Sialadenitis is an inflammatory disease of the salivary gland, usually of a viral or bacterial nature. Disease is accompanied by an increase in volume, compaction, soreness of the affected salivary gland, a decrease in salivation, dry mouth, a violation of general well–being; in complicated cases, the formation of stones or abscess. The diagnosis is established taking into account the data of bacteriological and cytological analysis of the discharge from the ducts, sialometry, ultrasound of the salivary glands, sialography, sialoscintigraphy, examination of biopsies of small salivary glands. Treatment involves antiviral and antibacterial therapy; calculous form shows the removal of stones.
ICD 10
K11.2 Sialadenite
Meaning
Sialadenitis is an inflammatory lesion of large or small salivary glands, leading to a violation of the salivation process. In dentistry, sialadenitis accounts for 42-54% of all diseases of the salivary glands. The most common cases of sialadenitis are children and patients aged 50-60 years. The most common form of disease is mumps, studied in the framework of infectious diseases and pediatrics. In addition, patholofy can accompany the course of systemic diseases (for example, Sjogren’s disease), which are considered by rheumatology. Specific inflammatory lesions of the salivary glands in tuberculosis, syphilis are the area of interest of the relevant disciplines – phthisiology and venereology.
Classification
Classification of sialadenitis involves their division, taking into account the clinical course, causal factors, the mechanism of infection and morphological changes into the following groups:
1. Acute sialadenitis:
- viral (influenza, cytomegalovirus, Coxsackie-induced sialadenitis, mumps)
- bacterial (postoperative, post-infectious, lymphogenic, contact, associated with obstruction of the salivary gland duct by a foreign body)
2. Chronic sialadenitis:
- parenchymal (inflammation of the parenchyma of the salivary glands)
- interstitial (inflammation of the connective tissue stroma of the salivary glands)
- sialodochitis (ductal sialadenitis)
Chronic form may have a nonspecific and specific etiology. Chronic specific sialadenitis includes tuberculosis, actinomycosis and salivary gland syphilis.
Acute form in its development can go through the stages of serous, purulent inflammation of the salivary gland and its necrosis.
Causes
The causative agents of sialadenitis are viral or bacterial agents that affect the salivary glands. Bacterial sialadenitis is most often caused by the microflora of the oral cavity or microorganisms spreading from distant foci of infection (staphylococci, streptococci, colibacteria, anaerobic flora). Contact sialadenitis is usually observed with phlegmon of the soft tissues adjacent to the gland. Lymphogenic sialadenitis develops after respiratory infections (tracheitis, sore throat, pneumonia), diseases of the maxillofacial region (periodontitis, boils, carbuncle, conjunctivitis). In postoperative sialadenitis, there is always a link between the disease and previous surgical intervention on the oral cavity or salivary gland. Sialadenitis associated with foreign bodies may be caused by sialolithiasis, ingestion of small grains, bones, toothbrush villi, etc. into the duct of the salivary gland.
Among viruses, influenza viruses, adenoviruses, paramyxoviruses, cytomegaloviruses, Coxsackie and Epstein-Barr virus, herpes simplex, etc. play the greatest etiological role in the occurrence of sialadenitis. The causative agents of specific sialadenitis are actinomycetes, Mycobacterium tuberculosis, pale treponema.
Infection of the salivary glands occurs more often through the mouth of the duct, less often by contact, hematogenic or lymphogenic route. The occurrence of sialadenitis is facilitated by a weakening of immunity, stagnation of secretions in the ducts of the gland or a decrease in salivation in severe infections, after surgical interventions on the abdominal cavity, due to damage to the gland. There is an increased risk of sialadenitis in patients with xerostomia; patients receiving radiation therapy of the oral cavity; persons suffering from anorexia.
Symptoms
Due to anatomical and topographic features, the parotid glands are most often inflamed, less often the submandibular, sublingual and small salivary glands. Acute sialadenitis manifests with an increase in the volume and compaction of the affected salivary gland, swelling of soft tissues; pains that tend to increase when chewing, swallowing, turning the head and irradiation into the ear, temple, lower jaw. There may be a limitation of the amplitude of opening the mouth, stuffy ears.
The inflammatory process in the gland is indicated by a violation of its function: hyposalivation (less often hypersalivation), the appearance of mucus, pus, flakes (cells of the exfoliated epithelium) in saliva. Often acute sialadenitis occurs with deterioration of well-being, fever. When examining the gland, a dense infiltrate is palpated, with purulent melting of which a symptom of fluctuation is determined.
Complications
With a complicated course of acute sialadenitis, the occurrence of salivary fistulas, abscess and phlegmon of the parotid-masticatory and submandibular areas, stenosis of the salivary ducts is not excluded. Chronic sialadenitis occurs with intermittent exacerbations, during which there is swelling and slight soreness in the area of the affected salivary glands, decreased salivation, an unpleasant taste in the mouth.
Diagnostics
Depending on the age of the patient, the etiology of inflammation of the salivary glands and the main diseases that it accompanies, sialadenitis can be detected by a dentist, a therapist. An external examination reveals a local swelling in the salivary gland (outside or from the oral cavity), the discharge of pus from the mouth of the excretory duct when massaging the gland.
Various forms of sialadenitis can be differentiated by clinical manifestations, as well as using laboratory and instrumental data. Important information about the specifics of the processes occurring in the salivary gland can be obtained by PCR, biochemical, cytological, microbiological examination of the secretion, biopsy of the salivary glands with histological examination of the material. The presence of species-specific antibodies in the blood serum is determined by enzyme immunoassay.
Anatomical and topographic features and functional disorders of the glands are analyzed based on the results of ultrasound of the salivary glands, sialography, sialoscintigraphy, sialotomography, thermography. To quantify the secretion of salivary glands, sialometry is used. Differential diagnosis of sialadenitis should follow the path of exclusion of sialadenosis, salivary stone disease, cysts and tumors of the salivary glands, lymphadenitis, infectious mononucleosis, etc.
Treatment
Depending on the type of pathogen, etiotropic therapy of sialadenitis may include the appointment of antiviral or antibacterial drugs. With viral sialadenitis, the oral cavity is irrigated with interferon; with bacterial, antibiotics and proteolytic enzymes are instilled into the duct of the salivary gland. In the infiltration stage, novocaine blockades are performed according to Vishnevsky, dimethyl sulfoxide solution is applied to the gland area. When abscessing, an opening of the abscess is shown.
In chronic sialadenitis, gland massage, physiotherapy (electrophoresis, fluctuation, galvanization, UHF) is added to drug therapy. With strictures, the ducts of the salivary gland are booged; if salivolites are detected, they are removed by one of the accepted methods (lithotripsy, sialendoscopy, lithoextraction, etc.). In the case of persistent, recurrent course of sialadenitis, the issue of extirpation of the salivary gland is resolved.
Prognosis and prevention
The outcome of sialadenitis, in most cases, is favorable. In the case of acute form, recovery usually occurs within 2 weeks. In severe or advanced cases, sialadenitis may be accompanied by cicatricial deformation or overgrowth of the ducts, persistent violation of salivation, necrosis of the gland.
Prevention consists in strengthening immunity, maintaining oral hygiene, treating concomitant diseases, eliminating stomatogenic foci of chronic infection.
