. In the event of a breakthrough of the infiltrative capsule, the purulent contents pour out with the formation of a fistula. If the abscess breaks into the surrounding tissues of the oral cavity, it is possible to form a diffuse inflammation (phlegmons), fraught with very serious consequences, for example, sepsis.
A salivary gland abscess is diagnosed by a dentist based on anamnesis and data obtained during the examination. Salivary gland abscess must be differentiated from early forms of sialadenitis, sialolithiasis, cysts, tumors of the salivary gland and lymphadenitis. The following diagnostic procedures are performed.
- Bacteriological analysis. To accurately determine the causative agent of the disease, secretions from the gland are examined.
- Instrumental techniques. Ultrasound of the salivary glands and sialography are performed, which allow you to accurately identify the localization, the stage of the inflammatory process and the degree of damage to the gland.
- Cytological examination. In some cases, it is necessary to study the cellular material of the salivary glands to exclude the oncological nature of the disease.
Treatment of salivary gland abscess
The treatment of pathology involves surgical intervention in a hospital setting. The surgeon performs an autopsy and emptying of the abscess, after which the abscess cavity is drained to ensure the outflow of purulent exudate and the discharge of salivary stones. To prevent the progression of the inflammatory process, antibacterial drugs are injected directly into the affected gland. When tissue necrosis begins, the gland or part of it is removed (resected).
After opening the purulent cavity, the surgeon determines which areas of the gland can function, and which are no longer able to produce saliva. If the excretory duct is not affected by necrotic changes, part of the gland can be preserved, otherwise it is completely removed. In the postoperative period, complex treatment is indicated, which includes antibiotics, immunostimulating drugs, vitamins, physiotherapy procedures: laser and magnetic therapy. Of great importance during rehabilitation is a proper balanced diet, which is prescribed by a doctor.
Prognosis and prevention
Salivary gland abscess is a very serious disease, fraught with serious consequences, therefore, at the first symptoms, it is necessary to consult a doctor as soon as possible, who will accurately diagnose and prescribe the correct treatment. A timely operation usually allows you to give a favorable prognosis, recovery occurs within 14 days. If the disease is neglected, it is possible to spread the inflammatory process to the surrounding tissues and develop complications, for example: osteomyelitis, phlegmon and sepsis. In this case, the prognosis is unfavorable, in particularly severe cases, a fatal outcome is possible.
Prevention measures help to avoid salivary gland abscess and severe complications. It is necessary to carefully observe oral hygiene, especially after undergoing surgical operations. In the presence of sialadenitis, it is important to strictly adhere to the doctor’s prescriptions in order to prevent the development of an abscess, as well as to stop smoking until recovery. In case of dry mouth, it is recommended to eat foods that cause excessive salivation: lemons, sauerkraut, cranberries, etc., but it is necessary to consult a doctor about this. It is necessary to treat infectious and chronic somatic diseases in a timely manner, strengthen the immune system, and regularly sanitize the oral cavity.