Sialadenosis is a reactive dystrophic lesion of the salivary glands, occurring with a violation of their secretory and excretory functions. In most cases, sialadenoses are associated with endocrine, neurogenic, allergic diseases, nutritional disorders and occur with a painless, symmetrical increase in the volume of salivary glands, a decrease in salivation. Diagnosis of sialadenosis requires sialometry, sialography, ultrasound of salivary glands, sialoscintigraphy, CT, cytological and biochemical examination of ductal secretions, biopsy of gland tissues. Treatment of sialadenosis includes drug blockades, physiotherapy, acupuncture, infusion therapy with rheopolyglucine solutions and hemodesis.
Sialadenosis (sialosis) is a non–inflammatory and non-tumor disease of the salivary glands, accompanied by their enlargement and/ or dysfunction. In dentistry, sialadenoses account for about 10% of the total pathology of the salivary glands. Sialadenosis is mainly diagnosed in people over 30 years of age, with the same frequency in men and women. Since sialadenosis often accompanies the course of endocrine, systemic, dysmetabolic, allergic diseases, this pathology is also of practical interest for endocrinology, rheumatology, gastroenterology, allergology and other disciplines.
According to the localization of pathological changes, interstitial, parenchymal and ductal forms of sialadenosis are distinguished. In the development of the disease, the initial stage, the stage of pronounced clinical changes and the late stage of sialadenosis are distinguished.
The primary assessment of the size of the large salivary glands is carried out taking into account the examination and palpation data:
- I – salivary glands have normal dimensions: they are not visually determined and are not enlarged during palpation.
- II – a slight increase in the size of the salivary glands, which is not detected by eye, but is determined by palpation.
- III – a significant increase in the size of the salivary glands, determined visually and palpationally.
The etiological classification of sialadenoses involves their division into neurogenic, endocrine, allergic and nutritional disorders (alimentary).
Sialadenosis can be caused by physiological and pathological causes. So, sialadenosis can occur in women during pregnancy or lactation. Pathological sialadenoses occur in autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, scleroderma, psoriasis, Sjogren’s disease, Mikulich’s disease, etc.), endocrine and metabolic disorders (diabetes mellitus, liver cirrhosis, metabolic syndrome), eating disorders (anorexia), alcoholism. In addition, sialadenosis can develop in patients with menstrual disorders (hypomenstrual syndrome), chronic pancreatitis, prostatitis.
Allergic sialadenoses occur when taking certain medications. Postoperative and post-traumatic sialadenosis may occur due to surgical intervention on the salivary gland or its trauma. In the absence of the above physiological and pathological conditions in the patient, they speak of sialadenosis of unclear origin.
The mechanism of development of sialadenosis is not completely clear; it is assumed that its implementation is associated with the following main factors: neurohumoral dysregulation of the innervation of the salivary glands, disorders in the microcirculatory system and lipid oxidation, congenital changes in the architectonics of the ductal system. These processes cause functional insufficiency and structural restructuring of glandular tissue (hypertrophy of acinuses, replacement of glandular tissue with adipose).
In most cases, sialadenosis affects the parotid, less often the submandibular, and exceptionally rarely the sublingual salivary glands. As a rule, the pathological process is bilateral in nature. Clinical manifestations of sialadenosis are not very specific. Usually patients notice the appearance of painless swelling in the salivary glands. The enlargement of the salivary glands persists for a long time, their size does not change when eating. With sialadenosis, salivation is often reduced, resulting in xerostomia.
When examining a patient with sialadenosis, a change in the configuration of the face is detected due to symmetrical (less often unilateral) swelling of soft tissues. On palpation, enlarged glands are usually painless, sometimes slightly painful, dense, with a smooth surface. The nearby lymph nodes are not changed; mouth opening occurs freely. When massaging the salivary gland, transparent saliva is released; less often, the secret has a cloudy, viscous character.
Sialadenoses also include diseases that occur with reduced or increased salivation, but are not accompanied by an increase in salivary glands. Their clinic, diagnosis and treatment are discussed in detail in the relevant articles.
Thus, increased salivation (hypersalivation) occurs with stomatitis, gastric ulcer and duodenal ulcer, helminthiasis, pregnancy toxicosis, etc. states. Reduced salivation (hyposalivation) may accompany the course of atherosclerosis, cervical osteochondrosis, neurasthenia, vegetoneurosis, oral candidiasis, acute infectious diseases, etc.
General methods of examination of a patient with suspected sialadenosis include questioning, examination, palpation, clinical and biochemical blood and urine tests, the study of carbohydrate metabolism parameters (blood glucose determination, glucose tolerance test). Private diagnostic methods are aimed at confirming non-inflammatory and non-tumor changes in the salivary glands. With the help of ultrasound of the salivary glands, their increase, heterogeneity of the parenchyma, increase or decrease in echogenicity is determined.
There are no specific radiological signs of sialadenoses. With sialography, an expansion or narrowing of the salivary ducts may be detected, slowing the removal of the radiopaque drug from the gland. Radiosialograms also demonstrate a decrease in the secretory ability of the salivary glands. Computed tomography allows you to detect a bilateral increase in the volume and density of the gland, excluding a tumor lesion.
Additional diagnostic methods include sialometry, cytological examination of duct secretions, biochemical examination of saliva. The diagnosis of sialadenosis is confirmed by aspiration or incision biopsy of the salivary glands. Histological examination reveals an increase in acinuses, the presence of dystrophic changes in them, the absence of inflammatory infiltration.
To identify concomitant diseases of sialadenosis, patients may need the advice of narrow specialists: rheumatologist, endocrinologist, gastroenterologist, gynecologist-endocrinologist, urologist-andrologist, allergist-immunologist, etc. As part of diagnostic measures, other possible causes of salivary gland enlargement are excluded: sialadenitis, mumps, tumors and cysts of the salivary glands, salivary gland stones.
Treatment of sialadenosis is a difficult task. Therapy of concomitant disease is usually accompanied by some reduction in the size of the salivary glands, but does not solve the problem completely. For the symptomatic treatment of sialadenosis, acupuncture, courses of novocaine blockades are used. Among the methods of physiotherapy, novocaine electrophoresis and galvanization are applied to the area of the cervical sympathetic ganglia; pulsed magnetotherapy, laser therapy to the area of the salivary glands; hyperbaric oxygenation is possible.
Drug prescriptions for sialadenoses may include vitamin E intake, intravenous administration of rheopolyglucin solutions and hemodesis. In the absence of satisfactory results of conservative therapy, surgical treatment may be indicated.
The prognosis and prevention of sialadenosis depend entirely on the underlying disease.